ORGANIZATIONAL RESPONSES TO MANAGED CARE - ISSUES FOR ACADEMIC HEALTHCENTERS AND IMPLICATIONS FOR PEDIATRIC PROGRAMS

The health care market dynamics that supported and directed the growth and development of Academic Health Centers (AHCs) have changed dramat ically in the last 10 years. AHCs are struggling to adapt to new reimb ursement mechanisms and to compete effectively for limited dollars, bu t are constrained by administrative and governance structures that are slow to evolve. Their multiple missions, including education, researc h, and care for complex patients and underserved populations, are at r isk. Although most recognize the need for substantive reorganization, available resources and market specifics vary dramatically from one AH C to another. The current approaches to adaptation by four AHCs are de scribed, along with some of the unique challenges confronted by academ ic pediatric programs.