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Press Release Date: June 23, 1999
John M. Eisenberg, M.D., administrator of the U.S. Agency for Health Care Policy and Research (AHCPR), announced today that the agency plans to spend up to $11 million to support two to three centers of excellence for health care market and managed care research. The studies conducted by these centers will help public policymakers understand, monitor, and anticipate how changes in the nation's market-driven health care system affect costs, access to services, and quality of care. Some of the studies are expected to look at the impact of these changes on rural and minority populations. The announcement calls on interested investigators to submit letters of intent by September 2, 1999, and to apply for the research program grants by November 10, 1999.
Under a 1995 initiative, AHCPR supported 11 studies of the impact of major changes in health care markets. Major findings about changes in physician labor force participation and income, hospital mergers and integrations, and the structure of health insurance markets are now informing the decisions of federal and state policymakers. Over the past few years, however, health care markets have become increasingly complex. Costs appear to be rising again; some HMOs are withdrawing from Medicaid and Medicare programs; for-profit ownership is increasing; some hospital-health plan mergers from the past are being dissolved; and new consolidations are producing complex multi-product, multi-market health plans and diversified provider networks. Moreover, employers and health care coalitions are having greater impact on the shape of health care markets than before. But other things are not changing: Access to health care continues to be a problem in
rural markets, and racial and ethnic disparities in health outcomes and quality persist. Policymakers in both the public and private sectors need further information so they can forge sound policies and strategies in response to both market changes and persistent problems.
Each center will perform several inter-related projects that revolve around a general theme conceived by the principal investigator. Within the limits of the theme, individual projects will address provider and health plan behavior, purchaser behavior, access to care of persons belonging to racial and ethnic minorities, and rural health markets.
AHCPR expects applicants to use existing data sources, including administrative data and other available data tracking market transactions. Development of large new surveys is not anticipated, but projects may involve some new data development, such as of State-level data detailing regulatory structures for providers, health plans and purchasers.
Individual projects may use a combination of qualitative and quantitative research methods. Qualitative methods may be especially useful in studying rapidly changing environments and can be used on their own to deepen understanding of the transformation of health care delivery systems, or to complement quantitative methods, thereby strengthening the research design.
Investigators are expected to disseminate their research beyond the peer-reviewed literature. They will build methodologies into the grants to accomplish a broader dissemination to public policy audiences, and AHCPR staff will assist in these efforts by periodically organizing public policy conferences to disseminate findings and other products developed under this initiative.
AHCPR expects to begin funding the winning applicants by May 2000. Each selected program project can expect to receive $750,000 to $1 million in AHCPR funds the first year, with comparable levels of support for the second through fifth year. Eligible organizations include public or private nonprofit organizations, such as universities, clinics, state and local government agencies, and federal government agencies. For-profit organizations are not eligible, but they may participate in the research project grants as members of consortia or as subcontractors.
For further details and application instructions, see "Healthcare Markets and Managed Care," in the June 23, 1999, NIH Guide for Grants and Contracts (http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-00-001.html). A companion piece, AHCPR Guidelines for the Research Program Project Grant, will be on the Funding Opportunities section of the AHCPR Web site.
For additional information, contact the AHCPR Press Office (301) 427-1364: Karen Migdail (301) 427-1855 (KMigdail@ahrq.gov).