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From Bench to Bedside: Preserving the Research Mission of Academic Health Centers

A new report by The Commonwealth Fund's Task Force on Academic Health Centers concludes that unless payments for biomedical research are restructured, the ability of the nation's 125 academic health centers (AHCs) to carry out their invaluable research and training missions may be significantly reduced.

In From Bench to Bedside: Preserving the Research Mission of Academic Health Centers, the Task Force asserts that recent changes in the health care market and public policies may hamper the ability of AHCs—medical schools and their closely affiliated clinical facilities and faculty group practices—to conduct their research activities as effectively as they have in the past. These changes could reduce the amount of biomedical research, including clinical research, undertaken at AHCs.

Despite conducting nearly 30 percent of health-related research and development in the United States, AHCs do not receive adequate financial support from the National Institutes of Health (NIH) to cover the direct and indirect costs of this research. The reduction in Medicare payments to AHCs mandated by the Balanced Budget Act of 1997 may further constrain their research mission.
The report notes that AHCs have historically cross-subsidized their research with clinical revenues. However, competitive pressures caused by the growing market dominance of managed care have forced AHCs to accept reduced payments from health plans for patient services, challenging AHCs' ability to cross-subsidize research.

To protect the research mission of AHCs, the report recommends that the NIH providefunding to cover more of the costs of principal investigators' salaries, construction and renovation of facilities, and maintenance of laboratories and equipment through direct capital support and restoration of the Biomedical Research Support Grant. In addition, the NIH should increase funding for AHCs to help translate new medical discoveries into practical treatments and procedures and to evaluate new medical technologies.

To strengthen the ability of AHCs to conduct research, the report also advocates that AHCs substantially restructure the organization and management of their research activities to improve efficiency and reduce costs. In addition, AHCs should further take steps to improve the academic standing of clinical researchers by improving the training and mentoring of medical students, residents, and young faculty interested in clinical research careers.

Facts and Figures
  • AHCs perform approximately 28 percent of the nation's health-related research and development.
  • On average, AHC clinical researchers in high managed care markets published 17 percent fewer papers than their colleagues in low managed care markets.
  • Internal funding for research is more than twice as high at AHCs in markets with low rates of managed care, such as Chicago and Atlanta (6.1% of total funds), as it is at AHCs in high managed care markets, such as Minneapolis-St. Paul and San Diego (2.5% of total funds).

Publication Details



From Bench to Bedside: Preserving the Research Mission of Academic Health Centers, Task Force on the Future of Academic Health Centers, The Commonwealth Fund, April 1999