Education costs in two public teaching hospitals.

The authors examined the impact of costs of education on the overall expenses of two major teaching hospitals during a period of rapid growth and change in the Minneapolis and St. Paul, Minnesota, health care environment. By using a retrospective faculty-time study and the two hospitals' estimated costs for education, education costs of each hospital were compared--within and across facilities--with annual hospital operating expenses, with inflation, and by educational program. Unit costs were estimated for undergraduate and graduate medical students. Over the study period, allocated education costs averaged 13-14% of the hospitals' operating budgets. The combined mean allocated cost per medical student and resident was approximately +73,000 in 1983-84. During this period, allocated education costs were in line with medical inflationary trends and did not drive hospital expense increases. These findings suggest that policymakers wishing to restrain the rise in health care costs should look beyond cutting the costs of education programs and find other solutions.

Physician need. An alternative projection from a study of large, prepaid group practices.

To model a base level of physician demand in a managed health care system, we examined in 1983 the ratios by specialty of full-time equivalent physicians to health maintenance organization members in seven large, closed-panel health maintenance organizations, each with more than 100,000 members. The medical director of each plan was surveyed by mailed questionnaire and telephone interview to determine the plan's number of full-time equivalent physicians by specialty and members served. Out-of-plan physicians contracted by the group were included within the specialty distribution wherever possible. We compared our findings (4779.4 full-time equivalent physicians serving 4,297,790 members) with Graduate Medical Education National Advisory Committee and others' projections of physician need and supply. Based on this model and unknowns that might affect utilization, our study suggests that at least 111 physicians per 100,000 population would be necessary in a system that emphasized reduced utilization of services and that more primary care physicians would be needed than the Graduate Medical Education National Advisory Committee predicted would be available.

The cost of complexity: the teaching hospital.

There are factors other than teaching that should be considered to understand why teaching hospitals are more costly than their community hospital counterparts. Often these factors are compensated under the rubric of education. Medicare's reimbursement of direct and indirect medical education expenses is discussed as an example of such compensation of teaching hospitals' hidden contributions. However, to designate the teaching function as the sole cause of higher costs is inaccurate. The following factors are suggested as contributing to teaching hospital costs: intensity of care; case mix of patients; ambulatory care programs; care of the medically indigent; biomedical research; other program development; and physical and organizational locations. These factors must be defined separately, understood in terms of their social and financial value, and paid for at appropriate levels to meet the increasing demand for accurate cost accounting by teaching hospitals in the present environment of competition and funding cutbacks.

Histiocytosis X and compulsive water drinking: report of a case.

We describe a patient with histiocytosis X and compulsive water drinking. The association of diabetes insipidus with histiocytosis X is well recognized, and this patient was initially considered to have diabetes insipidus. It was only after further testing that the proper diagnosis was made.