America's teaching hospitals, where doctors are trained and new treatments developed, face imminent financial crisis unless there are drastic changes in the way they are funded and operated, according to a major task force report released yesterday.
Such changes might include taxing all hospital patients to support the training of doctors and the care of those without health insurance, and restricting training funds solely to graduates of approved American and Canadian medical schools, according to the report by the Commonwealth Fund.
The report, a two-year project by a 16-member national task force of medical school professors, hospital administrators and other authorities, addresses the increasing pressure on teaching hospitals created by government and private efforts to contain health care costs.
The central problem faced by these hospitals, the report said, is that their extra responsibilities have made them too expensive, prompting many paying patients to go elsewhere for medical care. Teaching hospitals usually charge more than hospitals that do not train doctors, due to educational costs as well as the price of sophisticated equipment and increased ordering of medical tests by doctors in training.
In addition, recent changes in Medicare reimbursement to such hospitals threaten further financial weakening, the report said. It cited cutbacks in the money they receive for training physicians, and a new system that pays uniform fees for all patients with a given diagnosis, even though those at academic hospitals often are sicker and need more expensive care.
Overpriced in a shrinking market, many such hospitals are having trouble meeting their goals of turning out new doctors, performing critical research and providing specialized services such as burn and cancer treatment.
"We are going to have to work with government, the private sector and others . . . if we're going to really preserve our function -- education, research and development -- and if we are going to have a proper role in uncompensated care" of poor patients, said Dr. Robert Heyssel, president of Johns Hopkins Hospital and chairman of the task force.
Heyssel said the report tells Congress, insurance companies and nonteaching hospitals that the high cost of training new physicians and treating those who cannot pay "is a responsibility that they can't opt out of."
The report recommends taxing admissions to all hospitals or taxing health insurance premiums to pay for doctors' training. It advocates cutting back on training positions and the number of years of training funded by Medicare and other sources because there is an oversupply of medical specialists.
It also suggests restricting funding for residency slots to American and Canadian medical school graduates. Foreign medical students, who make up about 20 percent of the nation's hospital residents, would have to fund their own training -- estimated at more than $150,000 for three years.
To assure medical care for patients without insurance -- about 20 million people, according to a 1982 survey -- the report recommends taxing all hospital admissions or health insurance premiums to create a pool of funds, or extending the Medicaid program.
It also suggests separating the cost of doctors' education from that of patient care.