This paper examines the year-long process of policy debate and formulation centered around establishing GME consortia as a centerpiece for workforce planning and funding in the postregulatory era in New York State and the role of information in this reform process. In the end, information played a necessary role in framing and focusing the debate, but it was more a combination of political and financial realities that proved to be the sufficient forces to move all sides to a brave new world for health care policy in New York.

BACKGROUND

Graduate medical education has always been an essential core component of the mission of New York's academic teaching hospitals. Over the course of the past two decades, the training of resident physicians also became a staple for service delivery for virtually all institutions serving inner-city poor populations in the state. Of 230 licensed acute care hospitals in New York State, 103 participate in teaching programs. Powerful financial incentives built into the Medicare hospital payment system combined with equally powerful incentives provided by five iterations of New York State's regulated all-payer hospital reimbursement system (New York Prospective Hospital Reimbursement Methodology [NYPHRM I to V]) create compelling fiscal pressures to train as many residents as possible to maximize reimbursement and service delivery capacity, regardless of workforce policy needs. It has been estimated that Medicare provides an average of $70,000 per year per resident nationwide (Mullan et al., 1993). In New York State, GME payments from all carriers total approximately $190,000 per resident per year, with reimbursement from Medicare exceeding an average of $80,000 per resident (New York State Department of Health, 1995). It was partially this big business aspect of GME that spurred New York State teaching hospitals' opposition to proposed workforce changes under the Clinton Health Care Reform Plan. It was also one of the reasons that the senior senator from the state, Senator Daniel Patrick Moynihan, painted these proposals to change funding to academic institutions as ''sins against the Holy Ghost" (U.S. Congress, 1994).



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement