Why are consumers encouraged — indeed virtually required — to make choices among Medicare Part D plans, but discouraged from making choices about airbags, and prohibited from choosing to accept higher wages in return for accepting certain health risks in the workplace? Why are physicians and patients allowed to take on the risks associated with certain drugs but not others?

“There may be sound answers to these questions,” John Graham and Jianhui Hu observe in the lead paper [1-week free access] of the current issue of Health Affairs. However, there are no federal rules or accepted general principles that determine “when risk-benefit choices are reserved for the individual, when they should be made by the regulator, and when the individual is permitted to make constrained choices based on information that has been carefully screened for quality by the government.” Graham, the onetime head of the Information and Regulatory Affairs Office, Office of Management and Budget, and now dean of the Frederick S. Pardee RAND graduate school, and Hu, a RAND graduate student, recommend that “an authoritative body (such as the Institute of Medicine) develop guidelines” addressing these questions.

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