A U.S. Perspective on AHSCs: A Future of Increased Diversification

Academic Health Sciences Centres (AHSCs) have long been viewed much as the historic battleship - possessing great force, power and bulk, but increasingly vulnerable to forays of lighter and more agile competitors. This commentary reviews the efforts of leaders of AHSCs in the United States to reposition their institutions at the centre of integrated delivery systems, partly as a result of greatly increased reliance on clinical revenue to support the historic teaching mission. While Lozon and Fox point to increased involvement of AHSCs in broad regional systems of care financed through a coordinated strategy, integrated systems in the United States may be fragmenting as marketplace-driven financial schemes actually discourage integrated care. From the perspective of organizational theory, the future seems to imply a diversification of organizational forms for the AHSCs in the United States, with a corresponding strategy of lessening reliance on clinical revenues through enhancement of research funding.