MEDICARE FUNDING OF NURSE EDUCATION - THE CASE FOR POLICY CHANGE

Objectives.-To determine the magnitude and distribution of US Medicare funding for nursing education and to assess the extent to which Medic are funding contributes to meeting national health care workforce prio rities. Data Sources.-Medicare Hospital Cost Report Information System , American Hospital Association Annual Survey of Hospitals, and Nation al League for Nursing national surveys of schools of nursing. Data Ana lysis.-Using hospital identifiers, data from three data sets were merg ed and analyzed to estimate percentage distributions of Medicare fundi ng according to types of educational programs, hospital characteristic s, and student enrollment. Results.-Fifteen percent of direct Medicare graduate medical education funding goes to hospitals for the training of nurses and paramedical personnel. Totaling approximately $174 mill ion in 1991, 71% of these funds went to hospitals for nursing educatio n costs. Most of the nation's teaching hospitals (289 of 381 Council o f Teaching Hospitals member hospitals) and nurse education programs (1 112 of 1484) do not qualify under existing policies for Medicare nursi ng education reimbursement. Sixty-six percent of Medicare nurse traini ng funds, totaling $114 million in 1991, went to 145 hospitals operati ng diploma nursing programs; these programs produce less than 10% of n urse graduates. Three states (Pennsylvania, New Jersey, and Ohio) rece ived nearly one half (48%) of the $114 million for diploma nursing edu cation. Conclusions.-Medicare is the largest single source of federal support for nursing education. Yet, the majority of Medicare nursing e ducation funding goes to hospitals affiliated with an increasingly sma ller, idiosyncratic subset of nurse training programs. Unlike graduate medical education, Medicare supports primarily preprofessional educat ion in nursing. Graduate education, including the preparation of nurse practitioners, does not generally qualify for reimbursement. Medicare reimbursement for nursing education must be retargeted.