By Chris Brown
When faced with a medical emergency, it’s only natural to demand the best care available. For many, this aid is provided by a teaching hospital. These medical centers, of which University of Louisville Hospital is one, operate as combined business-academic endeavors, and not only support their surrounding communities by treating patients from diverse socio-economic backgrounds, but also serve as research centers. Teaching hospitals provide invaluable training to resident physicians as they make the transition from classroom to consultation.
But changes in the health care market over the last decade, coupled with state and federal budget problems across the nation, have helped create a tough situation for these health care centers.
Grant money and clinical revenue from fee-for-services health coverage programs and private-pay patients have helped hospitals cover the costs of doing business and teaching students. However, when teaching hospitals become capable of funding themselves, such self-reliance comes at a price. When a teaching hospital stands on its own two feet, state governments often see an opportunity to play Jenga with the hospital’s budget. Fiscal policy-makers’ motto: so long as it stands, we’ll pretend not to see it wobble.
As more Americans are insured by managed-care plans, self-sufficient teaching hospitals also face the pinch from the funding caps that HMOs place on reimbursement for patient care.
Not surprisingly, the average HMO feels responsible to cover only the costs of patient care, not the training of health care professionals. Many cut any extra funding that hospitals would use to cover educational costs for medical training by paying only costs related directly to patient services.
While there are measures to ensure the solvency of teaching hospitals’ budgets, even those programs are frequently dismantled by congressional stop-gapping. Congress’ 1983 effort to help cover educational costs for teaching hospitals, Indirect Medical Education (IME), is seeing its money dwindling. Because 1997’s federal Balanced Budget Act mandates decreasing spending in one area before increasing it in another, funding available for IMEs is often lost to defense initiatives, environmental protection and other projects. At the same time, Medicare and Medicaid, as well as many of the nation’s largest insurance companies, are still trying to reduce expenses by encouraging customers to switch to HMO coverage plans.
All of this backs teaching hospitals into a corner, forcing them to spread funding even thinner in order to cover both patient care and educational operations. As budgets tighten, it becomes increasingly difficult to juggle the pins flying above the heads of most teaching hospitals, which are trying to treat patients efficiently, teach students effectively and conduct research progressively — all while remaining competitive with independent hospitals which are free from the added burdens of teaching and research expenses.
The solution to these hospitals’ problems lies largely in the hands of health care coverage providers. To ensure cutting-edge medical care for their customers, HMOs must realize that patient care starts with quality health care training, and that tomorrow’s professionals rely on teaching hospitals for their educations today.
CHRIS BROWN is a sophomore pursuing a double-major in Chemistry and Spanish, and is the Managing Editor for The Louisvlle Cardinal. Contact him at: cbrown@louisvillecardinal.com
