PROPOSALS FOR FUNDING GRADUATE MEDICAL-EDUCATION - THE INSTITUTE-OF-MEDICINE REPORT IN CONTEXT

Federal support of graduate medical education (GME) has been accepted as an intrinsic ingredient of the Medicare program since that program' s inception. Streams of clinical income generated by teaching hospital s, medical faculty practice plans, Medicaid, and other state and feder al sources have also made important contributions to GME. Although it is difficult to ascribe legislative intent precisely, Medicare funding seems to have based on a 2-fold assumption: that GME was socially ben eficial and that there were legitimate costs to teaching hospitals ass ociated with their educational missions, even though such costs were h ard to identify specifically. The benefits and costs include the high quality generally ascribed to a teaching hospital environment; extra s ervices and teaching costs; active, unsponsored research; a higher pro portion of complex medical conditions and care; and technology develop ment and introduction. The argument for Medicare support of GME is thu s partly based on better service to all Medicare beneficiaries, and pa rtly on a broader social investment in education and teaching hospital s, with benefits accruing to both present and future Medicare particip ants. Teaching hospitals and their young physicians in training are al so important in providing care to underserved poor populations.