Financing the Additional Service Costs of Teaching English Medical Students by the Service Increment for Teaching (Sift): An Exposition and Critique

Bevan, Gwyn

doi:10.1111/j.1468-0408.1987.tb00195.x

Cited by 15 publications

(8 citation statements)

References 8 publications

(5 reference statements)

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“…RAWP subsequently recommended that SIFT should be set at 75% of this median excess cost per student although there was little justi®cation for the choice of this multiplier. 11 The later revision 9 employed regression analysis and the results were used to argue that 75% of the average additional costs per case in teaching hospitals could be attributed to an`undergraduate' effect and a further 20% to`research'. 10 It was acknowledged, however, that both may be capturing costs attributable to other components (i.e.…”

Section: ±91mentioning

confidence: 99%

Service Increment for Teaching (SIFT): a review of its origins, development and current role in supporting undergraduate medical education in England and Wales

Clack¹,

Bevan

Eddleston³

1999

Medical Education

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Section: ±91mentioning

confidence: 99%

Service Increment for Teaching (SIFT): a review of its origins, development and current role in supporting undergraduate medical education in England and Wales

Clack¹,

Bevan

Eddleston³

1999

Medical Education

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“…There was little justification for using the 75% figure12 despite references to what has become known as the York study 13. Although the RAWP report stated that the sole purpose of the original SIFT programme was “to cover the additional service costs incurred by the NHS in providing facilities for the clinical teaching of medical students,” both reports indicated that their estimates of the increment were likely to exceed these costs.…”

Section: The Evolution Of Siftmentioning

confidence: 99%

The medical service increment for teaching (SIFT): a 400m anachronism for the English NHS?

Bevan

1999

BMJ

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In 1997-8, over £400m ($640m) of NHS money was designated as the medical service increment for teaching (SIFT). 1 The manifest purpose of SIFT is to ensure that the NHS supports quality and innovation in undergraduate medical education. This includes supporting the increasing role of teaching in hospitals other than the main university hospital affiliated with each medical school, general practices, and other community settings.2 3 SIFT is designed to be paid in addition to income gained by medical schools for teaching medical students. The latent purpose of SIFT, which paradoxically dominates its distribution, is to ensure a "level playing field" in the healthcare market by covering "historic infrastructure costs, whether or not they are currently required for education."2 As designed, SIFT is thus in conflict with one of the aims of the government's white paper, The New NHS, which sought to end the way in which instability in the healthcare market resulted in "shoring up the status quo rather than creating the space to plan and implement major improvement." 4 Allocations of SIFT are based on the product of the annual SIFT rate (about £36 000 for institutions outside London and £39 000 in London) and the number of whole time equivalent students who are in the last three years of the five year curriculum, which are traditionally the years of clinical teaching.2 Thus a medical school that has an annual intake of 150 students will have about £16m in SIFT funding available for distribution to healthcare trusts and general practices that teach students. In 1996-7, nearly 90% of SIFT funds were allocated to the main acute teaching trusts (or teaching hospitals); most of the £170m allocated to the Thames regions is spent in London.1 Details are not published, but income from SIFT for the main university hospital may exceed £10m annually (and may also be its second most important source of income after the local health authority).This paper examines the way in which rates of SIFT funding have been estimated and interprets the results of these allocations. It does not consider the allocation of SIFT for dental students. This paper argues that current policies conflict with the objectives of equity and efficiency expressed in The New NHS. 4 Excess costsExcess costs of main university hospitals There are three troubling facts about the costs of running the main university hospitals. Firstly, simply dividing total hospital costs by the total number of cases shows that the main university hospitals have high unit costs; thus, they seem to be inefficient. The most recent published empirical basis for the current SIFT allocations, compiled for the 1988 review of the Resource Allocation Working Party 5 by Foote et al,6 reported that the costs per case at the main university hospitals in 1984-5 were about 30% higher than those in non-teaching hospitals. These excess costs may be accounted for by the costs incurred in teaching medical students, supporting research, the further training of doctors, and for providing specialised ...

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“…But the prior question is, does the problem matter anyway, given that our concern should be with balancing the total/combined output of joint products against the total cost? Yet the answer must be that it does matter, given the unique role of teaching hospitals, the fact that funding on a RAWP-formula plus SIFTformula basis typically does not nearly meet their total costs (see Bevan, 1987b), and the possible consequence of this that the level of funding made available locally to teaching hospitals will increasingly squeeze their resources and constrain their capability to lead medical innovation and set the example of being 'centres of excellence'.…”

Section: Problems For Research Identified By the Agra Reportmentioning

confidence: 99%

“…The papers by Bevan( 1987a and b) review the conceptual basis upon which the SIFT system of teaching hospital resource allocation is founded. COSTS AND JOINT PRODUCTS OF ENGLISH TEACHING HOSPITALS 2 1 1 Columns (3) and (5) in the AGRA Report Table reproduced in Appendix 1, give a wide range of excess costs of teaching hospitals linked with particular medical schools (see Bevan, 1987a for an exposition of the methods used to derive the data of the AGRA Table). Some of the above variability can be explained quite easily.…”

Section: Problems For Research Identified By the Agra Reportmentioning

confidence: 99%

The Costs and Joint Products of English Teaching Hospitals

Perrin

1987

Financ Acc Manag

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Financing the Additional Service Costs of Teaching English Medical Students by the Service Increment for Teaching (Sift): An Exposition and Critique

Cited by 15 publications

References 8 publications

Service Increment for Teaching (SIFT): a review of its origins, development and current role in supporting undergraduate medical education in England and Wales

Service Increment for Teaching (SIFT): a review of its origins, development and current role in supporting undergraduate medical education in England and Wales

The medical service increment for teaching (SIFT): a 400m anachronism for the English NHS?

The Costs and Joint Products of English Teaching Hospitals

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