Bicknell W J, Beggs A C, Tham P V
Department of International Health, Boston University School of Public Health, Boston, MA 02118, USA.
Health Policy Plan. 2001 Dec;16(4):412-20. doi: 10.1093/heapol/16.4.412.
We summarize a model for determining the full cost of educating a medical student at Thai Binh Medical School in Vietnam. This is the first full-cost analysis of medical education in a low-income country in over 20 years. We emphasize policy implications and the importance of looking at the educational costs and service roles of the major health professions. In Vietnam fully subsidized medical education has given way to a system combining student-paid tuition and fees with decreased government subsidies. Full cost information facilitates resource management, setting tuition charges at a school and adjusting budget allocations between medical schools, teaching hospitals, and health centres. When linked to quality indicators, trends within and useful comparisons between schools are possible. Cost comparisons between different types of providers can assist policy-makers in judging the appropriateness of expenditures per graduate for nursing and allied health education versus physician education. If privatization of medical education is considered, cost analysis allows policy-makers to know the full costs of educating physicians including the subsidies required in clinical settings. Our approach is intuitively simple and provides useful, understandable new information to managers and policy-makers. The full cost per medical graduate in 1997 was 111 462 989 Vietnamese Dong (US$9527). The relative expenditure per Vietnamese physician educated was 2.8 times the expenditure in the United States when adjusted for GNP per capita. Preliminary findings suggest that, within Vietnam, the cost to educate a physician is 14 times the cost of educating a nurse. Given the direct costs of physician education, the lifetime earnings of physicians and the costs that physicians generate for the use of health services and supplies, it is remarkable that so little attention is paid to the costs of educating physicians. Studies of this type can provide the quantitative basis for vital human resource and health services policy considerations.
我们总结了一种用于确定越南太平医科大学培养一名医学生的全部成本的模型。这是20多年来对低收入国家医学教育进行的首次全面成本分析。我们强调政策影响以及审视主要卫生专业的教育成本和服务角色的重要性。在越南，完全由政府补贴的医学教育已被一种将学生缴纳学费与政府补贴减少相结合的体系所取代。全面成本信息有助于资源管理、确定学校的学费收取标准以及调整医学院校、教学医院和健康中心之间的预算分配。当与质量指标挂钩时，就可以了解学校内部的趋势并进行有意义的校际比较。不同类型提供者之间的成本比较可以帮助政策制定者判断护理和相关健康专业教育与医师教育的人均毕业生支出的合理性。如果考虑医学教育私有化，成本分析能让政策制定者了解培养医师的全部成本，包括临床环境所需的补贴。我们的方法直观简单，为管理人员和政策制定者提供了有用且易懂的新信息。1997年培养一名医学毕业生的全部成本为1.11462989亿越南盾（9527美元）。按人均国民生产总值调整后，越南培养一名医师的相对支出是美国的2.8倍。初步研究结果表明，在越南，培养一名医师的成本是培养一名护士成本的14倍。鉴于医师教育的直接成本、医师的终身收入以及医师使用卫生服务和用品所产生的成本，令人惊讶的是，培养医师的成本很少受到关注。这类研究可为重要的人力资源和卫生服务政策考量提供定量依据。
