Gray BH, Collins S, Gusmano M; Academy for Health Services Research and Health Policy. Meeting.

Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.

Presented by: Bradford H. Gray, Ph.D. Director, Division of Health and Science Policy, New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029-5293. Tel: 212-822-7286; Fax 212-822-7369; E-mail: bgray@nyam.org.

Research Objective: The Agency for Health Care Research and Policy was created by legislation passed in December 1989 and was supplanted by the Agency for Healthcare Research and Quality in December 1999. By documenting AHCPR's history and how it and its activities have been viewed by key constituents inside and outside of government, this paper will identify the conflicting interests that must be managed in the new millennium by a federal research agency that focuses on health care - a politically charged field in which research findings often have policy implications. The project seeks first to provide an authoritative account of the major events in the Agency's history, as well as their causes and consequences. Key events include the establishment of the Agency, its involvement in health reform in the Bush and Clinton administrations, its near death experience during the Republican revolution in 1995, changes in leadership, major programs, and strategy, and finally its reauthorization with overwhelming support and a new name in 1999. The second goal is to understand how the choices made by the Agency have been viewed by key constituencies from the Hill, OMB, health professional associations, and the field of health services research. All of this has implications for the future of the Agency and health services research.Study Design: The paper will be based on interviews with more than 60 key informants and an extensive review of the Agency's documentary history (budget support documents, congressional hearings, strategic plans, evaluations of Agency programs). Interviewees include: (1) individuals in the Agency, DHHS, OMB, the White House, and Congress, who had first hand involvement with all stages and major events in the Agency's tumultuous ten years, (2) researchers supported by the Agency (particularly PORT directors), (3) members of the Agency's national advisory committee, (4) individuals who lobbied Congress regarding the Agency, and (5) past presidents of AHSR. Principal Findings.. AHCPR's brief history has seen two changes of leadership, a major reorganization (doing away with the separate extramural and intramural programs), abandonment of the distinctive activities with which it began (the Patient Outcome Research Teams and the practice guideline development program), a dramatic redefinition of the Agency's "customers," a near-death experience (with a major budget cut), and then reauthorization five years later with only 7 dissenting votes in the House. Managing the Agency, whose budget depends upon annual decisions in DHHS, OMB, and Congress, involves choices that affect important constituents, shape the research agenda, and that carry political benefits and dangers. These choices have included how the Agency's customers are defined; whether to invest in projects that involve quick, small payoffs or large, long-term payoffs; whether to use a limited budget to support a few large projects or many small ones; resource allocation decisions regarding intramural vs extramural activities, including the number and focus of grants; whether and how to become involved in the governmental policy-making processes; and how involved to become in quasi-regulatory activities. Key constituencies, including Agency staff and advisory council, OMB, authorizing and appropriating committees, and professional associations (e.g., AHSR), have conflicting preferences regarding programmatic directions. Conclusions: The Agency is healthier than it has ever been and has adopted a definition of "customers" that may serve its political interests well, even though not wholly satisfactory to the Agency's researcher constituency. AHRQ remains the principal federal health services research agency, but appropriations with which to support research on the organization and financing of services will continue to be difficult to obtain. The Agency's large national surveys (MEPS) and its more clinically-oriented research on outcomes and effectiveness have greater support in budgetary circles, but such research may prompt unforseen challenges from policymakers and private industry as the Agency's near-death experience in 1995 demonstrated.Implications for Policy: Future federal support of health services research depends upon the Agency's fate in the budget process. Advocates of health services research should understand the conflicting institutional constraints and pressures that affect the Agency and its leadership.Funding Sources: Robert Wood Johnson Foundation; Commonwealth Fund

Publication Types:

• Meeting Abstracts

Keywords:

• Administrative Personnel
• Budgets
• Delivery of Health Care
• Government Agencies
• Health Services Research
• Humans
• Leadership
• Policy Making
• Practice Guidelines as Topic
• United States Agency for Healthcare Research and Quality
• Weights and Measures
• economics
• hsrmtgs

Other ID:

• GWHSR0000922

UI: 102272596

From Meeting Abstracts