In the first June 2017 issue of the New England Journal of Medicine, Joseph Newhouse and Sharon-Lise Normandpublished a review of health policy trialsas part of the Journal’s series involving The Changing Face of Clinical Trials. Their review focused on trials involving financial incentives for patients or health providers. Two of the most notable trials, the RAND Health Insurance Experiment and the Oregon Health Insurance Experiment, had significant findings that impacted the health policy sphere; the RAND experiment is still used to estimate effects of insurance plans, and the Oregon experiment helped strengthen advocacy in the Obama administration for the expansion of Medicaid.

Both these trials centered on the insurance contract, but trials can also test consumer incentives. Potential issues arising in health policy trials include the size, payment (or non-payment) to participants, length, baseline and oversampling. The authors also discuss the issue of whether randomized trials should be used by insurers, including Medicaid and Medicare, or whether it will negatively impact or discourage applicants.

Newhouse was principal investigator for the RAND experiment, and with Alan Zaslavsky was also an investigator for the Oregon experiment.

Newhouse and Normand described design challenges associated with policy trials involve, and identified strategies to mitigate the challenges. They said, “[Health policy trials] resemble trials of treatment or diagnostic strategies more than trials of drugs or devices. Nonetheless, randomization can be and has been successfully conducted in the sphere of policy.”

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Photo: RAND