The ascendancy of managed care is upsetting a relationship that some call a key to the strength of American health care: the cross-subsidization of the teaching and research enterprises from patient care income. Most medical schools have depended on clinical income to support their teaching and research missions because, several administrators told The Scientist for this article, tuition, government research grants, and state funds do not cover the true costs of teaching and research. As clinical revenues to academic health centers decline--or threaten to--medical school administrators find themselves pressured to identify new, reliable sources of funding and to operate their centers more like a business. That has led to cost-cutting and, in some cases, mergers between academic health centers and other hospitals.
CERTAIN PLEASER: Boris Draznin, a professor of medicine at the University of Colorado, says that when existing faculty are exempted from changes in tenure, negotiations go much smoother. ...
