Background

More than ever decision makers need rigorous, evidence-based research on clinical effectiveness and the broader impact of health technologies and clinical coverage decisions on the U. S. healthcare system. 

The U.S. spent $2.1 trillion for health care in 2006, and that number is expected to spiral to $4.1 trillion by 2020, even though over 45 million Americans have no dependable health care coverage. Studies show that much of what is purchased in our health care system has little impact on the health of our population.  As a result, the Commonwealth Fund reported in 2007 that though we spend more in the aggregate and per capita than any other nation, the U.S. health care system ranks last compared with five other nations on measures of quality, access, efficiency, equity, safe care, coordinated care and outcomes.  

Clearly, leaders in health care need to carefully focus on those interventions that have proven benefit, and avoid wasting resources on those that have not proven their ability to generate greater benefit than harm.  This is especially true in State Medicaid programs in which scarce resources limit the amount of care and coverage that can be provided.