Weissert C S, Knott J H, Stieber B E
Michigan State University.
J Health Polit Policy Law. 1994 Summer;19(2):361-92. doi: 10.1215/03616878-19-2-361.
Recent calls for restructuring of the nation's health care system have highlighted the deficiencies in the current system of education for the health professions. Of particular concern are the dominance of specialization and hospital-based training and the tendency of new health care providers to settle in communities without substantial health needs. The states are the key actors in reforming health professions education, serving as a primary funding source for health professions schools, chief licensors and regulators of health professions, regulators of private health insurance, key providers of Medicaid, and architects of a variety of subsidy and regulatory programs providing incentives for health professionals to choose specialties and locations for practice. This article provides a taxonomy of state policies affecting health professions education reform and classifies the states according to the choices they have made. Findings show that few states take advantage of their policy options across the four policy types and that most tend to concentrate their efforts on a few policies--ignoring potential means of encouraging more primary care providers in underserved areas. Results from regression models explaining state choice of policy adoption highlight the political nature of policy choice and the highly variable nature of state response in health professions education reform.
近期有关美国医疗保健系统重组的呼声凸显了当前卫生专业教育体系的不足之处。特别令人担忧的是专业化和以医院为基础的培训占据主导地位，以及新的医疗保健提供者倾向于在医疗需求并不旺盛的社区定居。各州是卫生专业教育改革的关键参与者，它们是卫生专业学校的主要资金来源、卫生专业的主要执照颁发机构和监管机构、私人医疗保险的监管机构、医疗补助的主要提供者，以及各种补贴和监管项目的设计者，这些项目旨在激励卫生专业人员选择专业领域和执业地点。本文提供了影响卫生专业教育改革的州政策分类，并根据各州所做的选择对其进行了分类。研究结果表明，很少有州能充分利用这四类政策选项，而且大多数州倾向于将精力集中在少数政策上，而忽视了鼓励在服务欠缺地区增加初级保健提供者的潜在手段。解释各州政策采纳选择的回归模型结果凸显了政策选择的政治性质以及各州在卫生专业教育改革中的反应高度可变的性质。
