Science Directions

Most of the excitement over the new health-care reform law has been about the extension of health coverage to those without insurance, the reduction of health-care costs and putting an end to discriminatory insurance practices.

Of special importance to psychologists are the focus on integrated health care, the inclusion of mental health services at parity with medical services and the extension of the 5 percent Medicare psychotherapy payment restoration through 2010. Coupled with expansion of preventive health services and a commitment to reduce health disparities, health-care reform will improve access to mental health services for most Americans.

Many contentious issues were debated in the months leading up to passage of the legislation. Indeed, many questions remain. Yet, throughout this debate, one provision of health-care reform has consistently received support: the need for research on comparative effectiveness. This is a good thing for the future of health care, and it is a good thing for psychology and psychological science.

Congress and President Barack Obama were emphasizing the importance of comparative effectiveness research even before the new health-care legislation. The American Recovery and Reinvestment Act of 2009 allocated $1.1 billion for comparative effectiveness research. That law also created a Federal Coordinating Council for Comparative Effectiveness Research to coordinate comparative effectiveness research across the government and to recommend a strategic framework moving forward.

The coordinating council outlined its recommendations in a June 2009 report. The council defined comparative effectiveness research as “the conduct and synthesis of research comparing the benefits and harms of different interventions and strategies to prevent, diagnose, treat and monitor health conditions in ‘real world’ settings.”

Perhaps more important was the council’s elaboration on this definition. Specifically, it made clear that “defined interventions compared may include medications, procedures, medical and assistive devices and technologies, diagnostic testing, behavioral change and delivery system strategies.” Those who are responsible for leading the country’s comparative effectiveness research infrastructure recognize the importance of including behavior-based interventions in the comparative mix.

The principal legislation associated with health-care reform is the Patient Protection and Affordable Care Act. Contained within Title VI of the act is Subtitle D, which focuses on patient-centered outcomes research. This is where health-care reform continues the investment in comparative effectiveness research started with funding from the American Recovery and Reinvestment Act. The act calls for the establishment of a Patient-Centered Outcomes Research Institute. APA is already pressing for the inclusion of psychologists and behavioral scientists in the governing architecture of the institute.

It is very important for psychology and psychological science to be engaged in this part of health-care reform. It is our opportunity to establish the evidence in support of psychological interventions, and to demonstrate the efficacy of those interventions relative to other approaches.

As APA president in 2009, James H. Bray, PhD, emphasized these points in his comments to the Institute of Medicine. He stressed the need for comparative effectiveness research to compare different behavioral and psychosocial interventions, to compare behavioral and psychosocial interventions with medical interventions, to include behavioral and psychosocial outcome measures in all health studies, and to examine health intervention outcomes across the life span and for different minority and gender groups.

For much of the past two years, APA has been focusing its attention on health-care reform. Thanks to the sustained efforts of a professional advocacy staff and the active engagement of thousands of members, most of our legislative priorities were achieved. Now the really hard work begins. True to the history of our field, research will be the foundation on which we build.