Newhouse J P, Wilensky G R
Health Aff (Millwood). 2001 Mar-Apr;20(2):136-47. doi: 10.1377/hlthaff.20.2.136.
The debate over Medicare payments for graduate medical education has been conducted under the premise that such payments cover the added costs of training. Standard economic theory suggests that residents bear the costs of their training, implying that the additional costs of teaching hospitals are not attributable to training per se but to some combination of a different patient care product, unmeasured case-mix differences, and the costs of clinical research. As a result, payment for the additional patient care costs at teaching hospitals should come from the Medicare trust fund; any subsidies for training should come from general revenues.
关于医疗保险为毕业后医学教育支付费用的争论，一直是在这样一个前提下进行的，即此类支付涵盖了培训的额外成本。标准经济理论表明，住院医师承担其培训成本，这意味着教学医院的额外成本并非源于培训本身，而是源于不同患者护理产品、未衡量的病例组合差异以及临床研究成本的某种组合。因此，教学医院额外患者护理成本的支付应来自医疗保险信托基金；任何培训补贴都应来自一般税收收入。
