Leveling the playing field: A report of the commonwealth fund task force on academic health centers

Abstract

Over the last 50 years, the nation's academic health centers (AHCs)--defined here as the 125 institutions that include at least a medical school and its closely affiliated clinical facilities and faculty practice plans--have come to serve a unique set of functions in the nation's health care system and in their communities. The AHCs produce a variety of health-related goods and services that have social value, but tend to be undervalued and undersupplied in competitive markets.These goods and services include basic and clinical research, the training of health professionals, certain highly specialized clinical services, and continuous innovation in health care services. In the balance of this paper, we refer to these functions as the "social missions" of AHCs. (Though some AHCs, especially the publicly owned centers, also consider care for the indigent a vital social mission, not all AHCs are disproportionate providers of indigent care. Therefore, this paper does not deal specifically with the indigent care mission of AHCs.)A number of commentators 1-3 have suggested that the evolution of the US health care system into a more market-competitive system could have dramatic consequences for the ability of AHCs to discharge their social missions. Providing these goods and services requires resources. Until recently, AHCs and other teaching institutions financed a significant proportion of these costs through From Partners

Understanding competitive advantage in the general hospital industry: evaluating strategic competencies

“…The dual missions of providing health care to a market as well as providing graduate education may put academic hospitals at a distinct competitive disadvantage to their nonacademic counterparts (Blumenthal, Campbell, and Weissman, 1997). Therefore, it is important to acknowledge these different organizational missions and classify each hospital accordingly.…”

Building research relationships with managed care organizations: Issues and strategies.

“…The result of changes in the research environment of academic medical centers has been demonstrated in investigations of the relationship between managed care penetration and research productivity. Since 1990, NIH research grant support has been growing less rapidly in AHCs in markets with high MCO enrollment than at institutions with low or moderate MCO penetration (Blumenthal & Thier, 1998). The amount of institutional support as a proportion of total funding is more than twice as high in less competitive markets compared with the most competitive markets (Weissman, Saglam, Campbell, et al, 1999).…”

“…More than six million Medicare beneficiaries and half of Medicaid recipients are enrolled in managed care plans (Fox, 2001). At the same time, clinical research in academic health centers, the traditional site for conducting randomized clinical trials (RCTs), has declined (Blumenthal & Thier, 1998). The need for research to inform the larger, systems-based issues of the organization and delivery of primary care services has never been greater (Dudley, Landon, Rubin, et al, 2000; Institute of Medicine, 1996; McNeese-Smith & Nyamathi, 1999).…”

Assessment of Training in Health Disparities in US Internal Medicine Residency Programs

“…There was limited assessment of the impact of the curriculum on outcomes for the learner or the patients they care for. Only 30% of 31 this may provide an opportunity for meaningful learning in the context of graduate medical education. Point of care teaching around health disparities and social determinants of health can be a powerful mechanism for residents to internalize these complex topics through the eyes of their own patients.…”