1. I am grateful to all who provided information in interviews: William Belden, Brian Biles, Peter Bouxsein, Robert Brook, Bonnie Brown, Peter Budetti, Thomas Burke, Barry Clendenon, Jarrett Clinton, Robert Crittenden, William Dorotinsky, Michael Fitzmaurice, Beth Fuchs, Donald Goldstone, Rep. Willis Gradison, Robert Graham, Michael Hash, Jan Heiniger, Alice Hersh, Darrell Jodrey, Judith Miller Jones, Charles (Chip) Kahn, John Kelly, John Kralewski, Ann LaBelle, Richard Lauderbaugh, Steve Lieberman, Tony McCann, Mary McGrane, John Marshall, Karen Nelson, Larry Patton, Gregory Pawlson, Karen Politz, Wendell Primus, Richard Rettig, Jamie Reuter, William Roper, Anthony Schwartz, Thomas Scully, Donald Steinwachs, Michael Stevens, David Sundwall, Margaret VanAmringe, Rep. Henry Waxman, Marina Weiss, Norman Weissman, John Wennberg, Christine Williams, and Karl Yordy. Because many asked not to be quoted, much information in this paper is not attributed .
2. Section 2611 of the Public Health Service Act provides that 1 percent of appropriated funds be available for evaluation studies. Although the HHS assistant secretary for health could use these funds for a variety of evaluation purposes, most have generally not been so used and have remained with the different PHS agencies for their own use .
3. NCHSR did receive substantially increased funding after 1986 because of the decision to conduct the National Medical Expenditure Survey using PHS evaluation funds for the purpose. However, AHSR was not able to convince Congress to make substantial increases in appropriations for general health services research funds that could be used for investigator-initiated projects. The increase between 1983 and 1990 ($16.1 million versus $17.1 million) did not even keep up with inflation .
4. This position was reached by AHSR early in 1989 after years of debate within its board over the best bureaucratic location for health services research .