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This report is based on interviews with health care purchasers in the United Kingdom and the United States about how they value and use research assessing health technology and clinical effectiveness. The principal finding of the report is that purchasers value this research “but few use it when making health care purchasing decisions.” Moreover, those “who do use this information tend to do so sporadically, rather than applying it in a proactive, systematic manner.”

The Milbank Memorial Fund commissioned this report on behalf of an informal group of persons who make policy for purchasing health care in the United Kingdom and the United States. The members of this group are identified on the facing page.

The Fund is an endowed foundation based in New York City. It collaborates with policymakers in the public and private sectors to analyze, develop, implement, and communicate about health policy.

The group of purchasers met in London in 1997 and in New York the following year. The purpose of these meetings, as a British purchaser wrote, was to

consider the developments that have taken place…in relation to purchasing as the process has become more sophisticated and specifically to address the issue of the information that purchasers need to purchase effective and cost-effective health care…Discussing the developments and limitations of the situation in [each] country in the presence of individuals from a different system, but with many areas of shared concern, is…likely to be mutually beneficial.

The organizers of these meetings hypothesized that people who did similar work each day would find common interests despite the enormous differences in the organization and financing of health services in the United Kingdom and the United States. Moreover, focusing on common interests might reduce the tedious hours of elementary descriptions of national health care policies and systems that absorb considerable time at many international meetings.

The hypothesis proved correct. The UK purchasers—each of whom worked within the National Health Service—and the US purchasers—who served in the executive and legislative branches of government, private industry and a public corporation—immediately found common ground. They described their systems and policies in the context of discussing problems in purchasing health services for populations.

The members of the group have completed three projects. A report published in June 2000 assesses the implications for policy of research on genetics. A second project convened experts in assessing health care technology from the two countries to explore practical possibilities for collaboration in the dissemination of information. This report describes the current use of the research findings that are disseminated.

Many people deserve credit for this report. Pam Charlwood, John James, and Margaret Stanley formulated the questions about the use of research by purchasers to which policymakers wanted answers. John James and Barbara Stocking participated in describing the overall purpose of the group and recruiting its members from the United Kingdom. The members of the group are identified by title above. Barbara Stocking, Regional Director, National Health Service Executive, Southeast Regional Office, could not participate in the ongoing work of the group.

Charlwood, James, and Stanley guided the persons in both countries who conducted the interviews and wrote the report. Angela Coulter, then Executive Director of Policy and Development at the King’s Fund, now Chief Executive of the Picker Institute Europe, and Janie Dallender, then Primary Care Health Researcher in the Directorate of Research and Development of the Kensington & Chelsea and Westminster Health Authority, now Senior Researcher in the Mental Health Research Section of the Sainsbury Centre for Mental Health, participated in planning the project. Dallender conducted interviews in the United Kingdom. Jessie Gruman and Cynthia Gibson of the Center for the Advancement of Health helped plan the project. Gibson conducted interviews in the United States. Harry Nelson, a staff writer for the Milbank Memorial Fund, conducted interviews and wrote the earliest draft of the report. Gibson was the principal writer for subsequent drafts, which had significant contributions from Coulter, Dallender, and Gruman.

We owe particular thanks to the 55 purchasers in the two countries who supplied the information on which this report is based in telephone interviews. The interviewees were offered anonymity in order to facilitate their participation in the project.

Daniel M. Fox
President

Samuel L. Milbank
Chairman