Medical Education and Societal Needs A Planning Report for Health Professions (1983) / Chapter Skim
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10. Financing Medical Education
10. Financing Medical Education
Pages 243-260
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From page 243... ...
Sources of funds include federal and state governments, families or individuals that pay tuition, insurance companies that pay f or patient care, and philanthropy. Organizations involved in medical education include medical schools and numerous patient care sites in which students gain clinical experience.
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From page 244... ...
Medical schools and teaching hospitals are today experiencing financial pressures caused by the decrease in funding levels or by the complete withdrawal of many sources of funds upon which they had come to rely. Although there are many reasons for the overall decline in government funding, the ma Jor reasons are twofold: f irst , a general concern with the high cost of medical care and the proportion of national resources devoted to health care -- a concern that has become more acute as fiscal pressures on federal and state budgets have increased; second, a perception that the aggregate supply of 244
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From page 245... ...
Although increases in tuition and fees have been the subject of much discussion, their proportional contribution to medical school revenues has not shown much change over the last 20 years. Medical schools and hospitals are adjusting to the new environment of more constrained financial resources.
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From page 246... ...
Medical Schools had not responded to the 1963 legislation with sufficient expansion to assure the desired increase in the physician supply. Schools became eligible for awards based on the number of full-time medical students.
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From page 247... ...
L 92-157 included special construction support for schools in health manpower shortage areas and f inancial incentives f or training primary care professionals .
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From page 248... ...
Medical schools today are trying to make up the loss of federal capitation through tuition increases and expanded medical practice plans. To date, state institutional support has in aggregate not fully compensated for federal reductions, and in view of fiscal pressures on the states it seems unlikely that substantial funding increases will come from that source.
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From page 249... ...
. By 1975 over 48 percent were receiving scholarships, with an average value per student of almost $2,000.1° In l9Bl/82, more than 34,000 scholarships worth a total of $144 million were awarded.7 States have also been involved in loan and scholarship programs for medical students, although the state role in loan funds has been largely confined to administering federal programa.ll State scholarship programs, developed in the late 1970s, are similar to National Health Service Corps scholarships in that they contain a service-payback provision requiring delivery of primary care in underserved areas of the state, with a dollar payback option.
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From page 250... ...
Because of its relatively high interest rates and the availability of cheaper sources of money, HEAL has not been considered a first-choice loan. However, with the shifting availability of loans and with rising tuitions, one observer notes that in some high-tuition schools, financial administrators have been forced to assume that all medical students will borrow from HEAL as well as from the Guaranteed Student Loan (GSL)
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From page 251... ...
However, in the light of the cuts being made, there is concern that medical education may become a luxury of the rich, that the qualifications of students may decline, and that the schools that serve a large proportion of, minority students may suffer disproportionately. Patient-Care Services Payment for patient care by federal and state government has increased demand for the product of medical education ~ physicians -- and has paid for that education through support of clinical training and through revenues that accrue to medical Schools from medical practice plans (in which some of the revenue generated by faculty physicians practicing medicine f low back into the medical schools ~ .
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From page 252... ...
Some foresee heightened conflict between the patient-care and teaching missions of the academic community and excessive pressures on faculty to produce patient-care revenues. However, although there is variety among plans, and they are still evolving' the AAMC survey suggests that they all "aim to control the intensity of faculty practice, to provide ample compensation for clinical faculty, and to retain a portion of net practice earnings as unrestricted revenue of the medical school and/or its clinical departments.''l4 To the extent that the plans successfully pursue these goals, the education of medical students should not suffer.
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From page 253... ...
In 1982, 92 percent of domestic graduates were matched. The crunch has been felt by graduates of foreign medical schools~only 39 percent of those with U.S.
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From page 254... ...
Conclusion Ma jar policy ob jectives behind the federal and state health manpower and health education actions of the last two decades included 0 expansion of the physician supply, 0 expansion of the supply of primary care physicians, o lowering of f inancial barriers to medical education for economically disadvantaged people, and 0 expansion of the physician supply in underserved areas. The extent to which these goals have been achieved varies.
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From page 255... ...
However, since scholarship programs are generally more precisely targeted to a group of people or trying to achieve a specific narrow policy goal, it may be that the impact of scholarships has been quite significant. In 1963/64, 5,000 medical students received $3.6 million in scholarships.
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From page 256... ...
Teaching hospitals are therefore competing with community hospitals for patients, especially paying patients. Medical schools and teaching hospitals have started to develop strategies to deal with these mounting financial pressures.
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From page 257... ...
Medical schools are no more immune to financial pressures than are teaching hospitals. Loss of federal capitation support (which has not generally been made up by increased state institutional support)
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From page 258... ...
Meharry, which has educated ~u percent or the nation's black medical faculty members, benefited from the federal emphasis on primary care and minority enrollment from the mid-19 60s until the late 1970s. The president of Meharry has pointed out that the school does not have major research funding and has relied on capitation, Medicaid and Medicare funding, and low-cost student loans and scholarships (particularly the National Health Service Corps)
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From page 259... ...
and Levenson, M Institutional support for medical schools and teaching hospitals.
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From page 260... ...
A Patient care reimbursement: Implications for medical education and physician distribution.
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