Market forces and unsponsored research in academic health centers.

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Abstract
Despite continued increases in the research budget of the National Institutes of Health (NIH), there is concern that academic health centers (AHCs) in highly competitive health care markets may experience lower research productivity and less success in obtaining research grants.1,2 One possible explanation for this phenomenon that has not been explored previously is that increasing local competition leads to reductions in internal sources of funding.3-6 Clinical research may be particularly dependent on such sources of support.7-9 As clinical revenues are threatened, some fear that AHCs will be less able in the future to provide the same level of internal support for research as they have in the past.10