REFORMING MEDICARE-FINANCED GRADUATE MEDICAL EDUCATION

摘要

In 1965 Congress voted to subsidize American medical education through the Medicare program because it believed that educating medical professionals was in the best interest of the public. Today, Medicare is the single largest payer of graduate medical education (GME), the training that physicians receive between medical school and independent practice, in the United States. In 2009 alone, Medicare GME payments covered the costs of 90,000 residents in more than 1,100 accredited teaching hospitals across the United States. Despite receiving over $9.5 billion in subsidies for GME from the federal government in 2009,4 teaching hospitals are losing money and are not producing enough primary care physicians to meet the medical demands of society. The reasons for this are threefold. First, teaching hospitals inherently have higher operating costs than nonteaching hospitals because of their dual purpose to educate physicians and to treat patients. Second, in America's capitalist marketplace, public goods like teaching hospitals must compete with private, nonteaching hospitals for market share.