Policy makers agree that the US health care system needs new and better ways to ascertain the risks, benefits, and costs of new medical technologies as they are introduced into practice.1- 3 One central policy mechanism to develop such evidence is to link insurance coverage with a requirement that patients participate in relevant research, including registries and clinical trials. Medicare has introduced its own version of this approach, termed coverage with evidence development (CED), and has used it in several high-profile coverage decisions.4 But the policy has been criticized as coercive and unfair.5 The future of CED at Medicare and of similar approaches among private insurers may well depend on whether such approaches are viewed as ethical.
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