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Outliers: Will research suffer after reform?

(This item has been edited to correct Anup Malani's job title.)

Better health insurance coverage—such as that being provided by healthcare reform—may be bad for medical innovation.

That's one conclusion of a study produced by two University of Chicago professors who studied the relationship between insurance coverage and medical breakthroughs.

While the study, “How Do Health Care Reforms Affect Medical R&D? The Subject Market Effect,” includes a dizzying amount of mathematical calculations to back up their claims, one of the authors put it in the more simple terms of supply and demand.

A major reason why drug and device companies are able to recruit patients for their studies is because some patients have no insurance, can't afford traditional care and, as a result, seek care through a research study, says Anup Malani, a law professor and co-author of the study. With large numbers of people slated to get insurance coverage under healthcare reform, the cost of the alternative to participation in a research study drops significantly, taking away a big reason for volunteering, Malani says.

He's not suggesting that patients be stripped of their insurance to feed researchers' need for guinea pigs. “One way to get rid of the (problem) would be to loosen the limitations on the amounts paid to research subjects,” increasing the incentive to participate, he says. Institutional review boards overseeing research studies tend to keep a tight lid on compensation for participation—and there are good reasons for doing so—but a change may be needed to keep innovation strong, at least in the short run, he says. The longer-term effects of broader insurance coverage on innovation are not as clear, he says.

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