Center for Studying Health System Change

Providing Insights that Contribute to Better Health Policy


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Center for Studying Health System Change (HSC)

Fact Sheets
December 2013


For nearly 20 years, HSC, a nonpartisan policy research organization, was at the forefront of identifying and analyzing emerging health care trends at the community level. HSC focused on changes in the financing, delivery and quality of health care in the United States, with a particular emphasis on the policy implications of these changes. Founded in 1995 by the Robert Wood Johnson Foundation (RWJF) and led by HSC President Paul B. Ginsburg, Ph.D., a nationally known health care economist and health policy expert, HSC conducted rigorous surveys and in-depth cases studies to identify emerging trends in the nation’s health care system. From 1995 to 2003, RWJF served as HSC’s exclusive funder. Beginning in 2003, HSC sought support from many different sources: foundations, governmental entities and private organizations. Regardless of funder, HSC maintaine editorial control of all research findings. Instead of advocating for particular policies, HSC served as an honest broker of information for policy makers, the news media, employers, health care providers, insurers and the public. Based in Washington, D.C., HSC was affiliated with Mathematica Policy Research. On Dec. 31, 2013, HSC merged with Mathematica Policy Research and ceased operations as an independent organization.

Health Care in Communities

Ultimately, all health care is organized and delivered at ground level—in local communities—where HSC collected information about the changing health system. As part of the Community Tracking Study (CTS), HSC periodically made intensive site visits to 12 metropolitan communities selected randomly to be representative of the nation. HSC also conducted other site-visit studies, for example, of six California communities, and smaller qualitative studies focused on narrower topics, such as health information technology. Along with fielding national surveys of consumer households and physicians, HSC researchers conducted studies using other survey data and administrative data, such as medical claims. HSC researchers combined quantitative and qualitative findings to provide policy makers with a vibrant picture of changing health care market dynamics and the implications for health care policy.

HSC’s Key Policy Research Areas

HSC’s focus on local market dynamics provided targeted research and analysis that contributed to better health policy. To assist policy makers, HSC focused on four key policy areas:

  • Health Insurance Coverage and Costs
  • Access to Care
  • Quality and Care Delivery
  • Health Care Markets

Site Visits to 12 Nationally Representative Communities

HSC periodically conducted intensive site visits to Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y. In each community, HSC researchers interviewed about 50 local health care leaders, including employers, physicians, hospital executives, policy makers, safety net providers and insurers. HSC completed the seventh round of site visits in 2010.

National Household and Physician Surveys

Since 1996, HSC conducted six national surveys of American households and five national surveys of physicians.

Health Tracking Household Survey. Approximately 17,000 people took part in the 2010 survey. The survey focuses on assessing whether consumers’ access to health care is improving or declining over time. The survey also explores patients’ satisfaction with the care they receive and with their insurance coverage. The 2010 survey is nearing completion.

Health Tracking Physician Survey. Approximately 4,700 practicing physicians across the country took part in the 2008 survey, providing information about how the practice of medicine is changing. Physicians respond to questions about their ability to provide needed services for patients, how much charity care they provide, how they are compensated and many other topics.

The National Institute for Health Care Reform
The National Institute for Health Care Reform is a nonpartisan, nonprofit 501 (c)(3) organization established by the International Union, UAW; Chrysler Group LLC; Ford Motor Company; and General Motors to conduct health policy research and analyses to improve the organization, financing and delivery of health care in the United States. The Institute contracted with HSC between 2009 and 2013 to conduct health policy research and policy analyses, and HSC President Paul B. Ginsburg, Ph.D., served as the Institute’s research director. All research and analyses were conducted using HSC’s rigorous standards for quality and objectivity.

Additional Funders
To maintain its reputation for high-quality, independent and nonpartisan research, HSC only accepted funding when it retained the right to publish all research results. Along with the National Institute for Health Care Reform and RWJF, other funders included the Agency for Healthcare Research and Quality; the California HealthCare Foundation; the Commonwealth Fund; the Henry J. Kaiser Family Foundation; National Institutes of Health - National Institute on Aging; National Institutes of Health - National Cancer Institute; and the RWJF Changes in Health Care Financing and Organization Initiative.
Timely Access to All HSC Publications and Related Data Files
HSC was committed to providing convenient and timely access to survey data files and related publications. HSC’s publication series included Issue Briefs, Data Bulletins, Tracking Reports, Research Briefs, Community Reports and Policy Analyses—all of which combined to provide detailed information on survey and site-visit findings, along with other research. All HSC publications and survey public-use and restricted-use data files are available on the Web at

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The Center for Studying Health System Change Ceased operation on Dec. 31, 2013.