Center for Health Administration Studies (CHAS) at the University of Chicago School of Social Service Administration

History of CHAS Pre-School of Social Service Administration

The history of CHAS began over 84 years ago and is the product of Chicago’s academic landscape and New York’s pharmaceutical industry during the era of the Great Depression and World War II. The origin of CHAS began with the inception of New York–based nonprofit, the Health Information Foundation (HIF), and then transitioned into an academic center at the University of Chicago under the leadership of the Graduate Program in Hospital Administration (GPHA). The GPHA was founded in 1934 at today’s current University of Chicago Booth School of Business.

In 1950, the Health Information Foundation (HIF) was established by leaders in the pharmaceutical, chemical, and allied health fields and became a public relations powerhouse for voluntary health insurance (Hoffman, 2012). The purposes and activities of the foundation were organized to document through research the accomplishments of the present system of medical care; to define areas in the health field in need of improvement; to investigate possible solutions to current problems; and to bring, through all means of communication, research findings, needed facts, and new knowledge related to health problems to organizations active in the health field and to the public generally (NEJM Editorial, 1958). In 1952, Odin W. Anderson, an associate professor at the University of Western Ontario, Canada, with a PhD in sociology from the University of Michigan, became the research director for the HIF (Mullner, 2009). Anderson was a social researcher with a great deal of health services experience. He joined the Foundation with plans for a nationwide survey to determine health-care costs and voluntary health insurance costs and in 1956 published Family Medical Costs and Voluntary Health Insurance (Anderson and Feldman, 1956). Findings showed that 15% of Americans were in debt due to medical care costs.

In 1954, the executive director of the American Hospital Association, George Bugbee, assumed the role of president of the HIF. Bugbee and Anderson began to explore academic institutional opportunities to continue Anderson’s national survey work. Bugbee had a close professional relationship with fellow American Hospital Association (AHA) member Ray E. Brown who, from 1951 to 1962, was the head of the GPHA in the Graduate School of Business (GSB) at The University of Chicago, as well as the Superintendent of the University Hospitals. Bugbee began finding more studies and protocols on judging the effectiveness of hospital operations as useful for curriculum development associated with GPHA (Blanks, 1991). The HIF became affiliated with The University of Chicago in 1962 under an Agreement approved by the Circuit Court of Cook County (Budget Committee, 1966). The University of Chicago, with the approval of then GSB Dean George P. Shultz, agreed to acquire the HIF assets and liabilities and to carry on the research and public education activities formerly conducted by the foundation in the general field of public health. Subsequent gifts and funds received from the HIF were required to be accounted separately but were allowed to be commingled for investment purposes.

After the receipt of HIF assets and liabilities, the resulting academic research center was named the Center for Health Administration Studies (CHAS) to address a lack of interdisciplinary health-care research at The University of Chicago. Bugbee assumed directorship of both CHAS and the GPHA. When former HIF researcher and CHAS principal investigator Odin Anderson received tenure at The University of Chicago, he replaced George Bugbee as the director of CHAS in 1970. The mission of the new center was to “bring together various resources” from Biology, Economics, Hospital Administration, and Social Science departments to focus on the “social and economic aspects of medical care.”

Under Anderson, CHAS escalated its research productivity. Anderson began to produce even more ambitious studies of the health-care system (Weeks, 1981). One of these studies was the National Study of Internal Medicine Manpower (NaSIMM), which was published in 29 special issue articles by the American College of Physicians in the Annals of Internal Medicine from 1976 through 1992 (American College of Physicians–American Society of Internal Medicine, 1976–1992). Lu Ann Aday, who was hired as a CHAS researcher in 1973, was selected to direct the NASIMM study during her CHAS appointment. Aday, along with Ronald Andersen and senior researcher Gretchen Fleming, comprised the main CHAS research team in the late 1970s and early 1980s. NaSIMM was a mass survey of doctors in many different specialties, and it covered health care in a broad, systematic fashion. The equitability of the health-care industry was a frequent subject of study by CHAS researchers, beginning in 1971, with a study of ambulatory care in low-income neighborhoods. Additional studies of health-care access with a focus on those systematically excluded from the health care included: “A Framework for the Study of Access to Medical Care” (Aday & Anderson, 1974), “A Social Indicator of Access to Medical Care” (Taylor, Aday, & Anderson, 1975), and “Social Surveys and Health Policy Implications for National Health Insurance” (Aday, Andersen, & Anderson, 1977). These studies not only inspired further research in health-care access, they also provoked interest in methodological considerations relevant to health services research, considerations that would ultimately be influential in shaping the character of program evaluation and intervention research in the social services field (Shortell & Richardson, 1978).

When Ronald Andersen assumed the CHAS Directorship from Odin Anderson in 1980, he also was appointed as the director of the GPHA. Due to funding challenges and the departure of research personnel, including Aday and Fleming, Ronald Andersen began to consider possible restructuring and relocation of CHAS and GPHA (Gould & King, 1984). Alumni of GPHA, many of whom had become administrators of major hospitals and health-care systems or distinguished academics, had become loyal supporters of both GPHA and CHAS. Over the years, alumni contributed to the fundraising for endowments, particularly during GPHA Fortieth and Fiftieth fund drives. In 1989, GSB Dean John P. Gould, in a correspondence to the Accrediting Commission on Education for Health Services Administration, announced that the GSB would no longer support GPHA or any other industry-specific specialization (Gould, 1989). And, beginning with the academic year 1990–1991, the GSB no longer offered a separate concentration in health administration studies. Courses in health administration continued at GSB and the University but were no longer organized as a concentration in the MBA curriculum. Accordingly, the accrediting agency for the health administration program would change from the Accrediting Commission on Education for Health Service Administration to the accrediting agency for the GSB. The University believed strongly that both CHAS and GPHA continue their “health services mission.” Then, recognizing the synergies of the CHAS mission with that of the School of Social Service Administration, in 1991, Dean Jeanne Marsh of the School of Social Service Administration negotiated the relocation of CHAS, GPHA, and their related endowments, then about US$2.2 million in market value (CHAS Endowments, 1991), from the GSB to the School of Social Service Administration. Working with Dean Gould, President Hannah Gray, Provost Gerhard Casper, and the Board of Trustees, Dean Marsh relocated the research and training programs of CHAS and GPHA to the School of Social Service Administration.

History of CHAS Post-School of Social Service Administration

CHAS Programming

The relocation and restructuring of CHAS also led to the development of innovative programming reflective of SSA researchers’ interests in social determinants of health, health and social service integration, health and behavioral health. CHAS programming exists in four areas of (1) faculty research support and development, (2) doctoral student research support, (3) research dissemination and translation, and (4) health policy and services research partnerships and cosponsorships.

Lessons Learned Regarding the Success and Stability of a Center for Health Policy and Services Research in a Graduate School of Social Work

Lessons can be learned from the long, distinguished history of CHAS at the University of Chicago. At least three factors have contributed to the success and sustainability of this social work research center:

Clear and consistent mission: The focus of CHAS throughout its 84-year history at the University of Chicago on health equity and access has served as its orienting focus throughout leadership changes and institutional rearrangements. A clear articulation of mission enabled CHAS to support and pursue a coherent set of research projects that could accumulate to inform the national conversation on health policy and services. Further, it served as a guide for University decisions regarding institutional support and resources.

For over 80 years, the Center For Health Administration Studies (CHAS) has pursued the mission of conducting and promoting research and knowledge development to reduce health inequities and improve access. The move to the School of Social Service Administration over 25 years ago was consistent with this mission. The focus and programming of the Center has expanded to reflect the resources available from SSA and the changing landscape of health care. Passage of the Affordable Care Act, growing recognition of the impact of social determinants of health, interest in behavioral health, and integrated health and social services all have influenced the work of CHAS at the School of Social Service Administration. The success and distinction of the Center for Health Administration located in the School of Social Service Administration offers lessons to social work regarding the sustainability of a research center in a graduate school of social work.