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AHCPR News and Notes

AHCPR to fund centers of excellence for research on health care markets and managed care

John M. Eisenberg, M.D., Administrator of the Agency for Health Care Policy and Research, has announced the Agency's plans to spend up to $11 million over 5 years 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 request for applications (RFA) released on June 23, 1999, by AHCPR 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 on the impact of major changes in health care markets. Findings from these studies 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, and some HMOs are withdrawing from Medicaid and Medicare programs. For-profit ownership is increasing, and some hospital-health plan mergers from the past are being dissolved. Also, new consolidations are producing complex multiproduct, multimarket 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.

On the other hand, some things are not changing. For example, 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 funded under this RFA will undertake several interrelated 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 by people who belong to ethnic and racial minority groups, and rural health markets. AHCPR expects applicants to use existing data sources, including administrative data and other available data that track market transactions.

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 these new projects by May 2000. Each center will receive $750,000 to $1 million in AHCPR funds the first year, with comparable levels of support for years 2 through 5. 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 more information and application instructions, see "Healthcare Markets and Managed Care," (RFA-HS-00-001) in the June 23, 1999 NIH Guide for Grants and Contracts online at A companion piece, AHCPR Guidelines for the Research Program Project Grant, can be accessed online. Print copies of the Request for Applications, along with application forms and instructions, are also available from the AHCPR Publications Clearinghouse.

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