Appendix F . — Model for an Institute for Health Care Evaluation * by John P . Bunker , M . D . , and

Current Federal policy is to reduce the Government’s responsibility for health care, substituting wherever possible market mechanisms, and to vest residual control in regional and local authorities. Towards this end, the Reagan administration has recommended to Congress sharp reductions in expenditures for medical technology assessment. This approach is reflected in the failure to fund the National Center for Health Care Technology (NCHCT) and major cutbacks for the National Center of Health Services Research (NCHSR), the National Center for Health Statistics, and the Office of Research and Demonstrations of the Health Care Financing Administration (HCFA). The budget of the National Institutes of Health (NIH) has been relatively spared, but, with even modest decreases in NIH funding, any cutbacks can be expected to occur primarily in the areas of evaluation and clinical trials (4). This reduction would occur at a time when the pressures for more comprehensive evaluation are increasing, both from academic institutions and from private and governmental insurers. One partial solution to this conflict might be to develop a private Institute for Health Care Evaluation (IHCE), which would operate as a nonprofit corporation (perhaps replacing NCHCT) and extend the Nation’s capacity to evaluate medical technologies. IHCE could be composed of members from several groups concerned with the evaluation of health care: governmental insurers (HCFA); private medical insurers (Blue Cross, Blue Shield, and commercial carriers), health maintenance organizations (HMOs); professional associations (represented, perhaps, by the Council of Medical Specialty Societies and its program for clinical procedure review); and health consumers. Each of the parties could benefit from the data that IHCE generated. Health care professionals could use the data to improve the quality of patient care; health consumers could have increased information on which to base their selection of coverage; and insurers could have access to data allowing them to make more rational and timely coverage and reimbursement decisions.