THE IMPACT OF MANAGED CARE ON CLINICAL RESEARCH

Traditionally, US teaching hospitals have subsidised research by charg ing higher costs for treatment; however, this approach is being challe nged. The growth of managed-care organisations, concerned about maximi sing profits, has led many to argue that clinical research will be dam aged, whether by the loss of internal funds for research or by reducti ons in the numbers of patients available for studies. This review exam ines the evidence on which this argument is based. There is some evide nce that managed-care organisations are refusing to cover patients who are involved in clinical trials, although, in general, they are recep tive towards research providing that it is explicit and seen as releva nt. The indirect effects of competition are, arguably, more important. Although many academic centres have established strategies to protect research funds, those working in the most competitive healthcare envi ronments are obtaining fewer externally funded research grants. They a re also publishing fewer papers and are working in climates that are s een as less supportive, with less ability to undertake research that i s not externally funded. There is little evidence that managed care is reducing access to patients for clinical research. The growth of mana ged care is, together with certain other trends, also influencing the nature of clinical research. The overall consequences of these differe nt factors are difficult to predict, although there are grounds for co ncern about recruitment and retention of junior researchers. The relat ionship between the various actors involved in healthcare and research is dynamic and, as pressure is excerpted in a particular direction, o thers adapt. It may be some time before the consequences of policies b eing enacted now are apparent.