David Blumenthal Interview

     Male Voice:     Spell your full name and position that you

hold - not spell your position, but spell your full name.

[Inaudible]

     David Blumenthal:    David Blumenthal - D-A-V-I-D B-L-U-M-E­

N-T-H-A-L.    Director of the Institute for Health Policy at

Massachusetts General Hospital and Partners Health System.

     Jennifer Muldoon:    Doctor Blumenthal, why did you choose to

work in the field of health services research?

     David Blumenthal:     I was interested in health policy and I

was interested in academics, and I don't think I identified it

as health services research, but I identified it as multi-method

research related to health policy.     So it was just where I ended

up because of my interests.     I think it was before    I got

involved before the field had been defined as health services

research.

     Jennifer Muldoon:    And in your opinion, what are some of

the most significant contributions of the field of health

services research?

     David Blumenthal:     I think we've made enormous

contributions in all kinds of ways - related to measurement of

hard to measure things like quality and safety and cost of care

and evaluation methodologies, patient satisfaction, patient

reports - tools that are now being widely used in trying to
create transparency and accountability in the health care

system.     I think we've also made a lot of contributions to

understanding the dynamics of payment and how payment affects

behavior.

     And I think we've made a lot of contributions understanding

the effects of insurance on behavior and lack of insurance on

people's lives, their health, their well-being, their

contentment with their lives.     We've also, I think, defined a

lot of conditions for change      what the politics of healthcare

is about and what conditions permit or inhibit change in health

systems.     One could go on and on and on - lots of things.

     Jennifer Muldoon:     What are some of the opportunities for

the future?

     David Blumenthal:     The opportunities for the future, I

think, lie in many domains.     We have a lot to learn about how to

measure the performance of health systems so that we can reward

them or punish them for poor performance.     We have a lot to

learn about how to implement new findings in an expeditious way.

We have a lot to learn about how to design healthcare benefits

so that we preserve the appropriate care and discourage

inappropriate care.     And, above all, we have a lot to learn

about costs and how to change the trajectory of cost increases

over time.
     Jennifer Muldoon:   Do you have any advice for someone

considering a career in health services research?

     David Blumenthal:   I guess my advice would be that they

need to be trained rigorously in methods.   They need to

understand how to do research and do it well, but they also

should take the time to understand the clients for their

research, whether those clients are practicing physicians or

healthcare organizations or policymakers or managers because we

are in a very applied field, for the most part, and the more one

understands about the way systems actually operate, the more

effective our research will be.

     Now there's also, of course, room for research that's

purely methodologic in nature, and that's very important too,

but a relatively small number of people do that kind of work.

I'd say the preponderance of people in our field study real

health problems to try to solve them.   And for that kind of

work, having practical experience of some kind or deep

understanding of the process of care and the process of policy

development is important.

     Jennifer Muldoon:   How has your attendance at annual

meetings and involvement with Academy Health influenced your

career?

     David Blumenthal:   It's been enormously important for

meeting the people I needed to meet in order to do the work that
I've done.   I've learned a lot from the substantive sessions.

I've learned about problems that are of interest and how to

approach them.     And I think it's given me a sense of community

and motivated me in my work because there were role models I saw

early in my career who I wanted to be like and I mostly met them

here at this meeting.

     Jennifer Muldoon:     Twenty-five years ago when the annual

meeting was just getting started, what were the important health

policy and health services research issues at the time?

     David Blumenthal:     I think it was much less clear at that

time how to structure improved coverage, though it's not to say

that we've made a lot of progress since then.     But I think the

conceptual and the economic issues were less well understood and

a lot of work has been done on that since that time.     I think

cost increases had been identified as important issue by then

because of Medicare and Medicaid, and there was a lot of work

done on it then.    And technology and its uses were probably more

clearly on the agenda than it is right now.     And quality was a

relatively unidentified issue.     It had not yet emerged with the

salience that it has right now and it wasn't heavily or

effectively researched at that time.

     Jennifer Muldoon:    What are the issues for the future?

     David Blumenthal:     I think that how to organize systems to

improve their performance is the really critical issue for the
future - how to eliminate waste, improve outcomes at the lowest

possible cost.   So I think we're getting to a point where we're

not writing and talking as much how to cover uncovered people.

We know how to do that; it's a matter of making the political,

tough political, choices, but we are talking a lot about how to

organize systems of care, which has always been on the agenda,

but not with the same level of rigor or understanding that we

have now.

     Jennifer Muldoon:   What are some of your favorite memories

of the annual research meeting?

     David Blumenthal:   That's a hard question - twenty-five

years worth of memories to sort out.    I guess I have memories of

being in    feeling that I was becoming the colleague of some of

the senior people that I had most respected - having the sense

that they were getting to know me; that I was not just a junior

person who was on the margins of the meeting, but someone who

had a community here.    So I think those kind of crystallized in

receptions and parties and the annual big reception that's held.

So I'd say most of my best memories are of those kinds of

gatherings where one could talk intimately - not intimately, but

seriously - with friends and colleagues.

     Jennifer Muldoon:   Where would you like to see the field in

twenty-five years?
     David Blumenthal:   I think it needs a whole lot more

support, and I think it needs to be much more creative in

identifying natural experiments to evaluate, and I think it

needs to be much more driven by the concrete decisions that

policymakers and managers need to make.    That's not to say that

it has to be all applied, but I think we always have to connect

the findings, our findings, to a problem and understand the

connection to what we might discover and how that problem might

be remedied.

     Jennifer Muldoon:   What role should Academy Health play in

achieving that?

     David Blumenthal:   Well, Academy Health is, I think, the

glue that keeps the community together, and I think that if it

keeps pushing on our investigators to perform that role - and I

think it needs to keep making a case for this work for the

public and for the government because this is a public good that

can't be supported by private funds.     It has enormous value and

the government has to understand that if it's going to invest in

this work.

     Jennifer Muldoon:   Is there anything you'd like to add?

     David Blumenthal:   No, no, I think I'm talked out.

     Jennifer Muldoon:   That's great!

     David Blumenthal:   Thank you.

     Jennifer Muldoon:   Thank you very much.
David Blumenthal:   Sure.

Jennifer Muldoon:   If you look at the annual meeting-