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November 15, 2019

Moving Toward Evidence-Based Policy: The Value of Randomization for Program and Policy Implementation

Author Affiliations
  • 1Perelman School of Medicine, Department of Medical Ethics and Health Policy and Medicine, University of Pennsylvania, Philadelphia
  • 2Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
  • 3Columbia Law School, New York, New York
  • 4Mailman School of Public Health, Department of Population and Family Health, Columbia University, New York, New York
JAMA. 2020;323(1):21-22. doi:10.1001/jama.2019.18061

Public and private sector organizations are continuously developing new policies and interventions to improve health behaviors, health outcomes, and health care delivery. Examples include payment reforms (such as pay for performance or bundled payments), incentives for healthy behaviors, workplace wellness programs, and changing benefit packages and eligibility requirements in public and private insurance programs. However, promising ideas are usually implemented at full scale despite limited evidence. Rapid, universal rollout precludes the ability to randomly assign eligible individuals between treatment and control groups, which greatly limits the possibility of a rigorous evaluation of program consequences.

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