The Robert Wood Johnson Foundation's Efforts to Contain Health Care Costs

This chapter describes the history of the approach taken by the Robert Wood Johnson Foundation to health care cost containment. In its early days, the Foundation stayed out of the health care cost debate, pursuing other goals of improving access to and quality of health care. As health care costs increased in the late 1970s, the Foundation found it increasingly uncomfortable to sit on the sidelines. In 1982, it announced what would be its largest effort in the 1980s on containing health care costs—Community Programs for Affordable Health Care (CPAHC). By the 1990s, the Foundation had authorized an estimated $192 million on grants related to cost containment, financing and other similar issues. Steven Schroeder, newly appointed president of the Foundation at that time, decided to reduce cost containment from a goal to a half goal, and finally made it a component of all other health care programs. The author relates the perceived failure of CPHAC and other programs concerned with containing costs. She also acknowledges that the seemingly ambivalent attitude of the Foundation in this regard is most likely a product of uncertainty about its role and possible effectiveness around such a complex and multifarious problem.