Teaching Hospitals in the Usa: Institutions Under Stress?

Appendix 1

“…In this paper outline descriptions of the position have been given. These are amplified for England and the USA by other papers in this issue (Bevan, 1987a and b;and Anderson, 1987). It will be interesting to know more about similar developments elsewhere.…”

“…Special arrangements are however made for the higher costs of graduate training: see Anderson (1987). C O T H members provide a full range of hospital services and are major providers of services not normally available in community hospitals: C O T H members offered 58 per cent of the burn care units, 46 per cent of the organ banks and 39 per cent of the open-heart surgery facilities (see Table 9); and over 40 per cent of cardiac catheratisations, C T scans, open heart surgeries and megavolt radiation procedures took place in C O T H members.…”

Financing English Teaching Hospitals by Capitation

“…Second, a crucial issue to be resolved in English THs' finance is that of accounting for their activity in population-based approaches which aim to distribute hospital finance on an equitable basis. In the USA hospitals are mainly reimbursed on cases treated, and T H s get paid extra allowances for graduate medical education (Anderson, 1987b). The disregard of equity in the USA's formal financial arrangements means that the conflict between service and teaching needs is not manifested explicitly for THs.…”

Existing Problems and Potential Solutions of Us Teaching Hospitals: A Clinician‐teacher's Perspective

“…Hence T H s appear to be in the position of having to treat the more expensive and complicated paying patients (though this is difficult to document using the existing methods of data collection and analysis) plus treating increasing numbers of those patients who have no means for payment. Although as Anderson (1987) describes, THs in the USA have done well so far under the new arrangements. The fiscal pressures are likely to become intolerable and lead to managerial decisions necessary for survival of the hospital being not compatible with the code of ethics of medical practice.…”