Ebert R H, Brown S S
N Engl J Med. 1983 May 19;308(20):1200-8. doi: 10.1056/NEJM198305193082006.
There are 123 academic health centers in the United States, and they are markedly diverse in organization and function. Some have large research programs, others emphasize the education of nurses and allied health professionals, but all have one characteristic in common--namely, the dominant role of the medical school-teaching hospital combination. Their evolution has been shaped to a great degree by four federal initiatives: funding of research and research training by the National Institutes of Health, legislation that permitted close relations between Veterans Administration hospitals and medical schools, health-manpower legislation, and Medicare and Medicaid. Although academic health centers were created to foster the integration of structure and function, federal funding has always been categorical in support of research, teaching, or patient care. No federal funding was ever intended to stabilize the overall academic health center as an institution. This mattered little during a period of expansion, but the future of academic health centers is now uncertain in a period of federal cutbacks, rising health-care costs, and worry about an oversupply of physicians. Academic health centers must enter a new phase of institutional planning for which they are ill equipped. Special interests must be submerged for the good of the whole, diversity must be encouraged, and each center should exploit its own special strengths.
美国有123个学术健康中心，它们在组织和功能上存在显著差异。有些拥有大型研究项目，另一些则侧重于护士和联合健康专业人员的教育，但它们都有一个共同特征，即医学院与教学医院相结合所起的主导作用。它们的发展在很大程度上受到四项联邦举措的影响：国立卫生研究院对研究和研究培训的资助、允许退伍军人管理局医院与医学院建立密切关系的立法、卫生人力立法以及医疗保险和医疗补助。尽管学术健康中心的设立旨在促进结构与功能的整合，但联邦资金一直是按类别提供，用于支持研究、教学或患者护理。从未有过联邦资金用于稳定作为一个机构的整体学术健康中心。在扩张时期这无关紧要，但在联邦削减开支、医疗保健成本上升以及担心医生供应过剩的时期，学术健康中心的未来现在充满不确定性。学术健康中心必须进入机构规划的新阶段，而它们对此准备不足。为了整体利益，特殊利益必须被搁置，必须鼓励多样性，每个中心都应发挥自身的特殊优势。
