Jones M D, Boat T, Adler R, Gephart H R, Osborn L M, Chesney R W, Mulvey H J, Simon J L, Alden E R
University of Colorado School of Medicine, Children's Hospital, Denver, Colorado, USA.
Pediatrics. 2000 Nov;106(5):1256-70.
Some of the challenges of financing pediatric medical education are shared with all medical education; others are specific to pediatrics. The general disadvantage that funding of graduate medical education (GME) is linked to reimbursement for clinical care has uniquely negative consequences for freestanding children's hospitals because they therefore receive little Medicare GME support. This represents both a competitive disadvantage for such hospitals and an aggregate federal underinvestment in children's health care that now amounts to billions of dollars. The need to subsidize medical student and subspecialty education with clinical practice revenue jeopardizes both activities in pediatric departments already burdened by inadequate reimbursement for children's health care and the extra costs of ambulatory care. The challenges of funding are complicated by rising costs as curriculum expands and clinical education moves to ambulatory settings. Controversies over prioritization of resources are inevitable. Solutions require specification of costs of education and a durable mechanism for building consensus within the pediatric community. Pediatrics 2000;106(suppl):1256-1269; medical student education, continuing medical education, medical subspecialties, children, pediatrics, health maintenance organizations, managed care, hospital finances, children's hospitals.
儿科医学教育融资面临的一些挑战与所有医学教育相同；另一些则是儿科特有的。研究生医学教育（GME）的资金与临床护理报销挂钩这一普遍劣势，对独立儿童医院产生了独特的负面影响，因为它们因此获得的医疗保险GME支持很少。这对这类医院来说既是竞争劣势，也是联邦政府对儿童医疗保健的总体投资不足，目前这一数额达数十亿美元。用临床实践收入补贴医学生和亚专业教育的需求，危及了儿科部门的这两项活动，这些部门已经因儿童医疗保健报销不足以及门诊护理的额外成本而负担沉重。随着课程扩展以及临床教育转向门诊环境，成本上升使资金筹集面临的挑战更加复杂。资源优先级的争议不可避免。解决方案需要明确教育成本，并建立一种在儿科界达成共识的持久机制。《儿科学》2000年；106（增刊）：1256 - 1269；医学生教育、继续医学教育、医学亚专业、儿童、儿科学、健康维护组织、管理式医疗、医院财务、儿童医院
