What are recent trends in foundation giving for health policy?

The failure of national health care reform in the mid-1990s in no way lessened the commitment of foundations to improving the U.S. health care system through policy-related activities. According to the Foundation Center's Update on Foundation Health Policy Grantmaking, giving by the nation’s larger foundations for research, public education, and advocacy on health issues more than tripled (up 259 percent) from just under $100 million in 1995 to nearly $360 million in 2002. Support for health policy activities also grew faster than total health giving (up 167 percent) and overall foundation giving (up 152 percent) during this period. Health policy captured a record 12 percent of overall health giving in 2002, up from 9 percent in the mid-1990s.

"Funding policy-related work helps foundations to leverage their resources," noted Loren Renz, vice president for research at the Foundation Center. "This is especially important in fields such as health, where foundation giving accounts for a tiny fraction of the more than $1.6 trillion in annual U.S. health care expenditures."

Among other key findings from the report:

• Top Funders – The number of health policy funders grew by more than half, although the Robert Wood Johnson Foundation (RWJF) increased its dominance. From 1995 to 2002, the overall number of larger foundations included in the Foundation Center’s annual grants sample remained nearly unchanged while the number that funded health policy activities climbed by more than half to 136. At the same time, RWJF increased its health policy giving more than five-fold and its share of all foundation health policy grant dollars from roughly 45 percent in 1995 to 63 percent in 2002. Still, other health policy funders also showed substantial growth in their support during this period—from roughly $55 million to over $133 million—and they accounted for two-thirds of the 908 health policy grants in 2002.

• Giving Focus – Priorities in health policy funding have changed since the mid-1990s. Grantmaking to reduce public and private health care costs, improve quality, and initiate reform continued to account for the largest share of support in 2002. Yet this nearly 23 percent share was roughly half that reported in 1995. By comparison, giving to improve access to care for the uninsured and to eliminate disparities in health care climbed from less than 6 percent of policy grant dollars in the 1995 sample to over 19 percent in the latest sample. Among the largest grants awarded in this area in 2002 was $2.8 million in continuing support from the W.K. Kellogg Foundation to the Families USA Foundation for its Health Access State Support Center, which assists the advocacy efforts of state and community leaders. Other areas experiencing gains in their shares of support included health policy research and training, mental health and substance abuse, reproductive health, end-of-life care/right-to-die issues, and HIV/AIDS.

• Future Outlook – Foundation support for health policy activities is likely to increase. Budget shortfalls at the national, state, and local level, accompanied by a jobless economic recovery, suggest that efforts to improve existing public and private health coverage and to expand access to health care will continue to face many challenges. Emerging issues, such as the obesity crisis in the U.S. and the spread of new viruses overseas, will also compete with existing priorities. At the same time, funders are apt to experience far more modest growth in their resources. These factors suggest that health policy grantmaking, with its potential for impacting broad populations in a cost-effective way, will continue to grow in importance as a strategy for the nation’s health funders.

The Update on Foundation Health Policy Grantmaking can be accessed at no charge from the Research Studies area of the Foundation Center’s Web site.

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