Estimating the cost of primary care training in ambulatory settings

The Balanced Budget Act of 1997 legislated the idea of reimbursing ambulato ry sites for training medical professionals. However, very little is known about the costs of training in such settings. This paper assesses the cost of primary care training in ambulatory settings. Selection models were used to separate the cost of teaching from the cost of infrastructural differen ces between teaching and non-teaching sites. A probit equation modelled the likelihood of an ambulatory site having a teaching programme and a cost fu nction related total medical practice costs to clinical output, the presenc e of a health professions educational programme, the price of resources use d, characteristics of the medical practice and location. Data on 184 commun ity health centres (CHCs), group practices, health maintenance organization s (HMOs) and outpatient clinics were used. Teaching sites were found to hav e 36% higher operating costs than their non-teaching counterparts: 38% of t hese higher costs were due to infrastructural differences and 62% were the 'pure' costs of teaching, i.e. the costs of teaching the net of infrastruct ural effects. Copyright (C) 2000 John Wiley & Sons, Ltd.