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July 16, 1997, Vol 278, No. 3 >
ARTICLE | July 16, 1997

Relationship Between National Institutes of Health Research Awards to US Medical Schools and Managed Care Market Penetration FREE

Ernest Moy, MD, MPH; Anthony J. Mazzaschi; Rebecca J. Levin, MPH; David A. Blake, PhD; Paul F. Griner, MD
[+] Author Affiliations

Reprints: Ernest Moy. MD, MPH, Center for the Assessment and Management of Change in Academic Medicine, Association of American Medical Colleges, 2450 N St NW, Washington, DC 20037-1127 (e-mail: emoy@aamc.org).


JAMA. 1997;278(3):217-221. doi:10.1001/jama.1997.03550030057034
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References

Context.  —Medical research conducted in academic medical centers is often dependent on support from clinical revenues generated in these institutions. Anecdotal evidence suggests that managed care has the potential to affect research conducted in academic medical centers by challenging these clinical revenues.

Objective.  —To examine whether empirical evidence supports a relationship between managed care and the ability of US medical schools to sustain biomedical research.

Design.  —Data on annual extramural research grants awarded to US medical schools by the National Institutes of Health (NIH) from fiscal years 1986 to 1995 were obtained, and each medical school was matched to a market for which information about health maintenance organization (HMO) penetration in 1995 was available.

Main Outcome Measures.  —Growth in total NIH awards, traditional research project (R01) awards, R01 awards to clinical and basic science departments, and changes in institutional ranking by NIH awards were compared among schools located in markets with low, medium, and high managed care penetration.

Results.  —Medical schools in all markets had comparable rates of growth in NIH awards from 1986 to 1990. Thereafter, medical schools in markets with high managed care penetration had slower growth in the dollar amounts and numbers of NIH awards compared with schools in markets with low or medium managed care penetration. This slower growth for schools in high managed care markets was associated with loss of share of NIH awards, equal to $98 million in 1995, and lower institutional ranking by NIH awards. Much of this revenue loss can be explained by the slower growth of R01 awards to clinical departments in medical schools in high managed care markets.

Conclusions.  —These findings provide evidence of an inverse relationship between growth in NIH awards during the past decade and managed care penetration among US medical schools. Whether this association is causal remains to be determined.

REFERENCES

1 +
Iglehart JK.  Rapid changes for academic medical centers . N Engl J Med . 1995;;332:407-411.
2 +
Blake DA.  Whither academic values during the transition from academic medical centers to integrated health delivery systems? Acad Med . 1996;;71:818-819.
3 +
Jones RF, Sanderson SC.  Clinical revenues used to support the academic mission of medical schools, 1992-93 . Acad Med . 1996;;71:299-307.
4 +
Stein MD, Rubenstein L, Wachtel TJ.  Who pays for published research? JAMA . 1993;;269:781-782.
5 +
Berman J, Borkowski A, Rachocka H, Moore W.  Impact of unfunded research in medicine, pathology, and surgery . South Med J . 1995;;88:295-299.
6 +
Miller RH.  Competition in the health system: good news and bad news . Health Aff (Millwood) . 1996;;15:107-120.
7 +
Kassirer JP.  Academic medical centers under siege . N Engl J Med . 1994;;331:1370-1371.
8 +
Gold MR.  Effects of the growth of managed care on academic medical centers and graduate medical education . Acad Med . 1996;;71:828-838.
9 +
Blumenthal D, Meyer GS.  The future of the academic medical center under health care reform . N Engl J Med . 1993;;329:1812-1814.
10 +
Billi JE, Wise CG, Bills EA, Mitchell RL.  Potential effects of managed care on specialty practice at a university medical center . N Engl J Med . 1995;;333:979-983.
11 +
Carey RM, Engelhard CL.  Academic medicine meets managed care: a high-impact collision . Acad Med . 1996;;71:839-845.
12 +
Association of Academic Health Centers. The End of an Era of Cross Subsidization of Research: A Case Study of the University of Texas Southwestern Medical Center at Dallas . Washington, DC: Association of Academic Health Centers; 1996;.
13 +
Rich S.  New frugality of health care hurts research funding, medical schools say . Washington Post . (August 18) , 1996;:A6.
14 +
Burnett DA.  Evolving market will change clinical research . Health Aff (Millwood) . 1996;;15:90-92.
15 +
Rich S.  HMOs cut money for medical research . Pittsburgh Post-Gazette . (September 2) ,1996;:A6.
16 +
Walker PV.  Budget cuts and rise of managed care force change at hospital . Chron Higher Educ . (December 13) ,1996;:A30.
17 +
Pham A.  Medical brain drain: researchers leaving Boston say managed care economies are drying up seed money . Boston Globe . (July 13) ,1996;:65.
18 +
Lasalandra M.  Research cash and docs dwindle in Massachusetts health care . Boston Herald . (January 5) ,1997;:17.
19 +
Blumenthal D, Meyer GS.  Academic health centers in a changing environment . Health Aff (Mill-wood) . 1996;;15:200-215.
20 +
Mechanic RE, Dobson A.  The impact of managed care on clinical research: a preliminary investigation . Health Aff (Millwood) . 1996;;15:72-89.
21 +
Neilson EG, Ausiello D, Demer LL.  Physicianscientists as missing persons . J Invest Med . 1995;;43:534-542.
22 +
 Cross-institute studies: more grant stability on NIH priority list . US Med . (December) 1996;:1.
23 +
National Institutes of Health. NIH Extramural Trends: Fiscal Years 1986-1995 . Bethesda, Md: National Institutes of Health; 1996;.
24 +
National Institutes of Health. NIH Extramural Trends: Fiscal Years 1985-1994 . Bethesda, Md: National Institutes of Health; 1995;. NIH publication 96-3506.
25 +
Committee on Criteria for Federal Support of Research and Development. Allocating Federal Funds for Science and Technology . Washington, DC: National Academy Press; 1995;.
26 +
Ad Hoc Group for Medical Research Funding. The National Institutes of Health: A Resource Guide . Washington, DC: Association of American Medical Colleges; 1996;.
27 +
Interstudy Publications. The Interstudy Competitive Edge 6.1: Regional Market Analysis . St Paul, Minn: Interstudy Publications; 1996;.
28 +
Perry DR, Challoner DR, Oberst RV.  Research advances and resource constraints: dilemmas facing medical education . N Engl J Med . 1981;;305:320-324.
29 +
Geiger R, Feller I.  The dispersion of academic research in the 1980s .J Higher Educ . 1995;;66:336-360.
30 +
 In academic research funding, the rich get richer . Sci Government Rep . (November 1) , 1996;:6.

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Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Iglehart JK.  Rapid changes for academic medical centers . N Engl J Med . 1995;;332:407-411.
2 +
Blake DA.  Whither academic values during the transition from academic medical centers to integrated health delivery systems? Acad Med . 1996;;71:818-819.
3 +
Jones RF, Sanderson SC.  Clinical revenues used to support the academic mission of medical schools, 1992-93 . Acad Med . 1996;;71:299-307.
4 +
Stein MD, Rubenstein L, Wachtel TJ.  Who pays for published research? JAMA . 1993;;269:781-782.
5 +
Berman J, Borkowski A, Rachocka H, Moore W.  Impact of unfunded research in medicine, pathology, and surgery . South Med J . 1995;;88:295-299.
6 +
Miller RH.  Competition in the health system: good news and bad news . Health Aff (Millwood) . 1996;;15:107-120.
7 +
Kassirer JP.  Academic medical centers under siege . N Engl J Med . 1994;;331:1370-1371.
8 +
Gold MR.  Effects of the growth of managed care on academic medical centers and graduate medical education . Acad Med . 1996;;71:828-838.
9 +
Blumenthal D, Meyer GS.  The future of the academic medical center under health care reform . N Engl J Med . 1993;;329:1812-1814.
10 +
Billi JE, Wise CG, Bills EA, Mitchell RL.  Potential effects of managed care on specialty practice at a university medical center . N Engl J Med . 1995;;333:979-983.
11 +
Carey RM, Engelhard CL.  Academic medicine meets managed care: a high-impact collision . Acad Med . 1996;;71:839-845.
12 +
Association of Academic Health Centers. The End of an Era of Cross Subsidization of Research: A Case Study of the University of Texas Southwestern Medical Center at Dallas . Washington, DC: Association of Academic Health Centers; 1996;.
13 +
Rich S.  New frugality of health care hurts research funding, medical schools say . Washington Post . (August 18) , 1996;:A6.
14 +
Burnett DA.  Evolving market will change clinical research . Health Aff (Millwood) . 1996;;15:90-92.
15 +
Rich S.  HMOs cut money for medical research . Pittsburgh Post-Gazette . (September 2) ,1996;:A6.
16 +
Walker PV.  Budget cuts and rise of managed care force change at hospital . Chron Higher Educ . (December 13) ,1996;:A30.
17 +
Pham A.  Medical brain drain: researchers leaving Boston say managed care economies are drying up seed money . Boston Globe . (July 13) ,1996;:65.
18 +
Lasalandra M.  Research cash and docs dwindle in Massachusetts health care . Boston Herald . (January 5) ,1997;:17.
19 +
Blumenthal D, Meyer GS.  Academic health centers in a changing environment . Health Aff (Mill-wood) . 1996;;15:200-215.
20 +
Mechanic RE, Dobson A.  The impact of managed care on clinical research: a preliminary investigation . Health Aff (Millwood) . 1996;;15:72-89.
21 +
Neilson EG, Ausiello D, Demer LL.  Physicianscientists as missing persons . J Invest Med . 1995;;43:534-542.
22 +
 Cross-institute studies: more grant stability on NIH priority list . US Med . (December) 1996;:1.
23 +
National Institutes of Health. NIH Extramural Trends: Fiscal Years 1986-1995 . Bethesda, Md: National Institutes of Health; 1996;.
24 +
National Institutes of Health. NIH Extramural Trends: Fiscal Years 1985-1994 . Bethesda, Md: National Institutes of Health; 1995;. NIH publication 96-3506.
25 +
Committee on Criteria for Federal Support of Research and Development. Allocating Federal Funds for Science and Technology . Washington, DC: National Academy Press; 1995;.
26 +
Ad Hoc Group for Medical Research Funding. The National Institutes of Health: A Resource Guide . Washington, DC: Association of American Medical Colleges; 1996;.
27 +
Interstudy Publications. The Interstudy Competitive Edge 6.1: Regional Market Analysis . St Paul, Minn: Interstudy Publications; 1996;.
28 +
Perry DR, Challoner DR, Oberst RV.  Research advances and resource constraints: dilemmas facing medical education . N Engl J Med . 1981;;305:320-324.
29 +
Geiger R, Feller I.  The dispersion of academic research in the 1980s .J Higher Educ . 1995;;66:336-360.
30 +
 In academic research funding, the rich get richer . Sci Government Rep . (November 1) , 1996;:6.

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