Future Financial Economics of Health Professional Education Proceedings of a Workshop (2017) / Chapter Skim
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3 Understanding and Applying a Model for Financing Health Professional Education
3 Understanding and Applying a Model for Financing Health Professional Education
Pages 39-70
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From page 39... ...
ANALYZING TENSIONS Warren Newton, American Board of Family Medicine, opened the session by explaining the purpose behind using the debate pedagogy in education and for analyzing tensions in health professional education (HPE) financing at this workshop.
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From page 40... ...
The First Debate Newton began by introducing the two debaters, Ann Cary of the University of Missouri–Kansas City School of Nursing and Health Studies, and Patricia Hinton Walker of the Uniformed Services University of the Health Sciences. After both debaters presented the arguments either in favor or opposed to the position, Newton opened the floor for participant reactions and discussion.
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From page 41... ...
Zohray Talib, The George Washington University, followed Finnegan's remarks by saying she thought the question could be deciphered in different ways. When she read it, she was thinking from a global perspective about whether or not there should be a reliance on public versus private expenditure to expand and improve health professions education.
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From page 42... ...
Most importantly, how are those investments going to make a difference in the health of our communities? Patricia Hinton Walker, the other debater, offered additional points from her personal perspective growing up in the rural Midwest, not from her professional perspective in her role as an education and higher education administrator.
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From page 43... ...
"It has to be a public–private partnership." Newton reiterated Cary's call for being future oriented before asking Patricia Hinton Walker for her final remarks. Hinton Walker commented that where she works, the Uniformed Services University of the Health Sciences (USUHS)
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From page 44... ...
But of course, there are market forces in the private sector that will influence decision making at all levels, preventing social returns. The question she raised is how will market failures be counterbalanced if not with public funds?
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From page 45... ...
Like others, she and her colleagues at her table took the time to define social return in terms of meeting the needs of the community. The alternative is to provide funding that puts no pressure on the system to change.
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From page 46... ...
Rather than funding health professions institutions -- even those that are demonstrating a social return on investment -- a better approach may be to fund improvements in social factors that may return better value on health through supporting healthier communities. Palsdottir disputed an earlier claim that it is not possible to measure a social ROI.
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From page 47... ...
LEARNING FROM EXAMPLES OF EFFECTIVE HPE FINANCING Moderator Overview of Mismatches Joanne Spetz, University of California, San Francisco Joanne Spetz moderated the next session that was designed to explore the financial effectiveness of the health professions and education through specific examples. She opened with some remarks that laid out the economics of education and health care through mismatches that were outlined in Chapter 2 (see Figure 2-10)
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From page 48... ...
Other factors that limit the supply of health professionals are the long training requirements that are further lengthened by requirements of certification and licensure to practice. But in terms of quality control, regardless of licensing, consumers would still want to know that their practitioners have sufficient training before paying them for a service -- a service that varies in quality across providers and health facilities.
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From page 49... ...
These are examples of market failures where the revenue for hiring does not match the actual need, so prices and wages are not adjusting. Again, a mismatch is created between population need and demand for health workers.
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From page 50... ...
The first presenter, Wezile Chitha, is a physician and health economist and is the dean of health sciences at Walter Sisulu University in the Eastern Cape of South Africa. The second speaker, Robert Smith, who has a background in finance and workforce planning, is now the director of Strategy and Planning at Health Education England.
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From page 51... ...
This platform has expanded and includes all levels of care from households, clinics, community centers, and district hospitals through tertiary-level facilities, although the tendency is toward using secondary and primary care facilities. The types of students that WSU selects are generally drawn from underserved communities, predominantly from two rural provinces in South Africa, namely the Eastern Cape and KwaZulu-Natal.
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From page 52... ...
from this source, which they use for building infrastructure, developing research, and improving the clinical training platform. Financial assistance from the Department of Health comes in conditional grants to the government through two major platforms: the National Tertiary Services platform, which is called the National Tertiary Services Grant, and the Health Professionals Training and Development Grant.
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From page 53... ...
Meeting the Need for General Practitioner Roles by Use of Clinical Pharmacists Robert Smith, Health Education England Robert Smith framed his presentation around Health Education England (HEE) that holds a £5 billion pound (roughly $6.2 billion)
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From page 54... ...
This figure shows the relatively low historic growth to general practitioner workforce. Postgraduate medical education for both secondary care and primary care are directly state funded.
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From page 55... ...
This is not good news for the health sector, the state, or the government trying to implement health care policies.
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From page 56... ...
England, which has the country's health budget of £100 billion pounds and HEE at £5 billion, built a strategy for how to improve primary care and meet the primary care needs of the changing population. The clinical pharmacist program is one aspect of this wider strategy to meet those needs.
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From page 57... ...
Financing Dental Education Richard Valachovic, American Dental Education Association Valachovic started his presentation with contextual remarks about dental care and the dental education markets. There are about 160,000 practicing dentists in the United States.
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From page 58... ...
Overall, those in the United States who can pay for dental care generally do well, but access to care for the rest of the population remains a considerable challenge. Valachovic then described a dental education and a dental practice perspective.
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From page 59... ...
There are some public dental schools where the tuition is higher than some of the local private schools, which has become a problem. Dental Education and the Guiding Principles Valachovic then addressed the guiding principles described in Appendix B to raise concerns within dentistry and dental education in the United States.
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From page 60... ...
After that, seven private dental schools closed between 1986 and the year 2000, resulting in a decrease in graduates from 6,300 in 1980 to 3,900 in 1990. This occurred in part because of a perception that dental caries had been eliminated.
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From page 61... ...
Looking at the diversity of the dental education, it is essentially an even percentage of male versus female enrollees, and since the 1980s inclusion of underrepresented minority populations has almost doubled. In conjunction with the Association of American Medical Colleges, the American Dental Education Association has set up a medical and dental summer enrichment program that has essentially doubled the likelihood that minority students will get accepted into medical or dental school.
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From page 62... ...
These comments are a summary of the group discussions presented by the group leaders, and they should not be viewed as consensus. Group 1: Who Should Fund Health Professional Education?
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From page 63... ...
BOX 3-4 Breakout Groups and Leaders Group 1: Who should fund HPE? L eaders: Joanne Spetz, University of California, San Francisco, and Mary Beth Bigley, Health Resources and Services Administration Group 2: Identifying new sources of money to pay for HPE L eaders: Edson Correia Araujo, World Bank, and Zohray Talib, The George Washington University Group 3: Modernizing and maximizing government support L eaders: Robert Smith, Health Education England, and Wezile Chitha, Wal ter Sisulu Faculty of Health Sciences Group 4: Financial justification for socially accountable HPE L eaders: Kathleen Klink, Office of Academic Affiliations -- Veterans Health Administration, and Erin Fraher, Workshop Co-Chair, University of North Carolina at Chapel Hill
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From page 64... ...
She thought the metric could involve the proportion of students learning from different populations in hopes that the 90 percent of students being trained and educated in traditional settings could be exposed to a full range of privileged and underserved populations. Group 2: Identifying New Sources of Money to Pay for Health Professional Education The second group, led by Edson Araujo and Zohray Talib, identified and discussed new sources of money for potentially paying for future HPE.
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From page 65... ...
Araujo's final point was that to measure the effects on employment of HPE beyond the health sector, there needs to be more information about the education and health workforce. This data would have to provide more information beyond simply the numbers of health professionals in each country; having more information on the other factors that influence career choices -- such as anticipated wages, household income, and family circumstances -- would further improve the understanding of the true effects of HPE on employment.
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From page 66... ...
Group 4: Financial Justification for Socially Accountable Health Professional Education The fourth group considered financial justification for socially accountable HPE. Led by Kathleen Klink and Erin Fraher, this group explored in greater depth financial issues as they relate to social accountability and the meaning of social accountability in the health education context.
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From page 67... ...
Qualified faculty, mentors, and role models are essential in meeting student and trainee needs. The role of faculty development, she said, is critical in addressing the current educational gap of preparing today's workforce to attend to the social determinants of health in both individual and population health.
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From page 68... ...
Creating health training and learning environments that support nonhospitalbased end-of-life care and care for those considered frail could help to meet the goal of keeping frail and terminally ill people out of the hospital, a frequently cited preference of patients at the end of life. This involves a shift from expensive, fee-for-service care to team-based, supportive care in the home, through such mechanisms as the currently underused Medicare hospice benefit.
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From page 69... ...
2015. Building health workforce capacity through community based health professional education: Workshop summary.
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