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Understanding the Social Missions of Academic Health Centers


The traditional role of academic health centers (AHCs) is being re-evaluated as the shift to managed care changes the health care landscape. For the past 50 years, these university-affiliated teaching centers have been educating future physicians, conducting medical research, and treating the sickest and often the poorest patients.

Now, this high-tech, high-priced expertise is under siege, with AHC critics complaining that the institutions deliver basic health care too expensively, train too many unnecessary specialists, and ignore the national need for generalist physicians.

The societal advantages that AHCs actually offer in return for their high-cost services are examined in a new study, Understanding the Social Missions of Academic Health Centers, by David Blumenthal, M.D., Eric G. Campbell, Ph.D., and Joel S. Weissman, Ph.D. The authors present a cogent analysis of the nation's AHCs that can be used during the debate over health care costs.

The analysis shows that the missions--teaching, research, and medical care--provided by AHCs are the foundation of the high quality of health care provided to the nation's patients. It also demonstrates that these missions would not likely be adequately protected in a market-based health economy.

However, the authors find that both the mix of services and the efficiency with which they are delivered are open to improvement.

They also urge that any efforts to restructure AHCs continue to preserve their necessary social functions. The mix of physicians being trained, for example, could be changed without dismantling the system which trains them. Such changes in social missions should be informed, the authors conclude, by a clear understanding of both the fiscal and societal impact on the care of vulnerable populations, teaching, and research.

Facts and Figures

  • While AHCs represent a small percentage of all teaching hospitals, they sponsor 59 percent of all graduate medical education programs and residents.
  • Faculty practice plans and volunteer instructors in AHCs provided nearly $1 billion ($16,000 per medical student) to support their education.
  • About 42 percent of all life science research and development is conducted in academic institutions. The majority of support, nearly 90 percent, comes from government and private, non-profit sources.
  • The nation's 125 academic health centers constitute 2 percent of acute care hospitals, but provide 23 percent ($6.4 billion in 1994) of all uncompensated (bad debt and charity) care.
  • 46 percent of all transplant centers, a third of all trauma centers, 31 percent of dedicated AIDS inpatient units, and 26 percent of in vitro fertilization units are in AHCs.


The full report is not available at this time.


Publication Details



Understanding the Social Missions of Academic Health Centers, David Blumenthal, Eric G. Campbell, and Joel S. Weissman., The Commonwealth Fund, January 1997