Eisenberg J M
Section of General Internal Medicine, University of Pennsylvania, Philadelphia 19104.
J Gen Intern Med. 1990 Jan-Feb;5(1 Suppl):S70-80. doi: 10.1007/BF02600440.
As graduate medical education (GME) shifts to ambulatory settings, it is critical that financing follow suit. However, present financing of GME by Medicare is linked to payment for inpatient service, and few other payors pay explicitly for education. Human capital theory suggests that hospitals will be unwilling to finance GME unless their expenses are reimbursed. Reform of Medicare should include changes in how residents' time in ambulatory settings is counted, incentives for primary care education, and direction of funds to medical educators (rather than hospital administrators). Other federal initiatives could include changes in U.S. Department of Veterans Affairs (VA) support of residents and in Title VII grants. Non-federal payors also should contribute to paying for GME. Physician payment reform could help finance primary care GME, and an additional payment for bills submitted by physician-teachers should be considered. Medical educators must share responsibility by assuring that residencies are operated efficiently and that national needs for physicians are not subjugated to local service requirements.
随着毕业后医学教育（GME）转向门诊环境，资金随之调整至关重要。然而，目前医疗保险对GME的资助与住院服务支付挂钩，很少有其他支付方明确为教育付费。人力资本理论表明，除非费用得到报销，医院将不愿为GME提供资金。医疗保险改革应包括改变门诊环境中住院医生时间的计算方式、对初级保健教育的激励措施，以及资金流向医学教育工作者（而非医院管理人员）的方向。其他联邦举措可能包括美国退伍军人事务部（VA）对住院医生支持的变化以及第七章拨款的变化。非联邦支付方也应为GME支付做出贡献。医生薪酬改革有助于为初级保健GME提供资金，还应考虑为教师医生提交的账单额外支付费用。医学教育工作者必须分担责任，确保住院医师培训项目高效运作，以及国家对医生的需求不被地方服务需求所压制。
