Panton D M, Mushlin A I, Gavett J W
Med Care. 1980 Jun;18(6):668-74. doi: 10.1097/00005650-198006000-00009.
The ambulatory component of residency training jointly produces two products, namely, training and patient services. In costing educational programs of this type, two approaches are frequently taken. The first considers the total costs of the educational program, including training and patient services. These costs are usually constructed from historical accounting records. The second approach attempts to cost the joint products separately, based upon estimates of future changes in program costs, if the product in question is added to or removed from the program. The second approach relates to typical decisions facing the managers of medical centers and practices used for teaching purposes. This article reports such a study of costs in a primary-care residency training program in a hospital outpatient setting. The costs of the product, i.e., on-the-job training, are evaluated using a replacement-cost concept under different levels of patient services. The results show that the cost of the product, training, is small at full clinical utilization and is sensitive to changes in the volume of services provided.
住院医师培训的门诊部分共同产生两种产出，即培训和患者服务。在计算这类教育项目的成本时，通常采用两种方法。第一种方法考虑教育项目的总成本，包括培训和患者服务。这些成本通常根据历史会计记录构建。第二种方法试图根据项目成本未来变化的估计，分别计算联合产出的成本，前提是相关产出被添加到项目中或从项目中移除。第二种方法涉及医疗中心和用于教学目的的医疗机构管理人员面临的典型决策。本文报告了对一家医院门诊环境中初级保健住院医师培训项目成本的此类研究。使用重置成本概念，在不同患者服务水平下评估产品（即在职培训）的成本。结果表明，产品（培训）的成本在临床充分利用时较小，并且对所提供服务量的变化敏感。
