Center for Studying Health System Change

Providing Insights that Contribute to Better Health Policy

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HSC: A Legacy of Policy-Relevant Research to Inform Decisions

Founded in 1995, the Center for Studying Health System Change (HSC) worked to fulfill a vision set out by leaders at the Robert Wood Johnson Foundation. That vision was based on the premise that rigorous information and analysis built up from the community level could inform national health policy making. For almost 20 years as a subsidiary of Mathematica Policy Research, HSC pursued that mission, conducting policy research and analysis focused on the U.S. health care system to help policy makers in government and private industry make better decisions.

On topics ranging from Medicare reform to quality improvement to local market competition in health care, research conducted by HSC staff helped inform the nation’s response to health system changes by highlighting interactions between cost, quality, and accessibility of care. HSC was also a pioneer in strategic communications and disseminating health services research findings to decision makers. Modern Healthcare named HSC president Paul Ginsburg one of the country’s 100 Most Influential People in Healthcare eight times. During HSC’s 19-year run, its staff, consultants, and contractors produced 252 articles in peer-reviewed journals, 101 Community Reports, 28 Tracking Reports, 138 Issue Briefs, 87 Technical Publications, 22 Research Reports, 42 Research Briefs, 36 Data Bulletins, and 12 Commentaries.

Some of the specific ways in which HSC informed policy decisions include:

  • Its analyses of the market dynamics driving the proliferation of specialty hospitals informed the 2003 decision by Congress to issue a moratorium on construction of physician-owned specialty hospitals. Ginsburg and his colleagues received the first Health Services Research Impact Award from AcademyHealth for this work.
  • Its examination of the reasons physicians hesitate to provide care to Medicaid patients highlighted the low payment levels and high administrative burdens physicians face. This work has been widely cited and likely informed provisions of the Affordable Care Act that increased Medicaid reimbursement rates.
  • Its research on the price, quality, and transparency of medical services found that insured Americans have few incentives to consider price; most don’t believe that quality differs significantly across providers; and the move toward greater transparency reflects a belief that institutions should conduct themselves more openly. Project staff described the research in invited congressional testimony.
  • Its research found that insurance payments to hospitals and physicians differed widely across and within local markets, with some providers able to negotiate much higher rates than others. For example, the average inpatient hospital payment rates of four insurers ranged from 147 percent to 210 percent of the Medicare rate. Policy options to address the market power of some providers involve strengthening competitive forces or constraining payment rates through regulation.

Having established a high bar with respect to producing policy-relevant health services research, HSC ceased operations as an independent organization on Dec. 31, 2013. Mathematica is proud to have hosted HSC as a subsidiary and applauds the many accomplishments made by its staff. We are particularly pleased to have been part of this successful enterprise for delivering on a shared mission to improve public policy and well-being through the provision of rigorous information and analysis. Many HSC staff have joined Mathematica, and Mathematica has committed to making the HSC website available for future policy makers and researchers. For all of the staff whose dedication produced the HSC success, this website preserves much of their work so that the field can continue to benefit from their insights.

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