Bindman AB. Lung Cancer Screening and Evidence-Based Policy. JAMA Forum Archive. Published online October 15, 2014. doi:10.1001/jamahealthforum.2014.0041
Many people have dreamed of a day when health policy might be based less on the political clout of special interest groups and more on research evidence. Evidence-based health policy could lead to more rational decision-making than typically occurs today. For this to work, however, we need a process to collect and consider all of the relevant evidence before formulating a policy.
The discussion surrounding the use of computed tomography (CT) scanning to screen for lung cancer is a case in point.
The Affordable Care Act (ACA) included a provision that requires private health insurers to cover, at no cost to their beneficiaries, “[e]vidence-based items or services that have in effect a rating of A or B in the current recommendations of the United States Preventive Services Task Force (USPSTF) . . . .” On its surface, this sounds like a logical approach for translating evidence from research on preventive services into policy. The ACA removes patients’ financial barriers to receiving the most efficacious preventive services; it also requires health insurers to invest in preventive care and creates a level playing field for them to do so. However, the evidence that the USPSTF finds relevant for its recommendations is not the only thing important to consider in establishing a policy on coverage for a potential preventive service.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Andrew B. Bindman, MD Andrew B. Bindman, MD, is Professor of Medicine, Health Policy, Epidemiology and Biostatistics and a core faculty member within the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco. Dr Bindman has...