Faculdade de Economia, Universidade Nova de Lisboa, Campus de Campolide, 1099-032 Lisboa, Portugal.
Health Care Manag Sci. 2010 Sep;13(3):234-55. doi: 10.1007/s10729-010-9126-7.
One of the stages of medical training is the residency programme. Hosting institutions often claim compensation for the training provided. How much should this compensation be? According to our results, given the benefits arising from having residents among the house staff, no transfer (either tuition fee or subsidy) should be set to compensate the hosting institution for providing medical training. This paper quantifies the net costs of medical training, defined as the training costs over and above the wage paid. We jointly consider two effects. On the one hand, residents take extra time and resources from both the hosting institution and the supervisor. On the other hand, residents can be regarded as a less expensive substitute to nurses and/or graduate physicians, in the production of health care, both in primary care centres and hospitals. The net effect can be either positive or negative. We use the fact that residents, in Portugal, are centrally allocated to National Health Service hospitals to treat them as a fixed exogenous production factor. The data used comes from Portuguese hospitals and primary care centres. Cost function estimates point to a small negative marginal impact of residents on hospitals' (-0.02%) and primary care centres' (-0.9%) costs. Nonetheless, there is a positive relation between size and cost to the very large hospitals and primary care centres. Our approach to estimation of residents' costs controls for other teaching activities hospitals might have (namely undergraduate Medical Schools). Overall, the net costs of medical training appear to be quite small.
医学培训的一个阶段是住院医师培训计划。主办机构通常要求为提供的培训提供补偿。补偿金额应该是多少？根据我们的研究结果，鉴于住院医师在住院医师队伍中带来的好处，不应为提供医学培训而向主办机构收取任何转让费用（学费或补贴）。本文量化了医学培训的净成本，定义为支付的工资以外的培训成本。我们共同考虑了两个方面的影响。一方面，住院医师会占用主办机构和主管的额外时间和资源。另一方面，住院医师可以被视为在初级保健中心和医院中，在生产医疗保健方面比护士和/或研究生医生更廉价的替代品。净效应可能是正的也可能是负的。我们利用葡萄牙居民被集中分配到国家卫生服务医院这一事实，将他们视为固定的外生生产要素。所使用的数据来自葡萄牙的医院和初级保健中心。成本函数估计表明，住院医师对医院（-0.02%）和初级保健中心（-0.9%）的成本产生了很小的负边际影响。尽管如此，大型医院和初级保健中心的规模与成本之间存在正相关关系。我们对住院医师成本的估计方法控制了医院可能开展的其他教学活动（即本科医学院）。总的来说，医学培训的净成本似乎很小。
