health law, policy & management

‘The Potential Damage from Reducing Support for Health Services Research Is High’

In a new commentary in The Milbank Quarterly, Michael Stein discusses how federal funding cuts to academia will stymie research that aims to improve health systems and make healthcare more accessible, affordable, and equitable for all.

From slashing the majority of US foreign aid, to drastically reducing the federal workforce, to restricting academic research funding from the National Institutes of Health (NIH), the Trump administration is following through on its promise to overhaul the federal government and reshape national and global health efforts. 

“Indiscriminate cuts to health-related research through NIH will have broad societal implications for scientific progress, and community and individual well-being,” writes Michael Stein, interim dean of the School of Public Health and former chair and professor of health law, policy & management, in a new opinion piece in The Milbank Quarterly. “Reducing funding levels for science is an existential threat to our society’s chances to improve health, lengthen life expectancy, and reduce illness and disability.”

These cuts, he argues, will curtail advances in health services research, the area of research that studies how healthcare is structured and delivered to become more effective, equitable, and affordable for all patients. 

In the editorial, Stein outlines 10 threats that health services research will likely encounter in the wake of sweeping federal funding cuts:

1. Biomedical budget-cutting aimed at health services research areas deemed too “politicized,” such as Medicaid.
2. Medicaid and Medicare data, already difficult and expensive to access, could be made off limits to academic researchers. Coverage and cost figures thereby could be more easily manipulated in public announcements to hide policy truths.
3. Longstanding national population-based surveys, such as the Pregnancy Risk Assessment Monitoring System (PRAMS), have been cancelled, and others may impose new limits on the measurement (e.g., poverty indices) of certain research domains.
4. Data sets have already been removed from certain federal agency websites, limiting longitudinal studies. Efforts to coordinate and align ongoing state-level efforts to develop all-payer claims databases to inform policymaking in the public and private sectors may be at risk.
5. Altering or blocking guidance documents and recommendations from US Department of Health and Human Services agencies, such as the CDC and the Food and Drug Administration (FDA), would change the way the population thinks and learns about health.
6. Reversing the Foundations for Evidence-based Policymaking Act of 2018 (signed into law by Trump), which requires all cabinet-level agencies to support their policy and budget decisions with evidence, could put an end to policy research and economic analysis that builds evidence for developing and coordinating policy, crafting legislation, and establishing budgets.
7. Modifying the rubric used to assess grant applications to consider the cultural values of the parent academic institution, rather than limiting review to the methodologic rigor and significance of the research proposed, could upend the grant review process. This strategy could become part of an effort to control universities through biomedical grants.
8. Advancing health equity in a health care delivery system that too often fails minority, rural, and other underserved communities, could be at risk if “equity” work becomes what the administration considers unacceptably “controversial, high profile, or sensitive.” 
9. Interruption of graduate student training would deplete the next generation of health services researchers. Congress specified in 1989 that one-half of 1% of the National Research Service award budget for training be allocated for training health services researchers, increasing that outlay to 1% twenty-five years ago; this investment could be revoked.
10. Attacks (grant audits, refusal to fund) could target individual researchers for political views expressed in original research papers, editorials, or social media posts that offend the government.     

“We can only hope that today’s anti-scientific atmosphere does not blind policymakers to the fact that greater generation of evidence enables tax dollars to stretch further in the improvement of health,” Stein writes.

Read the full commentary here.