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In Washington, there is always a heated debate about government efficiency and effectiveness. But that debate has moved outside the Beltway and the consensus is sobering. A recent Gallup poll shows that more than half (56%) of Americans believe the federal government is “almost always wasteful and inefficient.” Only 8% say they think the government is responsive to the needs of the people it serves, according to data from the Pew Research Center. 

Budgets increase but outcomes don’t seem to improve—and in some cases they backslide. Programs promise impact but deliver complexity. People feel like they’re paying more and getting less. When government fails to deliver, it can breed broad distrust. To change that, we need high-quality data and rigorous research that lets us know where we stand, identifies waste, shares the perspectives of constituents, and informs policymakers.

Nowhere is the need for a more efficient and effective government clearer than in our health care system. The United States spends nearly 18% of our gross domestic product on health care—more than any other wealthy country across the world. In addition to private sector spending, health care programs are one of the largest drivers of government spending. Yet, despite this enormous investment, our outcomes lag. Americans are living shorter lives, experiencing higher rates of chronic disease, and facing steep barriers to access health care services.

Take the crisis in rural health care. Since 2005, nearly 200 rural hospitals have closed or dropped inpatient care, leaving many communities without access to essential services. This crisis disproportionately affects the South and the Midwest—and it’s only growing worse. Nearly half (46%) of rural hospitals are operating in the red and 432 are vulnerable to closure. By understanding the size and scope of the challenges facing rural hospitals, the American Institutes for Research (AIR) is putting evidence into action. We are working with small and rural hospitals to help them use evidence to recruit and retain a high-quality workforce, improve care, and better leverage federal policies.

We are also using data and research to improve kidney care, one of the most expensive areas of health care. Kidney disease affects about 1 in 7 Americans. Medicare alone spends about $150 billion annually for beneficiaries with chronic kidney disease or kidney failure, with much of that paying for emergency treatments and hospitalizations that could have been prevented with early screening. We have partnered with Medicare, doctors, and patients to develop data-driven solutions that expand early detection and preventive screenings, reduce costly, unplanned hospital visits, and increase accountability by reforming payment models to reward better outcomes. These types of evidence-based programs can find the savings that leaders like Dr. Mehmet Oz—the administrator for the Centers for Medicare & Medicaid Services—are seeking without reducing services to those who need them.

We also believe that evidence can help make sure the needs of patients drive the health care system—not the other way around. Through the national Partnership for Patients initiative, AIR helped hospitals provide safer care by better engaging patients and their families. Over four years, the initiative not only prevented an estimated 2.1 million harms to patients and saved 87,000 lives, but it also reduced costs by nearly $20 billion.

Veterans’ services are another area where research and technical assistance are making a difference. Government has a moral obligation to support those who put their lives on the line for our country, yet programs for veterans often fall short. The Post-9/11 GI Bill is a $100 billion program designed to help veterans and their families pay for postsecondary education. AIR was part of the largest-ever evaluation of the program to see if this GI Bill was living up to its promise. AIR found that nearly half of the veterans who personally used the benefits earned a degree within six years—more than twice the rate of financially independent students nationwide. And veterans who used the benefits were more likely to be employed within two years compared to non-veterans.

But in listening directly to stakeholders, the research team heard repeatedly how confusing rules, unclear deadlines, and a lack of reliable guidance kept veterans and their families from using the benefits they had earned. These findings are informing bipartisan efforts to simplify access, improve transparency, and make sure the benefits deliver for our heroes.

The erosion of public trust in government didn’t happen overnight, and that trust won’t be rebuilt quickly. Improving government isn’t about doing more or spending less. It’s about doing things better. Any efforts to do so must be built on a foundation of evidence. That means collecting and analyzing data to know how we are doing; conducting rigorous research to identify what works to solve problems; and standing side-by-side with our leaders and communities to implement solutions. That is how we can deliver on a government that is responsive to the needs of the American people and worthy of their trust.

Jessica Heppen is the President & CEO of the American Institutes for Research, which is based in Arlington, Va.

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