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Some Policy Reflections

Rashi Fein, PhD

JAMA. 2000;283:2436-2437.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Academic health centers (AHCs) face an unfamiliar new world of competition. It is true that they have always competed with one another, seeking the same faculty, students, donors, research grants, and even patients. Today's competition is more complex. It involves the emergence of relatively new outsiders (eg, freestanding specialized outpatient departments, dialysis units, day surgeries) offering niche products. Unlike AHCs, these competitors do not have a social contract with society. They perceive no obligation to provide a complete package of services designed to address the total health needs of the entire community, educate and train tomorrow's practitioners, and develop more effective therapies through research.

Because the new competitors limit their services and activities, they have a lower cost structure. Unable to compete with regard to price, AHCs find that much medical care and many research activities move off-site. Thus, their education and training activities, previously taking place . . . [Full Text of this Article]

Author Affiliation: Department of Social Medicine, Harvard Medical School, Boston, Mass.

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