A Tale Of Two Systems: The Changing Academic Health Center

PROLOGUE: Observers of the U.S. health policy scene are seldom surprised when they learn of another merger involving academic health centers (AHCs). The litany of complaints from AHCs and their supporters about growing financial pressures and the adaptive strategies that AHCs are employing to survive have become staples of any discussion involving academic medicine in America. What Americans may be more surprised to learn is that a similar drama is unfolding on the other side of the Atlantic as well. In this paper David Blumenthal and Nigel Edwards explore two recent mergers—one in Boston, one in London—involving prestigious AHCs. They find both striking similarities in the pressures that contribute to mergers and other cost-cutting strategies and important differences in the respective situations of the institutions involved. Blumenthal is a physician with a long-standing interest in AHCs and an impressive string of publications to his credit. He is director of the Institute for Health Policy at the Massachusetts General Hospital/Partners Health Care System in Boston and a professor of medicine and health care policy at Harvard Medical School. Blumenthal received his medical training at Harvard University, where he also earned a master's degree in public policy. Edwards, also a prolific writer, is policy director of Britain's National Health Service (NHS) Confederation, a membership organization that represents more than 95 percent of NHS organizations. He holds a master of business administration degree from the University of Westminster. ABSTRACT: Major changes in academic health centers (AHCs) may not be confined to the United States. Both Partners HealthCare System in Boston and University College London School of Medicine/University College Hospital Trust in London have recently undergone mergers, downsizing, and cost cutting on unprecedented scales. A comparison of the recent histories of these eminent AHCs reveals striking similarities in the clinical and academic pressures bearing down upon them and in their responses. It also reveals important differences in their situations and actions, traceable in large part to the contrasting roles of governments and markets in the health care economies of these two countries.