Health policy roundtable—view from the state legislature: translating research into policy

Health Services Research, April, 2005 by Christina E. Folz

Chair: Rep. Merwyn R. (Mitch) Greenlick, Ph.D., is a Democratic representative in the Oregon House of Representatives. He spent 30 years as Director of Research for Kaiser Permanente and 10 years as Chair of the Department of Public Health and Preventive Medicine at the Oregon Health and Science University's School of Medicine.

Panelists: Bruce Goldberg, M.D., is the Administrator of the Office of Oregon Health Policy and Research. Previously, Goldberg was the Medical Director for CareOregon, a Portland-based non-profit organization that serves Oregon Health Plan recipients. He was also an Associate Professor in the Departments of Family Medicine and Public Health and Preventive Medicine at Oregon Health Sciences University School of Medicine.

Rep. Phil Lopes is a freshman Democratic representative in the Arizona House of Representatives and the ranking Democrat on the State's health committee. He was formerly the Senior Manager of the Arizona Department of Health Services and Executive Director of the Health Systems Agency of Southeastern Arizona.

James Tallon is President of the United Hospital Fund of New York, a philanthropic and health services research organization. He served in the New York State Assembly for 19 years; he was Majority Leader from 1987 to 1993, and Chair of the State's health committee from 1979 to 1987.

Mitch Greenlick: "Be dear on who the novice is ..."

I am a recovering health services researcher. I ,an for public office partly because I grew tired of the legislature not implementing health policy that should have followed from the research. It has been very interesting for me to see policy from the inside, and I would like to share four tips for success in effectively translating health services research into state health policy.

1. Start developing the answer years before being asked the question. Imagine getting a call from someone who is planning to have a hearing on a health policy topic the following week. He wants to know if you can research this subject between now and next Tuesday. The answer to that question can only be yes. Ideally, a researcher would figure out 5 years before that time that that particular question was going to be asked. To be policy sensitive in health services research, you must think ahead about what the critical questions will be. For somebody like me who has been in the field for 40 years, it is pretty easy because the questions tend to be the same ones that were asked 40 years ago. The problem is that federal agencies do not understand that. They typically only support questions that were asked yesterday. So it is very important for researchers to think carefully, as they seek federal funding, about how to develop proposals that are based on questions that were asked yesterday but that will also be germane to questions that will be asked 5 years from now.

One of the first federal grants I received was to implement home health and skilled nursing services for the under-65 population of Kaiser Permanente in 1966. The grant came after we had done a study showing that posthospital needs estimates of Medicare were underestimated by a factor of three.

The Public Health Service amazingly gave us the funds because they believed somebody was going to ask them at some point what would happen if Medicare benefits were extended to the whole population; they wanted to have an answer in terms of posthospital needs. We delivered the study in 1972--a year late--and, three weeks later, the agency director testified before Congress on the Nixon Health Insurance Plan and addressed the question of what the under 65 population's posthospital expenditures would be. Fortunately, several of us had anticipated how the research would be used and were able to provide answers at the time that they were needed.

2. Remember the difference between being an advocate and a policy expert. It is appropriate for everybody as a citizen to advocate for policies that make a difference to them. But it becomes a problem when researchers wrap the cloak of science around positions for which they are advocating. That destroys the ability of legislators and their staff to trust what the experts are saying, because everyone knows to take an advocate's words with a grain of salt. The bottom line is to always tell the truth. Bruce Goldberg, who is on this panel, has built the most trust of any researcher I have known in the state of Oregon, and it is because he is willing to tell the truth, even when it means the legislature may move forward on policies he does not want to see implemented.

3. Remember the difference between a point estimate and a confidence interval. As researchers we are not always good at giving unqualified answers when policymakers ask for information. My suggestion is to try to give them answers that are clear, straightforward, and reasonably valid. Often, what matters is having a solid estimate, not whether the number is exactly precise and accurate.

I was on the commission that started the Oregon Health Plan in 1989. In the very first meeting, somebody asked, "How many uninsured are there in Oregon?" I raised my hand and told them, "400,000," which was based on a study we conducted recently. I was then asked how many of those uninsured are below 100 percent of the poverty level, to which I replied, "200,000."