Tuesday, April 13, 2021

Bringing rigorous testing to health care policy

This evaluation method is reminiscent of traditional approaches to assessing new surgical techniques – which have sometimes been shown to be useless or worse, after being subjected to more rigorous testing. Radical mastectomies, for example, were widely used decades before Randomized trial It has been shown that much less extensive and disruptive surgery after radiation was an equally effective treatment.

Of course, conducting randomized trials can pose more challenges to the evaluation of new surgery than to a new drug. A surgical technique can be difficult enough to be able to test it over a wider population, and remind the patient that the treatment he or she receives may be more difficult.

But such feasibility issues do not apply to new payment methods, which are well-defined and standardized interventions, and where blinding medical providers to payment regulations is not desired.

Yet, as in medicine, not all public policies can – or should – be randomized evaluations. One-of-a-kind government projects – such as the “Big Dig” in Boston or the Superconducting Super Collider in Texas – have no natural comparison group, randomly or otherwise. In times of crisis, or when policy disagreements are about ideology more than effects, the evaluation itself can be ill-founded.

But when – as is often matter – There is an opportunity for potential evaluation and Law Is necessary This, the Innovation Center’s experience underscores the value and feasibility of randomized trials of social policy. They can often be done At the same speed and cost As with any prospective study, more compelling results may be given. Random assignments where the government chooses the lottery that the program can receive can also be beautiful Method of allocating an intervention on a limited basis.

Randomized testing may not be the standard for government evaluation, but such things take time. for example, Food and Drug Administration Was empowered in 1962 to achieve “substantial evidence“Safety and efficacy of a new drug, yet it took more than five years to embrace the agency Random Test as appropriate standard.

Now while the Biden administration is fine again Force on All federal agencies are required to make “evidence-based decisions” based on the highest scientific standards, perhaps stricter testing of social policy will become as common as it is for new vaccines. This will help ensure that government services are delivered as effectively and efficiently as possible.

Amy Finkelstein John and Jenny S. of Economics at MIT. Macdonald is a professor, co-directing J-Pal North America, a research center at MIT that conducts randomized evaluations.

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