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Jerry Avorn, M.D., associate professor of medicine at Harvard Medical School, reviewed the study before publication. He says, "This study reminds us that cost-containment measures can have negative impacts on the care of patients, especially the most vulnerable ones. It provides important evidence that we need to follow the consequences of such cutbacks on the people they affect. Dr. Ray's study shows that this can be done rigorously. Unfortunately, those responsible for making these changes often fail to evaluate them this carefully."

While new medications receive years of scrutiny prior to entering the marketplace, policy often evades tough examination. "Some argue that the same kind of standard ought to be applied to policies, at least you ought to evaluate them to see if theyre achieving the benefits they are supposed to achieve and if they have any unanticipated effects."

The Tennessee Department of Health and its TennCare program have made changes in its delivery system since Ray's study began. But, he says, in other states these problems linger.

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Contact: Clinton Colmenares
clinton.colmenares@vanderbilt.edu
615-322-4747
Vanderbilt University Medical Center
7-May-2003