system; (3) centralized support services such as pharmacy and laboratory services; (4) uniform and computerized databases; and (5) standardized delivery of health care at the individual practitioner and clinic levels.
Close collaboration between academic health centers and managed care organizations is critical to the success of clinical research. As discussed in the workshop, however, managed care organizations perceive some clinical research as irrelevant to their patient needs and are not routinely consulted early in the experimental design of clinical trials. Conversely, clinical researchers at academic health centers find that some managed care organizations are reluctant to refer patients to clinical trials and are unwilling to pay for the routine patient care provided in the research context.
Close collaborations between academic health centers and managed care organizations can be achieved by (1) selecting research projects of importance to managed care, (2) seeking the active participation of relevant and interested providers, (3) identifying external funding for research protocols, (4) collaboration between academic investigators and the managed care organization, (5) facilitating publication of results in peer-reviewed publications, and (6) ensuring that the results are incorporated into managed care practice.
Although academic health centers have become dependent on clinical revenues to support a portion of their research activities, pressure from managed care is reducing both the profit margins and the faculty time that are available to support research and training. At the same time, managed care organizations have large patient populations and centralized information systems that create opportunities for epidemiological and clinical trials research. In the past 10 years, a few large and stable managed care organizations have developed the infrastructure and culture to collaborate with academic and government researchers. The creation of stronger partnerships between managed care organizations and academic health centers is one way to meet the public health need to combat emerging infections.
The system of managed care, however, is undergoing a rapid evolution that may threaten the stability and survival of these partnerships. NIH is working with the managed care industry to develop mechanisms that would continue to support clinical research in a managed care environment. Whether increases in the NIH budget or research funds from the pharmaceutical industry will replace