The managed care revolution that swept through the health care industry in the 1990s was seen as potentially threatening or beneficial to some of the Robert Wood Johnson Foundation's most important goals. On the one hand, there was the possibility that capitated payments (set fees paid per person regardless of the amount of care provided) and discounted reimbursement mechanisms would impede access to, and reduce the quality of, care. On the other hand, there was the possibility that by focusing on prevention and coordinating care, managed care would improve access and quality.
Because of the importance of these issues, in the early 1990s the Foundation staff considered mounting a prospective “evaluation” to better understand this national experiment in market-driven health care reform and its effect on access, quality and cost. The staff believed that such an evaluation could determine where the Foundation might be helpful in guiding or compensating for the managed care revolution. More important, a careful assessment of the impact of health system change could provide useful information to policy-makers.
To undertake this assessment, the Foundation funded, in 1994, the Health Tracking initiative and created the Center for Studying Health System Change to run it. To date, the Foundation has invested more than $100 million in this ambitious program to help policy-makers and the media understand the dynamics and effects of market-based health care.