NPC Request for Proposals: Beginning a Public Dialogue on Health Care Spending

About NPC’s Research

The National Pharmaceutical Council (NPC) is a health policy research organization dedicated to the advancement of good evidence and science, and to fostering an environment in the United States that supports medical innovation. NPC focuses on research development, information dissemination, education and communication of the critical issues of evidence, innovation and the value of medicines for patients.

NPC’s current research examines the most pressing topics related to real-world evidence, the optimal role and value of pharmaceuticals in emerging payment and delivery models, and biopharmaceutical and health system innovation.

Proposal Topic

Earlier this year, the Centers for Medicare & Medicaid Services announced that health care spending in the United States is projected to reach almost 20% of the gross domestic product (GDP) by 2025. This forecast is significant, as rising health care costs have far reaching implications and opportunity costs (i.e., when a society spends more on health care, it must spend less on education, infrastructure, etc.). As the public policy debate on how to contain health care spending intensifies, the dialogue is often focused at the sector level (i.e. biopharmaceuticals, hospitals, providers, procedures, devices, long-term care facilities, etc.) on how we can prune high-cost services and low-value care from the system to slow rising costs.

The current dialogue raises two concerns. First, it presupposes that we are currently spending or will spend too much on health care. This may or may not be true. If not true, it has the potential to create arbitrary confines for how much the US should spend on health care. Second, cost containment strategies that take a sector based (e.g., concerns about current spending on hospital care or prescription drugs or physician salaries) rather than a holistic-approach (e.g. approaches that manage cost to obtain the best outcomes at the disease or population level) have the potential to create unintended harm.

NPC is interested in reframing the policy debate around these two important policy concerns and is commissioning new research to assess: 1) how much the US should spend on health care; and 2) how should health care spending be allocated across the various sectors of the health care system?

Proposal Scope

NPC is interested in exploring these important policy questions, and is commissioning new research pertaining to: societal willingness-to-pay for health care services; how health care spending can be optimally allocated across various sectors and segmentations within the health care system; and the ethical and economic considerations related to evaluating health care spending.

NPC is interested in proposals that focus on, but are not limited to, the following research questions:

  1. Is there a limit to how much we (society, payers, employers, patients) should spend on health care? If so, is the percent of GDP the best way to measure it? Are there better metrics?
    • Empirical research could explore willingness-to-pay assessments from employers, payers, or patients
  2. What is the ethical framework through which society should evaluate health care spending and health outcomes?
  3. What are the business frameworks through which society should evaluate health care spending and health outcomes?
    • Should opportunity costs be incorporated into value assessments? If so, how should they be incorporated? What are the potential pitfalls?
    • Should spending and outcomes be evaluated on a sector (i.e., hospital, device, diagnostic, etc.) basis? Or does a more holistic approach make sense?
      • What structural barriers exist to a more holistic approach?
      • NPC is interested in case studies that elucidate whether a holistic or sector based approach leads to better health outcomes.
    • Is a uniform approach (e.g. the same approach regardless of disease or population) to how we think about spending and outcomes required, or should we use a more targeted approach for each individual disease and/or population?
      • NPC is interested in case studies that illustrate whether or not a uniform approach leads to better health outcomes. 
  4. What can we learn from EX-US efforts to manage health care spending? What are the impacts on health outcomes from these efforts? Are there lessons learned that are applicable to the US? Are there paths that should be avoided?
  5. Given past challenges in identifying and removing low value care, are there novel ways to address low value care to help pay for the care we desire?
  6. What are some of the potential policy proposals or solutions associated with this issue? How might society reach consensus on health care spending?

While NPC has an immediate need for proposals that focus on questions 1, 2 and 3 as described above, it plans to commission research related to all of the questions listed above in the near term. In addition, we welcome and encourage all research ideas that are pertinent to this topic, even if they are not explicitly addressed in the questions above. Proposals that include diverse perspectives in addressing these research questions are particularly encouraged. While budget and timeframe are project specific, shorter-term projects between $50,000 - $200,000 with timeframes of <12 months will be given higher priority in review. Serious consideration will be given to exceptional proposals that exceed $200,000. NPC research activities have an indirect cost cap of 25%. 

Submission Guidelines

Submissions will be evaluated based upon a combination of factors, including: the potential impact of the research; availability of data and content; project duration; probability of technical success; cost; and to what extent the research is important to key audiences.

Submissions should be sent to Lisabeth Buelt, Research Associate at NPC, and should conform to NPC’s proposal template. NPC will use a staged approach to review submissions. Initial concept proposals should be no more than 1 page. Those we select will have an opportunity to expand and refine their concept in a formal 5-10 page proposal. Concept proposals must be submitted no later than 5pm July 28, 2017. If you are interested in submitting a proposal but are unable to meet this deadline, please let us know. NPC will follow-up with all research proposals within eight weeks of the submission deadline.

To access past NPC-funded research, please visit our research library. If you have any questions, please contact Lisabeth Buelt. Thank you for your interest and participation.