The Community Tracking Study


Sponsored by the Robert Wood Johnson Foundation (RWJF), the Community Tracking Study (CTS) was a large-scale longitudinal investigation of health system change and its effects on people. Originally designed to track a cohort of American communities at two-year intervals beginning in 1996, this major research effort collected information to monitor and understand the evolution of health care in the United States. CTS investigated the ways in which hospitals, health plans, physicians, safety net providers, and other provider groups restructured their systems, and the forces driving the organizational change. Additionally, the project tracked 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, were studied in depth with site visits and survey samples large enough to draw conclusions about change in each community. The other 48 sites were studied less intensively with smaller survey samples and no site visits.

CTS was a project of the Center for Studying Health System Change (HSC), an organization which no longer exists.

CTS Surveys

Much of the information collected by CTS came from nationally representative surveys of households, health plans, and physicians that were conducted periodically by HSC.

Household and Followback Surveys. The Household Surveys interviewed Americans about their health status, chronic conditions, health insurance coverage, use of health services, perceived quality and satisfaction with care, unmet medical needs, medical expenses, and other health related topics. Administered to organizations that offered or administered the private health insurance policies reported in the first two rounds of the Household Survey, the Followback Surveys collected detailed information about private health plans, such as policy type, gatekeeping, consumer cost sharing, provider payment methods, and coverage of mental health and substance abuse services. In a major change, the last two rounds of the Household Survey discontinued the community focus intrinsic to CTS. The community based sampling design was replaced by national sampling not clustered in the CTS sites. Accordingly, beginning in the fifth round, HSC changed the name of the Household Survey from the Community Tracking Study Household Survey to the Health Tracking Household Survey. All six rounds of the Household Survey and both rounds of the Followback Survey are available from HMCA:

Physician Surveys. These surveys interviewed physicians about their practice of medicine, including practice arrangements, sources of practice revenue, level and determinants of physician compensation, care management strategies, physicians' allocation of time, provision of charity care, and career satisfaction. Like the the last two Household Surveys, the fifth and last Physician Survey discontinued the CTS-site-clustered sampling design and its name was changed accordingly. All five rounds of the Physician Survey are available:

Related Surveys

RWJF built a network of research organizations studying various facets of the changing health care system. Some of them simultaneously examined 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 collected 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. This study is available from HMCA:

Healthcare for Communities. Kenneth B. Wells, Roland Sturm, and Audrey Burnam (UCLA and RAND) were the principal investigators of the Healthcare for Communities Project (HCC), which tracked 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 are available from HMCA: