The stimulus and health care

The New England Journal of Medicine comments on the impact of the stimulus package on healthcare:

By launching broad federal initiatives for biomedical and comparative effectiveness research, the adoption of health information technology, and the protection of the privacy and security of medical records, the stimulus law should have major and immediate effects. It directs to health care about $150 billion in new funds (see table), most of which will be spent within 2 years. The spending includes $87 billion for Medicaid, $24.7 billion to subsidize private health insurance for people who lose or have lost their jobs, $19.2 billion for health information technology, and $10 billion for the National Institutes of Health (NIH). The new NIH funding, equivalent to a third of the institutes' $29.5 billion annual budget, was added at the insistence of Senator Arlen Specter (R-PA), a strong supporter of the agency. Specter, who has survived a brain tumor and two episodes of Hodgkin's disease, was one of the three Republicans in Congress who voted for the legislation.

The act also provides $650 million to support prevention and wellness activities targeting obesity, smoking, and other risk factors for chronic diseases and $500 million for health professions training programs, including $300 million to revitalize the National Health Service Corps (NHSC). The NHSC provides loan repayment, salary support, and scholarships for physicians and other providers who practice in underserved areas. Under the Bush administration, its budget decreased to about $125 million per year, and it could award only 84 scholarships in fiscal 2008, less than 1 per medical school. The package increases by 50% the overall support for the NHSC and other workforce programs run by the Health Resources and Services Administration.

On the medical research front, comparative effectiveness studies that directly compare the risks and benefits of different treatments for a particular condition are essential for improving practice and slowing cost escalation. Such studies, however, have been controversial; the pharmaceutical and medical device industries may not fund them, and some are concerned that the government or insurers may use the results to mandate specific approaches to treatment or to deny coverage.