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Patterns of Specialty Care: Academic Health Centers and the Patient Care Mission


Academic health centers (AHCs) make a unique contribution to their communities by delivering highly specialized care, such as trauma, HIV/AIDS, and burn care. Increasingly, however, the growth of managed care is steering patients away from AHCs and into less expensive hospitals, lowering the clinical revenues that have traditionally subsidized this patient care mission.

A new report by James A. Reuter of Georgetown University, Patterns of Specialty Care: Academic Health Centers and the Patient Care Mission, provides a quantitative look at AHCs’ specialty care mission and attempts to identify measures for tracking future changes in the provision of this care. Results could be used to alert policymakers should the specialty care mission become seriously threatened.

Using hospital discharge data from 1991 and 1994, Reuter finds that AHCs in metropolitan areas with high managed care enrollment provide the highest volume of specialized services. Although these hospitals represent only a tiny fraction of all nonfederal community hospitals in the United States, they contain nearly half of regional trauma units and burn units, and nearly a third of dedicated HIV/AIDS units. Twelve percent of all AHC hospitalized patients need innovative treatment and technologically advanced care.

The type of specialty care provided appears to vary by hospital ownership status. For example, private AHCs offer more, and a wider variety, of specialized services than any other type of hospital. Public AHCs also offer a broad range of highly technical and sophisticated services, but appear to provide substantially more burn and trauma care than their private AHC counterparts. Private and public non-AHC teaching hospitals and non-teaching hospitals all provide fewer highly specialized services than AHCs.

These trends and others identified by Reuter should help track future changes in specialty care services. Public policy, he suggests, should help safeguard this invaluable mission.

Facts and Figures


  • Although AHCs comprise only 2 percent of all community hospitals in the United States, they contain 47 percent of regional trauma units, 46 percent of burn units, and 31 percent of dedicated HIV/AIDS units.

  • AHCs account for a greater share of transplantation programs (34%) than other major teaching hospitals (27%).

  • Although AHCs’ share of the total market for coronary care is smaller than that of non-teaching hospitals, AHCs treat a much more complex mix of patients.

  • Public AHCs are three times more likely than private ones to provide burn care and have a third of all burn care beds in their communities.

  • Public AHCs treat a disproportionate share of Medicaid and charity cases involving some types of specialty care, including HIV/AIDS, high-risk infant, and trauma care.

Publication Details



Patterns of Specialty Care: Academic Health Centers and the Patient Care Mission, James A. Reuter, Georgetown University, The Commonwealth Fund, December 1998