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Managed Care

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Nation's move toward managed care challenges academic health centers to sustain research and training

Some researchers are concerned that the research functions of academic health centers could be endangered as a result of the financial and other pressures on academic health centers. A number of centers are struggling to find ways to maintain or expand the structures and funding required for their research programs while also developing competitive service delivery systems and sustaining their other missions, such as education and care of the poor. In order to determine the status of health services research programs at academic health centers, University of Wisconsin researchers David A. Kindig, M.D., Ph.D., and Nancy Cross Dunham, Ph.D., and Director of the Agency for Healthcare Research and Quality, John M. Eisenberg, M.D., analyzed interviews conducted in late 1998 with researchers at 10 health services research centers of different types and from different areas around the country.

The interviews revealed that most but not all such centers have received some form of core support from their parent institutions. Annual core financial support varied ten-fold, from $50,000 to $500,000 per year, but for the most part tended to represent a relatively small proportion of the research centers' total budget. Nearly all those interviewed were concerned about the difficulties that health services research centers face in trying to encourage the career development of young investigators through the provision of seed money to support the building of solid and sustainable research agendas.

Center directors noted that training grants from AHRQ and other agencies were helpful for training health services researchers but often were not adequate, with centers relying on supplementation from the parent institutions. A number of people interviewed indicated that their health services research centers had developed or were developing research relationships with local health systems and/or insurers, Medicaid health maintenance organizations, State health departments, and community organizations.

See "Needs and challenges for health services research at academic health centers," by Drs. Kindig, Dunham, and Eisenberg, in the November 1999 Academic Medicine 74(11), pp. 1193-1201. Reprints (AHRQ Publication No. 00-R007) are available from the AHRQ Clearinghouse.

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