Community Tracking and Related Studies

The Community Tracking Study

The Community Tracking Study (CTS) is a large-scale longitudinal investigation of health system change and its effects on people. Designed to track a cohort of American communities at two-year intervals beginning in 1996, this major research effort, sponsored by The Robert Wood Johnson Foundation (RWJF), is gathering information to monitor and understand the evolution of health care in the United States. CTS is investigating the ways in which hospitals, health plans, physicians, safety net providers, and other provider groups are restructuring their systems, and the forces driving the organizational change. Additionally, the project is tracking health insurance coverage, access to care, use of health services, health care costs, and perceived quality of health care.

Sixty sites (51 metropolitan areas and 9 nonmetropolitan areas) were randomly selected to form the core of CTS and to be representative of the nation as a whole. Twelve of the sites, consisting of metropolitan areas with more than 200,000 people, are being studied in depth, with site visits and survey samples large enough to draw conclusions about change in each community. The 48 additional communities, which also include small metropolitan and nonmetropolitan areas, are being studied less intensively, with smaller survey samples and no site visits.

CTS is a project of the Center for Studying Health System Change (HSC). Numerous publications on the CTS are available from the HSC web site. HSC also offers CTSonline, an interactive system that allows one to obtain customized tables with estimates from the CTS Household Survey and the CTS Physician Survey.

CTS Surveys

Much of the information collected by CTS comes from nationally representative surveys of households, health plans, and physicians that are conducted by HSC. HMCA plans to distribute the data from these and related surveys as they become available.

Household and Followback Surveys. Covering some 60,000 individuals, the Household Survey is administered to households in the 60 CTS sites, plus a supplemental national sample of households. Information provided by the Household Survey includes general health status, limitations in daily activities, health insurance coverage, health care utilization, and quality of care. The Followback Survey is designed to obtain detailed information on private health insurance coverage reported in the Household Survey. Administered to organizations that offer or administer private health insurance policies covering Household Survey respondents in the CTS sites, the Followback Survey collects information on policy type, gatekeeping, consumer cost sharing, provider payment methods, and coverage of mental health and/or substance abuse services. Both rounds of the Followback Survey and the four rounds of the Household Survey are available from HMCA:

Physician Survey. The Physician Survey interviews physicians in the 60 CTS sites and a supplemental national sample of physicians. Administered to more than 12,000 practicing physicians, topics covered by the survey include physician supply and specialty distribution, practice arrangements, sources of practice revenue, level and determinants of physician compensation, effects of care management strategies, and physicians' allocation of time, provision of charity care, and career satisfaction. HMCA currently distributes data from the first four rounds of the Physician Survey:

Related Surveys

RWJF has built a network of research organizations studying various facets of the changing health care system. Some of these are simultaneously examining the CTS communities.

Employer Survey. With a specific emphasis on the 60 CTS sites and 12 states of interest to the RWJF State Initiatives in Health Care Reform program, this survey was administered to a national probability sample of 22,000 private and public employers. Conducted by Stephen H. Long and M. Susan Marquis at RAND, the Employer Survey collects information on employers' offers of health insurance coverage, employees' eligibility and enrollment in health plans, and for each plan offered, the plan type (HMO, POS, PPO, conventional), the premiums (employer and employee contributions), benefits, cost-sharing, and employer self-insurance status. The latest round of this survey is available:

Healthcare for Communities. Kenneth B. Wells, Roland Sturm, and Audrey Burnam (UCLA and RAND) are the principal investigators of the Healthcare for Communities Project (HCC), which is tracking changes in health policy, health care delivery, access to care, and costs and outcomes of care related to alcohol, drug abuse, and mental health conditions. As part of this project, respondents to the first and second CTS Household Surveys were reinterviewed about their health, mental health, and daily activities; alcohol and illicit drug use; use of medications; general health insurance coverage and coverage for mental health, substance abuse, and prescription medications; access, utilization, and quality of behavioral health care; labor market status, income, and wealth; and life difficulties. Both rounds of the HCC survey can be obtained from HMCA: