Community Tracking Study Series

Investigator(s): Center for Studying Health System Change

The Community Tracking Study (CTS), a project ofthe Center for Studying Health System Change (HSC), is a large-scalelongitudinal investigation of health system change and its effects onpeople. Designed to track a cohort of American communities at two-yearintervals beginning in 1996, this major research effort, sponsored byThe Robert Wood Johnson Foundation (RWJF), gathers information tomonitor and understand the evolution of health care in the UnitedStates. CTS is investigating the ways in which hospitals, healthplans, physicians, safety-net providers, and other provider groups arerestructuring their systems, and the forces driving the organizationalchanges. Additionally, the project tracks health insurance coverage,access to care, use of health services, health care costs, andperceived quality of health care. Sixty sites (51 metropolitan areasand 9 nonmetropolitan areas) were randomly selected to form the coreof CTS and to be representative of the nation as a whole. Much of theinformation collected by CTS comes from nationally representativesurveys of households, health plans, and physicians conducted byHSC. The Household Survey is administered to households in the 60 CTSsites, plus a supplemental national sample of households, coveringsome 60,000 individuals. A survey of health plans, the FollowbackSurvey, elicits detailed information on private health insurancecoverage reported in the Household Survey from organizations thatoffer or administer private health insurance policies in the CTSsites. The Physician Survey interviews physicians in the 60 CTS sitesand a supplemental national sample of physicians. RWJF has built anetwork of research organizations that are studying various facets ofthe changing health care system, some of which are simultaneouslyexamining the CTS communities. Stephen H. Long and M. Susan Marquis atRAND conducted an employer survey (Robert Wood Johnson FoundationEmployer Health Insurance Survey [Community Tracking Study and StateInitiatives in Health Care Reform Program], 1997) with a specialemphasis on the 60 CTS sites. At UCLA and RAND, Kenneth B. Wells,Audrey Burman, and Roland Sturm are examining how public policies andmarkets are affecting access to substance abuse and mental healthservices. Their survey, National Survey of Alcohol, Drug, and MentalHealth Problems [Healthcare for Communities], 1997-1998, reinterviewedsome 9,600 respondents from the CTS Household Survey about theirhealth and daily activities, use of alcohol, illicit drugs, andmedications, health insurance coverage and coverage for mental health,plus access to, utilization, and quality of behavioral healthcare.