Economists on academic medicine: Elephants in a porcelain shop?

Health Affairs

Volumn 20, Issue 2, 2001, Pages 148-152

  Gbadebo, Adepeju L ^a   Reinhardt, Uwe E ^b  

^a HARVARD SCHOOL OF PUBLIC HEALTH   (United States)

^b PRINCETON UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AGED; ECONOMICS; HUMAN; MEDICAL EDUCATION; MEDICARE; NOTE; ORGANIZATION; SOCIAL BEHAVIOR; TEACHING HOSPITAL; UNITED STATES; UNIVERSITY HOSPITAL;

ACADEMIC MEDICAL CENTERS; AGED; EDUCATION, MEDICAL, GRADUATE; HOSPITALS, TEACHING; HUMANS; MEDICARE; ORGANIZATIONAL OBJECTIVES; SOCIAL RESPONSIBILITY; UNITED STATES;

EID: 0035290992     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.20.2.148     Document Type: Article

References (8)

1. Presidential candidate George W. Bush, during the third debate with Vice-President Al Gore, October 2000.
2. See, for example, Greater New York Hospital Association, Recent Efforts in GME Rightsizing: A Status Report and Literature Review, October 1999, (19 December 2000).
3. Veterans Health Administration, Department of Veterans Affairs, Report of Residency Realignment Review Committee, 7 May 1996, (19 December 2000).
4. J. Knickman et al., "The Potential of Using Non-Physicians to Compensate for the Reduced Availability of Residents," Academic Medicine 67, no. 7 (1992): 429-438.
5. The efficient quantity of a public good is the volume beyond the total collective benefit yielded by an extra unit of the good that would no longer cover the added cost of producing that unit. In theory, the "collective benefit" is represented by the sum over all citizens of the maximum amount each would be willing to pay to see that extra unit of output produced. Unfortunately, in practice that collective willingness to pay is almost impossible to ascertain, leaving the matter to an imperfect political decision.
6. According to standard theory, only the last, reluctant purchaser of a commodity - the marginal buyer in the market - derives from the commodity no greater value than he or she pays for it.
7. A. Smith, An Inquiry into the Nature and Causes of the Wealth of Nations (New York: Modern Library, 1937), chap. 10, 105.
8. To illustrate, if one divides the total revenues of accredited U.S. medical schools in 1999 ($38.3 billion) by the total number of medical students in that year (66,500), one arrives at revenues per student per year equal to $572,000. Annual tuition and fees ($1.46 billion, or $22,000 per student) account for only 3.8 percent of this total revenue. How much of that total can properly be allocated to the true annual cost of educating a medical student? Put another way, how much of the cost of research undertaken by medical school faculty can properly be allocated to the cost of educating a U.S. medical student? See J.Y. Krakower et al., "Review of U.S. Medical School Finances, 1998-1999," Journal of the American Medical Association 284, no. 9 (2000): 1127-1129.