RELATIONSHIP BETWEEN NATIONAL-INSTITUTES-OF-HEALTH RESEARCH AWARDS TOUS MEDICAL-SCHOOLS AND MANAGED CARE MARKET PENETRATION

Context.-Medical research conducted in academic medical centers is oft en dependent on support from clinical revenues generated in these inst itutions. Anecdotal evidence suggests that managed care has the potent ial to affect research conducted in academic medical centers by challe nging these clinical revenues. Objective.-To examine whether empirical evidence supports a relationship between managed care and the ability of US medical schools to sustain biomedical research. Design.-Data on annual extramural research grants awarded to US medical schools by th e National Institutes of Health (NIH) from fiscal years 1986 to 1995 w ere obtained, and each medical school was matched to a market for whic h information about health maintenance organization (HMO) penetration in 1995 was available. Main Outcome Measures.-Growth in total NIH awar ds, traditional research project (R01) awards, R01 awards to clinical and basic science departments, and changes in institutional ranking by NIH awards were compared among schools located in markets with low, m edium, and high managed care penetration. Results.-Medical schools in all markets had comparable rates of growth in NIH awards from 1986 to 1990. Thereafter, medical schools in markets with high managed care pe netration had slower growth in the dollar amounts and numbers of NIH a wards compared with schools in markets with low or medium managed care penetration. This slower growth for schools in high managed care mark ets was associated with loss of share of NIH awards, equal to $98 mill ion in 1995, and lower institutional ranking by NIH awards. Much of th is revenue loss can be explained by the slower growth of R01 awards to clinical departments in medical schools in high managed care markets. Conclusions.-These findings provide evidence of an inverse relationsh ip between growth in NIH awards during the past decade and managed car e penetration among US medical schools. Whether this association is ca usal remains to be determined.