Estimating the cost of primary care training in ambulatory settings

The Balanced Budget Act of 1997 legislated the idea of reimbursing ambulatory sites for training medical professionals. However, very little is known about the costs of training in such settings. This paper assesses the cost of primary care training in ambulatory settings. Selection models were used to separate the cost of teaching from the cost of infrastructural differences between teaching and non-teaching sites. A probit equation modelled the likelihood of an ambulatory site having a teaching programme and a cost function related total medical practice costs to clinical output, the presence of a health professions educational programme, the price of resources used, characteristics of the medical practice and location. Data on 184 community health centres (CHCs), group practices, health maintenance organizations (HMOs) and outpatient clinics were used. Teaching sites were found to have 36% higher operating costs than their non-teaching counterparts: 38% of these higher costs were due to infrastructural differences and 62% were the 'pure' costs of teaching, i.e. the costs of teaching the net of infrastructural effects.