The Impact Of Managed Care On Clinical Research: A Preliminary Investigation

Prologue: Clinical research at academic medical centers is supported by a variety of public, private, and institutional sources. However, as the health care world is overturned by the rapid emergence of a system driven by market principles, the sources of support for clinical research seem destined to change, too. In this paper Robert Mechanic and Allen Dobson discuss the impact of managed care on clinical research. Mechanic and Dobson have worked together on graduate medical education and hospital financing issues over the past seven years. Mechanic, who holds a master's degree in business from the Wharton School at the University of Pennsylvania, is a senior manager with The Lewin Group, where he specializes in health care financing and reimbursement. Mechanic has analyzed the impact of public and private health care reform and managed care on physicians, hospitals, and academic medical centers. He also has assisted in the design and analysis of health care reform proposals at the national level and in many states. Dobson is a vice-president of The Lewin Group and was formerly director of research at the Health Care Financing Administration. Dobson, who holds a doctorate in economics from Washington University in St. Louis, is leading an extensive analysis of physician practice expenses for a variety of physician groups. He also led the analysis of the potential future impact of managed care on the demand for inpatient hospital services for several major hospital groups. ABSTRACT: Rapid growth in managed care enrollment is likely to affect clinical research at the nation's academic medical centers (AMCs). Our site visit interviews indicate that managed care has not markedly reduced coverage for research-related care. However, market competition in some areas has limited AMCs' ability to subsidize research activities with clinical revenues. As they gain market share, managed care organizations will have a growing influence on research priorities. Therefore, it is important for the academic community to work with managed care leaders to identify areas for collaboration and an agenda for moving forward in the future.