WASHINGTON-- The federal government should revise its system for funding
the training of physicians, to help cut costs and adapt to ongoing changes
in health care delivery, says a report from the Institute of Medicine (IOM)
at the National Academy of Sciences.
An 11-member IOM panel chaired by Rosemary A. Stevens, PhD, of the University
of Pennsylvania, also urged broadening the kinds of institutions eligible
for federal support, making funding more equitable to all teaching hospitals,
and reducing the incentives for some hospitals to add more residents than
Given the demands to control health care costs, Congress should set
specific spending levels for graduate medical education each year, the
report said. It noted that Medicare spent in excess of $6 billion to help
pay the costs of training more than 100,000 physicians and other health
care professionals in fiscal 1996.
A considerable disparity exists in residency funding, with some teaching
hospitals receiving 10 times as much as others, the panel emphasized, and
this influences graduate medical education.
"Hospitals that are reimbursed $240,000 per year per resident have
a terrific incentive to add more residents, compared with those institutions
that only receive $24,000," said Dr. Stevens, professor of history
and sociology of science. "We need to create a better way of controlling
total costs and distributing funds so that hospitals train doctors in the
best possible way in fields where they are truly needed."
The IOM panel suggested direct medical education funds should go to
institutions other than teaching hospitals if they meet accreditation standards.
These include ambulatory health centers, managed care organizations, and
specialty centers such as children's hospitals. Graduate nursing education
should receive support according to the same principles that apply to physicians,
the report said.
The panel also called for reforming Medicare's system for indirect support
for medical education, which currently involves extra reimbursement to
teaching hospitals that treat Medicare patients.
Noting that the increasing enrollment of Medicare beneficiaries into
HMOs is draining away patients once treated in teaching institutions, the
IOM committee suggested creating a new trust fund. It would provide a defined
level of funding, based in part on an institution's historical commitment
to serving Medicare recipients rather than solely on the present levels
The panel said its recommendations, if instituted, would offer policy
makers more flexibility in dealing with the special needs of all types
of health care institutions.