Tallia A F, Swee D E, Winter R O, Lichtig L K, Knabe F M, Knauf R A
Department of Family Medicine, UMDNJ--Robert Wood Johnson Medical School, New Brunswick, 08903-0019.
Acad Med. 1994 Sep;69(9):747-53. doi: 10.1097/00001888-199409000-00021.
More generalists are needed for the American health care system. Will training these practitioners add to hospital costs? Although graduate medical education has been shown to add to hospital patient care costs, the authors questioned whether this were true for the hospital training of family physicians.
Based on data supplied by 12 participating New Jersey hospitals with family practice residencies, inpatients in 1991 were separated into three categories by the teaching status of their attending physicians: family practice, other teaching, non-teaching. The hospitals were stratified into two types for analysis: seven community and five multiresidency hospitals. Average cost (per case-mix--neutral case) was found for each category of patients within medical, surgical, pediatric, and obstetrical classes.
Among community teaching hospitals, the mean case-mix--adjusted cost per case for inpatients associated with family practice training was 6.3% less than that for inpatients with an equivalent case mix not associated with family practice training. Among multiresidency teaching hospitals, there was no difference between mean costs for inpatients associated with family practice training and non-teaching patients. The mean cost for inpatients associated with graduate medical training other than family practice was 8% higher than that for non-teaching inpatients.
These findings suggest that family practice residencies do not add to the direct inpatient costs of teaching hospitals, and in certain instances may even reduce hospital patient care costs. In times of increasing cost consciousness in health care and medical education, this provides a further rationale for institutions to sponsor graduate training in family practice.
美国医疗保健系统需要更多的全科医生。培训这些从业者会增加医院成本吗？尽管研究生医学教育已被证明会增加医院的患者护理成本，但作者质疑家庭医生的医院培训是否也是如此。
根据新泽西州12家设有家庭医学住院医师培训项目的参与医院提供的数据，1991年的住院患者根据其主治医生的教学状态分为三类：家庭医学、其他教学、非教学。这些医院被分为两种类型进行分析：七家社区医院和五家多住院医师培训医院。在医疗、外科、儿科和产科类别中，分别计算了每类患者的平均成本（按病例组合中性病例计算）。
在社区教学医院中，与家庭医学培训相关的住院患者的平均病例组合调整后成本比病例组合相同但与家庭医学培训无关的住院患者低6.3%。在多住院医师培训教学医院中，与家庭医学培训相关的住院患者的平均成本与非教学患者的平均成本没有差异。与家庭医学以外的研究生医学培训相关的住院患者的平均成本比非教学住院患者高8%。
这些发现表明，家庭医学住院医师培训项目不会增加教学医院的直接住院成本，在某些情况下甚至可能降低医院的患者护理成本。在医疗保健和医学教育中成本意识不断提高的时代，这为机构赞助家庭医学研究生培训提供了进一步的理由。
