Introduction: The Balanced Budget Act of 1997 legislated the idea of reimbursing ambulatory sites for training medical professionals. However very little is known about the costs of training in such settings. This paper uses a selection model to assess the cost of primary care training in ambulatory settings. Methods: Ambulatory teaching and non-teaching sites tend to have infrastructural differences because teaching sites need to provide adequate facilities and patient panels to sustain health professions education. Selection models were used to separate the cost of teaching from the cost of infrastructural differences between teaching and non-teaching sites. A Probit equation modeled the likelihood of an ambulatory site having a teaching program and a cost function related total medical practice costs to clinical output, presence of a health professions educational program, price of resources used, characteristics of the medical practice, and location. Self-reported financial data on 184 community health centers, group practices, HMOs, and outpatient clinics were used. Results: Model identification conditions were met. Ordinary Least Squares (OLS) estimates found that teaching sites had 36% higher operating costs than their non-teaching counterparts: 38% of these higher costs were due to selection effects (infrastructural differences) and 62% were the ’pure’ costs of teaching (costs of teaching net of selection effects). Conclusions: Estimation by OLS and ignoring selection effects would result in a greatly over-estimated cost of teaching.
Learning Objectives: At the conclusion of the session, the participant will be able to: 1. Discuss the concept of cost in medical education. 2. Identify appropriate models to estimate the cost of medical education. 3. Evaluate critically medical education cost estimates in the literature
Keywords: Cost Issues, Education
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.