The National Institutes of Health (NIH) issued a Guide Notice on November 25, to “clarify NIH policy related to funding health economics research,” in an effort to delineate NIH’s “priority areas of health economics research as well as reach aims that generally fall outside of the NIH mission.”
The notice is part of an ongoing issue that dates back to 2012 Congressional language in the Fiscal Year 2013 Labor, Health and Human Services and Education Appropriations bill that bans the National Institutes of Health (NIH) from supporting economics research. Representative Lucille Roybal-Allard (D-CA) responded to the language, along with 82 of her colleagues, in a letter to NIH “urging the continuation of behavioral and social science research, including economics.” The letter stated that “any consideration of reducing or eliminating economics research from NIH funding streams would be a very misguided and short sighted decision. This selective and regressive approach to information and knowledge is unacceptable, and we must work to ensure that health research remains as comprehensive and complete as possible.” Former House Majority Leader Eric Cantor (R-VA) also included language targeting health economics research in an early version of the Kids First Research Act, though it was removed from the final draft.
The NIH Guide Notice emphasizes that “health economics research offers rigorous tools that can help NIH pursue its overall mission to improve health, and is an integral part of the interdisciplinary science that NIH supports.” It is further noted that many of the NIH-supported “studies in disease prevention and intervention, health behavior, and community health incorporate methods and models from the economic sciences…NIH values economic contributions in our understanding of the relationship between health and society.” The agency’s support of five recipients of the Nobel Prizes in Economics is highlighted.
The notice states: “NIH will continue to accept applications involving both health economics research in which health outcomes and health-related behaviors are the primary focus, and the connection between the subject(s) of the study and improved understanding of health are clear and explicit.”
The notice highlights the highest-priority areas for NIH research, institute- and center-specific priorities, as well as areas of research that fall outside the purview of NIH.
The agency states that it is especially interested in “health economics research designed to understand how innovation in treatment, diagnosis, prevention, and implementation strategies can be most effectively deployed to improve health as well as research aimed at designing better intervention with these insights.” Examples of this type of research cited in the notice include research that uses economics methodologies to:
- Measure or model the actual or potential impact of specific interventions, approaches, or strategies on health-related behaviors, healthcare utilization, and health outcomes.
- Understand behavioral, financial, and other factors that influence the implementation, adherence, dissemination, and adoption of medical discoveries into health care.
- Determine the impact of both financial and non-financial incentives on health-related behaviors, healthcare utilization, and health outcomes.
- Assess how environmental, social, economic, and other factors affect health status, health-related behaviors, healthcare utilization, health outcomes (including health-related quality of life outcomes), health disparities, and responses to interventions.
Institute- and Center-Specific Priorities
The Guide Notice underscores that NIH may fund other areas of health economics research related to the mission-based priorities of its 27 institutes and centers (ICs) and as stipulated in the various ICs strategic plans and funding opportunity announcements. The supported research may include research using economic methodologies specific to the IC’s mission.
Research Areas Outside of the NIH Mission
The Notice specifies that research topics noted as not “sufficiently related to NIH’s mission of improving health and reducing disability, and would be more appropriately sponsored by other organizations and agencies,” include and is not limited to:
- Understand individual financial well-being, labor market outcomes, industrial organization, or economic growth without a specific and direct tie to health made within the study aims.
- Examine the financing of healthcare, including the impact of changes in structure or function of the health care marketplace on broad measures of health care cost but not health outcomes.
- Analyze the economics of health professions as they relate to compensation, efficient delivery, or market value, as opposed to health outcomes or access to quality health care.
- Estimate consumer demand for specific interventions, including measures of price elasticity and the effects of healthcare marketing strategies, in which the findings are designed to inform decisions related to profitability, rather than the quality of care or health outcomes.
- Assess the cost and efficiency of healthcare service delivery, in which cost is the primary or major factor by which comparisons are made, without considering clinical outcomes or quality of care.
In a blog post accompanying the notice,Carrie Wolinetz, Associate Director for Science Policy in the NIH Office of Science Policy, emphasizes that “health economics is only one example of the type of behavioral and social science research funded by NIH that is absolutely central to our ability to prevent and treat disability and disease.” Wolinetz concluded that NIH’s recognition of “potentially valuable areas of research” that do not “connect clearly” to the agency’s mission or priorities “underscores NIH’s strong commitment to responsible stewardship of the taxpayer dollars and to transparency in setting priorities for the agency.”