In the Nation's Compelling Interest Ensuring Diversity in the Health-Care Workforce (2004) / Chapter Skim
Currently Skimming:
3 Costs and Financing of Health Professions Education
3 Costs and Financing of Health Professions Education
Pages 88-126
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 88... ...
Some provide direct financial assistance to students and others indirectly support URM students through funding provided to institutions for diversity activities. All, however, provide support to increase URM participation in health professions and reduce financial barriers, directly or indirectly, for students who experience difficulty financing their training.
|
From page 89... ...
For a detailed review of publicly funded health professions programs that support URM students, the reader is referred to the commissioned paper, Public Financing of the Health Professions: Levers for Change, prepared by Karen Matherlee, which appears as an appendix of this report. For purposes of this report, the study committee defines health professions educational costs as a formulation involving total educational and living expenses: including tuition and fees (which vary considerably across institutions, particularly between public and private health professions education institutions [HPEIs]
|
From page 90... ...
COSTS OF UNDERGRADUATE EDUCATION: EFFECTS ON ACCESS AND COMPLETION Much of the available data regarding the impact of the high costs of education relates to college access and degree attainment. These findings have implications for health professions education and strategies that may be employed to reduce financial barriers for URM students entering these fields.
|
From page 91... ...
. financial barriers to a college education have risen sharply due to shifts in policies and priorities at the federal, state, and institutional levels, resulting in a shortage of student aid, and in particular need-based grant aid, as well as rising college tuition" (Advisory Committee on Student Financial Assistance, 2002, p.
|
From page 92... ...
The maximum award decreased from 84 percent of public 4-year costs during the 19751976 academic year to 39 percent of costs during the 19992000 academic year (College Board, 2000, and U.S. Department of Education, 2000b, as cited in Advisory Committee on Student Financial Assistance, 2001)
|
From page 93... ...
, using data from the National Postsecondary Student Aid Studies, found that while there were variations in financial aid by geographic region and type of institution, in general, African American students were more likely to receive nonneed grants (based on merit or other circumstance not related to financial need, such as academic, artistic, or athletic merit) , particularly those students attending public institutions.
|
From page 94... ...
speculates that since academic achievement and other institutional and student characteristics served as controls, the effect of race on receiving nonneed aid was the result of institutional financial aid policies and that African American students were specifically targeted for financial aid compared with white students (Heller, 2000)
|
From page 95... ...
. As mentioned in the outset of this chapter, providing financial aid alone is unlikely to remove all barriers to higher education for URM students.
|
From page 96... ...
. This section will review trends in costs of health professions education and debt incurred by students.
|
From page 97... ...
SOURCE: Valachovic et al., 2001. Reprinted, with permission, from the American Dental Education Association, 2004.
|
From page 98... ...
. For public school graduates, 16.8 percent of non-URM students completed with no educational debt, while only 8.4 percent of URM student graduated debt free.
|
From page 99... ...
. Nursing Education National-level data on the costs of nursing education, average levels of debt incurred by nursing students, and sources of financial aid for nursing education are not routinely collected and are therefore not as readily available as are data from other health professions.
|
From page 100... ...
In this latter year, tuition for resident at public programs decreased by approximately $1,000. National level data regarding debt for nursing students were not avail
|
From page 101... ...
. While 90 percent of students at Vanderbilt qualified for financial assistance as determined by the Free Application for Federal Student Aid (FAFSA)
|
From page 102... ...
These costs, as noted above, disproportionately burden URM students, who have fewer resources, on average, than non-URM students. More research is needed to assess these costs, the impact of educational and noneducational costs on URM students' decisions to pursue health professions careers, the availability of financial resources (both scholarship and loan)
|
From page 103... ...
Rico and Stagnaro-Green (1997) reported similar results in a study examining the relationship between debt and career choice in URM and non-URM students placed in residencies at Mount Sinai School of Medicine.
|
From page 104... ...
Students in other disciplines, such as dentistry, face similar circumstances. For example, in 1995 the average student loan debt of dental students (from private and public institutions)
|
From page 105... ...
investigated the role of financial aid in the education of minority doctoral students using a subset of the 19891990 National Postsecondary Student Aid Survey. Results indicate that minority students were more likely to take out loans and receive fellowships than nonminority students.
|
From page 106... ...
FINANCING OF HEALTH PROFESSION EDUCATION Financial Assistance for URM Students Low-income URM individuals considering health professions education face increasing tuition and other costs, on top of the undergraduate debt they have likely accrued. The thought of accumulating debt in excess of $100,000 can be daunting and serve as a barrier for prospective students.
|
From page 107... ...
these mechanisms; rather, it highlights some prominent examples of efforts to provide financial aid. Federal Sources of Financial Assistance Table 3-1 lists some of the largest federal health professions training programs that focus on increasing racial and ethnic diversity.
|
From page 108... ...
Minority Faculty Institutions Fellowship Program Division of Nursing Nursing Workforce Institutions Diversity Program Division of Health Scholarships for Institutions Careers Diversity Disadvantaged and Development Students Loans for Institutions Disadvantaged Students Disadvantaged Individuals Faculty Loan Repayment National Health Scholarship Individuals Service Corps (NHSC) Loan repayment Individuals program Indian Health Health Professions Individuals Service Scholarship Program NIMH & Minority Institutions SAMHSA Fellowship Program
|
From page 109... ...
based on financial need among others Faculty serve at eligible health Psychology, Dentistry, $1.3 mil (2002) professions programs in exchange Nursing, Medicine, for loan repayment among others Students compete for educational Dentistry, Nursing, $46.2 mil (2002)
|
From page 110... ...
Both scholarship and loan repayment programs are offered. Other HRSA programs that provide funding include three within the Division of Health Careers Diversity and Development, Student Assistance Programs, which provide loans and scholarships to individuals from disadvantaged backgrounds.
|
From page 111... ...
The amount of support varies, depending on federal allocations to the program and on cost-sharing arrangements that the program negotiates with universities. Private Sources of Financial Assistance Most funding available to URM students pursuing health professions education is provided by federal sources.
|
From page 112... ...
Kellogg Administered by the Institutions Scholarships and Dentistry Foundation American Dental financial aid; Education Association postdoctoral and fellowship support; faculty, student, and campus development Ford Administered by the Students Stipends for Psychology Foundation National Research predoctoral fellows Council Ford and dissertation Foundation Fellowships fellows for Minorities communities. NMF provides funding to students in the form of need-based scholarships to first- and second-year medical students.
|
From page 113... ...
The Foundation oversees the administration of two funds established by state legislation, the Health Professions Education Fund and the Registered Nurse Education Fund, and closely coordinates its programs with the Office of Statewide Health Planning and Development and its health professional education programs. The funding received from the California Endowment will support up to 20 scholarships and loan repayment grants annually to underrepresented and economically disadvantaged health professions students who will practice in underserved areas of California.
|
From page 114... ...
to help increase the number of minority students and faculty in the country's dental schools. The ADEA awards grants to schools that distribute funds to students and faculty in the form of scholarships and financial aid, postdoctoral and fellowship support, or faculty, student, and campus development.
|
From page 115... ...
. Do These Programs Increase URM Participation in Health Professions Education?
|
From page 116... ...
Grumbach and colleagues (2002) speculate that these strategies may be less effective for increasing the overall pool of URMs in health professions when employed for funding of residency training, since these programs are competing for a finite pool of URM students already enrolled in schools.
|
From page 117... ...
However, comparisons of programs and knowledge of best practices are lacking. Policy makers have a substantial need to obtain data to evaluate how well various programs that provide financial assistance to students succeed in recruiting and retaining URM students.
|
From page 118... ...
Several avenues have been discussed for using financial incentives to increase URM participation in health professions education, including the collection of data on various programs and efforts, the use of Medicare GME to develop new policy approaches, and expansion of the NHSC. Evidence from undergraduate education suggests that students may benefit from increased knowledge about the various sources of financial assistance and the provision of grant-based aid rather than loans.
|
From page 119... ...
An area in need of further exploration in terms of URM student participation in health profession education is the impact of institutional funding programs, policies, and perspectives dealing with URM access. At the institutional level, many students are funded based on need alone and many URM students are funded based on need and ethnicity.
|
From page 120... ...
In other efforts, New York State has initiated the Minority Participation in Medical Education Grant Program, which provides funds to institutions to enhance minority recruitment and retention, develop minority student mentoring programs, develop medical career pathways for minority BOX 3-1 University of Colorado Dental School and Orthodontic Education Company Partnership In January 2003, the School of Dentistry at the University of Colorado and the Orthodontic Education Company (OEC) initiated a 30-year business partnership with a $3 million gift and $92.7 million commitment from OEC to build the Lazzara Center for OralFacial Health and establish a training program in orthodontia.
|
From page 121... ...
Programs such as the ones outlined in this section may serve as models for ways to use public and private funds to increase diversity of the healthcare workforce. While much of the funding for health profession education is from public sources, private sources can also contribute and have much to gain by investing in diversity.
|
From page 122... ...
College tuition trends have prompted the College Board to call for colleges and universities to reaffirm their commitment to need-based aid and for the federal government to increase support to institutions that serve large percentages of high-need students. While the impact of financial barriers has not been well studied among health professions students, evidence from undergraduate education reveals that low-income students and some URM students may be less likely to apply to college and that aid, particularly grants, may be associated with increased attendance for low-income students.
|
From page 123... ...
Washington, DC: Advisory Committee on Student Financial Assistance. Advisory Committee on Training in Primary Care Medicine and Dentistry.
|
From page 124... ...
Journal of Student Financial Aid 30(2)
|
From page 125... ...
2000a. 19992000 National Postsecondary Student Aid Study (NPSAS: 2000)
|
From page 126... ...
Journal of Dental Education 65(6)
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.