Does X Really Cause Y?

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Does X Really
Cause Y?
By Bryan Dowd and Robert Town
September 2002

AcademyHealth is the national program
office for HCFO, an initiative of
The Robert Wood Johnson Foundation.

Foreword
Health policy issues often dominate state
and federal policymakers’ agendas. In the
most recent session of the United States
Congress alone, the House and Senate
addressed legislation concerning a patients’
bill of rights, prescription drugs for seniors,
and generic drug substitution. While
politics and legislative realities seem to have
starring roles in the process, in most cases,
research results and other information can
be solid supporting players. Those
responsible for the recommendations, if not
also the decisions, strive to increase their
knowledge of the problem at hand, as well
as the likely impact of the regulation or
legislation under consideration. However,
they frequently express frustration that they
do not have objective evidence-based and
timely information on which to base their
recommendations and decisions.
Health services researchers, meanwhile,
generate information about many of the
same pressing health policy issues. Each
year millions of dollars are spent by private
foundations and the federal government to
support health services research designed to
produce useful, policy relevant results. A
plethora of monthly journals are filled with
articles highlighting findings from studies of
health care costs, quality, and access, as well
as interventions designed to improve health
and health care. Many universities and
research institutions publish reports with
findings of interest to decision-makers.
The challenge for the field, in general, and
shared by us at The Robert Wood Johnson
Foundation’s Changes in Health Care
Financing and Organization (HCFO)
initiative, is to develop effective
mechanisms for researchers to make their
findings accessible to policymakers seeking
information. Typically, with this goal in
mind, we present summary research
findings in short documents focused on
specific issues. Often these summaries
clearly delineate the findings, but in an
effort to increase their clarity
and importance, there is very little
explanation of the methods used to develop
the findings or caveats that might be
applicable in a real-world setting.

This special report, emanating from a HCFO
meeting, “Managed Care Spillover: Research
and Policy Issues,” conducted by The
Academy for Health Services Research and
Health Policy (now AcademyHealth) on
November 8, 2001, takes another approach to
making research information accessible. We
asked Bryan Dowd to assist the audience of
senior-level decision-makers in understanding
how the findings from studies of the effects
of managed care spillover might be used to
inform policy discussions. He discussed
the challenges to evaluating complex
interventions or phenomena using standard
econometric techniques. He explained how
equations are used to depict the relationships
among the key variables being studied, and
he identified common sources of bias or error
that might affect the results of such analyses.
He also pointed out that while research and
policy development often require using
imperfect information, it is important for
those using research findings to ask
questions that allow them to identify and
account for such imperfections. Participants
at the meeting found Dowd’s insights and
brief review of econometrics to be helpful and
recognized that his guidance would be of
general use beyond the specific study findings
being disseminated and beyond those
participating in the meeting. Therefore,
the HCFO program commissioned Dowd
to further develop his presentation for
broader distribution.
While the report may be somewhat technical
for those with no exposure to econometric
methods, we hope that it will serve as a
useful guide to analysts and information
brokers with...
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