Academic Health Centers and the Changing Health Care Market

Abstract

Academic health centers (AHCs) have supported their mission of patient care, education, and research through a complex system of cross-subsidies, many of which originate from patient care activities. The proliferation of managed care and health care reform initiatives, however, are threatening this traditional method of financing. This article begins by describing the financing of AHCs and the web of cross-subsidization that occurs at these institutions. The article then reviews the literature on the threats that AHCs are facing in the current health care market, how these threats are affecting their mission-related activities, and how they are responding to and managing these threats. The article concludes with a summary of our current understanding of AHCs and presents a research agenda of issues in need of further study.

Telemedicine and the Academic Health Center: The University of Michigan Health System Model

“…Although diverse with regard to their organization, structure, size, and operation, the AHCs are similar in regard to their missions. 2 More specifically, the AHCs serve three essential roles simultaneously: (1) to provide medical education and training, (2) to conduct biomedical and clinical research, and (3) to provide direct patient care. Typically, their missions emphasize the training of the best physicians, conducting state-of-the-art medical research, and providing optimal patient care for serious and complex medical conditions.…”

“…[2][3][4] These threats revolve around financial problems resulting from expenses outpacing revenues, a trend of increasing regulations and restrictions on reimbursement, as well as rising consumer expectations. Unfortunately, much like the situation regarding telemedicine evaluation research, as Freburger and Hurley 2 point out, our understanding of the AHC is generally limited due to the "anecdotal, speculative, or descriptive nature" of the majority of the literature in the field.…”

“…2,4,7 The perceived threat by many AHC administrators is reflected in Eisenberg's rather dire suggestion of a corollary to Gresham's Law that states "bad money drives out good," namely, that "for-profit managed care drives out care, teaching and research." 7 A concern critical to the AHC and the completion of its missions is, of course, maintaining fiscal integrity and solvency.…”

“…The question facing many AHCs is how they can continue to finance their traditionally large and often increasing volume of charity care while meeting their specialized care, education, and research charges. 2 This situation may, in some instances, drive the AHC away from specialty training to primary care training-even if only to sustain revenues. 8,9 If this were to occur, it would have major negative short-and long-term consequences for patients and the community, as well as for the progress of scientific medicine.…”

Comparison of the Effectiveness of Two Lecture Methods in an OB/GYN Clerkship

“…I In nt tr ro od du uc ct ti io on n A decrease in clinical revenue due to the growth in managed and integrated delivery systems, increased competition for research dollars, and changes in federal subsidies for academic institutions are negatively impacting medical education. 1,2 Changes in medicine, medical education, and technology have influenced both graduate and undergraduate medical education. 3 A structured, consistent, didactic lecture system is extreme- ly important in a third-year medical clerkship.…”