Graduate medical education: the policy debate.
The cost of providing graduate medical education to the approximately 100,000 medical residents in the United States is approximately $18 billion. The government, primarily through the Medicare program, funds almost two thirds of the cost. Unfortunately, the federal government lacks a coherent policy with respect to what objectives it wants to achieve for this expenditure. This article traces (a) the evolution of graduate medical education funding; (b) current proposals to reform the funding mechanism; (c) how the Medicare program currently funds graduate medical education; (d) how funds are allocated to specific institutions; and (e) specific policy objectives that academic medical centers should be held accountable for achieving in return for receiving public funds.
Center for Hospital Finance & Management, Johns Hopkins University, Baltimore, Maryland 21205, USA. ganderso@jhsph.edu
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D000046:Academic Medical Centers / Q000191:economics*; D004503:Education, Medical, Graduate / Q000191:economics*; D005380:Financing, Government / Q000458:organization & administration*; D015276:Health Care Rationing; D006291:Health Policy / Q000191:economics*; D006801:Humans; D006278:Medicare; D011785:Quality Assurance, Health Care; D014146:Training Support / Q000458:organization & administration*; D014481:United States