The RWJF Community Snapshots Study: Introduction and Overview

Abstract

Prologue: With the health care system undergoing change at an unprecedented rate, countless questions arise. How does the integration of a hospital and its medical staff affect the care of patients? What forces are driving organizational change, and what will be the impact on the system? The Center for Studying Health System Change, a new Washington-based, Robert Wood Johnson Foundation (RWJF)-supported enterprise, has begun the ambitious process of tracking these questions and many others as the health care system is transformed through private and public actions. In this overview the center's president, Paul Ginsburg, discusses the key trends that emerged in fifteen communities that were studied by three research teams. Eight of the cross-cutting analyses produced by members of these teams follow this overview. The dramatic systemic changes that are under way also have affected the methods of health services researchers. Economist Jamie Robinson has characterized the result as “shoe-leather social science”— the combining of academic research methods with more journalistic pursuits. Nevertheless, all of the papers were subjected to external peer review, although the process was rapid and the time for revisions limited. The researchers found important differences in the nature of change and its speed across communities. Some of the communities are pursuing completely separate paths, with unique destinations, while common themes are struck in other locales. The political and business cultures also are strong influences on local health care systems. Ginsburg holds a doctorate in economics from Harvard University. Before resigning to build and preside over the new center, Ginsburg served for nine years (1986-1995) as executive director of the Physician Payment Review Commission (PPRC). Earlier in his career he was a senior economist at RAND and deputy assistant director of the Congressional Budget Office. Abstract: Teams of researchers visited fifteen communities—selected to reflect a range of health care market development, regions, and population size—to obtain a “snapshot” of health system change. The study found that organizational change is pervasive, even in those communities that do not receive attention in the trade press, but that much of the change has not yet affected consumers. While the forces driving change are similar across the communities, the responses—and the shape of change—differ in important ways. Factors leading to the differences include the size and capabilities of existing health care organizations, the community's experience with managed care, and the political and business cultures of the community.