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AHCPR and Packard Foundation Invite Applications for Research to Improve Health Care for Low-income Children

Agency for Health Care Policy and Research 2101 East Jefferson Street Rockville MD 20852


January 20, 1999 Paula Zeller, 301/594-6113; e-mail:

Karen Migdail, 301-594-6120; e-mail:


The U.S. Agency for Health Care Policy and Research (AHCPR) today announced a joint effort with the David and Lucile Packard Foundation to fund studies that will help purchasers and designers of health insurance and delivery systems improve health care for low-income children. Applications must be received by April 22, 1999.

"We have an historic opportunity to learn about the impact of public insurance programs on the access to and quality of care for low-income children," according to AHCPR Deputy Administrator Lisa Simpson, M.B., B.Ch. "This solicitation especially encourages research on how managed care and other recent changes in the financing and delivery of health care affect minority children and those with special health care needs - two under-studied populations."

AHCPR and the Packard Foundation together plan to award up to $2 million in fiscal year 1999 to support the first year of approximately five to eight projects under this Request for Applications (RFA). AHCPR and the Packard Foundation expect to spend $6 million on the projects over the course of three years.

According to Gene Lewit, Ph.D., senior program manager in the Children, Families and Communities Program of the Packard Foundation, most studies of the impact of financing and delivery changes have not looked at the broader systemwide effects - for example, how changes in the Medicaid program might affect the provider network in a community and in turn affect health care for the entire population of low-income children and their families in that community.

"The Children's Health Insurance Program (CHIP) provides an important opportunity to engage in these community studies. In addition, studies to be funded under this RFA should provide information that will be useful in designing and modifying CHIP and other health care programs for low-income children," Lewit said.

CHIP, enacted as part of the Balanced Budget Act of 1997, represents the largest expansion in children's health coverage since passage of Medicaid over 30 years ago. CHIP provides $24 billion to help States offer affordable health insurance to uninsured children in working families that make too much for Medicaid but too little to afford private coverage. Most participating States offer some form of managed care, and the features of such plans vary considerably.

Applicants to the RFA will focus on how the features of insurance programs (such as the scope of benefits packages and premium and cost-sharing requirements) and the organization of health care delivery systems associated with these programs (such as the network of providers, the procedures to access pediatric subspecialists or the mechanisms to link to social services) affect access to services and the quality of care received by low-income children. Studies will fall into one or both of two categories: enrollee studies that examine the impact on low-income children enrolled in insurance programs; and community studies that examine the impact on a low-income community's health care delivery system and all children that it serves.

Because the awards will be cooperative agreements, AHCPR expects awardees to work with other awardees and Agency and Foundation staff for the purpose of strengthening individual studies and generating generalizable results across projects, locations, populations, and insurance design and organizational delivery system features.

The RFA, entitled "Health Care Access, Quality and Insurance for Low-Income Children," was published today in the NIH Guide for Grants and Contracts. For details and application instructions, see AHCPR's Web site at, Packard's Web site at or the NIH Guide at

The RFA, and application forms, also are available from AHCPR's contractor, Equals Three Communications, Inc., 7910 Woodmont Avenue, Suite 200, Bethesda, Md. 20814-3015; telephone 301/656-3100.

AHCPR is the lead agency charged with supporting research designed to improve the quality of health care, reduce its cost and broaden access to essential services. AHCPR's broad programs of research bring practical, science-based information to medical practitioners, consumers and other purchasers.

The David and Lucile Packard Foundation is a private family foundation created in 1964. The Foundation provides grants in a number of program areas, including science, children, families and communities, population, conservation, and the arts. The Children, Families and Communities Program was established to seek ways to protect, nurture and improve the lives of children and their families. In addition to focusing on child health, the program also includes promoting child and adolescent development, economic security for families and preventing violence.

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Editor's Note: The Agency for Health Care Policy and Research (AHCPR) has released its new Strategic Plan, which outlines AHCPR's vision to foster health care research that helps the American health care system provide access to high quality, cost-effective services; be accountable and responsive to consumers and purchasers; and improve health status and quality of life. To realize that vision, AHCPR will pursue research, and promote the translation of research into practice, in three critical areas: supporting improvements in health outcomes; strengthening quality measurement and improvement; and identifying strategies to improve access, foster appropriate use and reduce unnecessary expenditures. AHCPR's Strategic Plan is available on AHCPR's web site or by calling Cathy Fatigati at 301/594-6381.