The idea seemed transformative. The Affordable Care Act would fund a new research outfit evocatively named the Innovation Center to discover how to most effectively deliver health care, with $10 billion to spend over a decade.

But now that the center has gotten started, many researchers and economists are disturbed that it is not using randomized clinical trials, the rigorous method that is widely considered the gold standard in medical and social science research. Such trials have long been required to prove the efficacy of medicines, and similarly designed studies have guided efforts to reform welfare-to-work, education and criminal justice programs.....

......“It’s the greatest irony,” said Gordon Berlin, president of MDRC, a nonprofit organization whose studies have influenced American policies on welfare, job training and education. In health care, of all areas, he said, in which every group that evaluates medical evidence ranks such studies as the most reliable by far, they have rarely been used.

“The results,” Mr. Berlin said, “speak volumes about the path not taken — an extraordinary body of evidence has been built to inform welfare policy and practice while we have only just begun the process of learning what works in health policy.”

The studies that are regarded as the most reliable randomly assign people or institutions to participate in a program or to go on as usual, and then compare outcomes for the two groups to see if the intervention had an effect.....

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