cation was to improve the stature of these university-based programs and eliminate nonuniversity programs. Likewise, when the National Institute of Dental Research (NIDR) was established in 1948, it rested its research strategy on the proposition that a university base for dentistry was essential to long-term progress in oral health science. This stance reflected a broader, postwar consensus that scientific research was fundamental to the nation's health, well-being, and security and that the country's universities and colleges had to play a central role in advancing knowledge and developing scientific talent (Bush, 1945).
America's universities have, since the end of World War II, experienced phenomenal growth and prosperity followed by some degree of retrenchment and instability born of slow economic growth, rising costs for research and development, and increased competition from other calls on society's resources (Williams et al., 1987; President's Council of Advisors on Science and Technology, 1992). Although the situation varies significantly from school to school and from state to state, the pressures on the university and the academic health center have generally intensified in the last decade.
These pressures include federal policies that have added or shifted responsibilities to other units, including states and academic health centers. Resources often have not been shifted or expanded to reflect costly added responsibilities in areas such as occupational health and safety and indigent health care. Indeed, federal and state resources for many longer-standing programs either have not kept pace with inflation or have declined far below the levels that promoted growth in the 1960s and 1970s. At the same time, budgets in many states have been severely strained by a slow and uneven recovery from a prolonged recession, difficult social problems, and public opposition to taxes for almost any purpose.
Educational costs, in common with costs for other service sectors of the economy, have been increasing at rates considerably higher than family incomes and inflation overall (Baumol, 1992). Most of this differential is attributed to rising labor costs that are difficult to offset by increased productivity, for example, through the replacement of people with machines. One result is concern that tuition may be reaching the limit of affordability, particularly at some private institutions.
Physical facilities added during the expansion years of the 1960s and 1970s are wearing out, and keeping up-to-date technologically