What matters: making the case for public support of teaching hospitals and medical schools

For the last 100 years, U.S. medical schools and teaching hospitals have convinced the public that they can be counted on to provide excellent care, train the next generation of medical professionals, advance research, and anchor their communities. Public support expressed through government funding has been correspondingly generous. But those who run academic medicine's institutions cannot take such support for granted, particularly in light of recent wide swings and inconsistencies in what the public wants, and must continue to work together proactively to show the public and its representatives that government funding is needed and deserved. In this article, the author focuses on issues of funding patient care, as the role of the government in supporting biomedical research as a public good is well accepted. The author reviews why academic medicine's institutions are unique and valuable (for example, teaching hospitals are generally the places that Americans expect to go for advanced specialized care; they also serve their communities' need for primary care, including care for the underserved). He then makes clear that the competitive marketplace model, which has recently begun to dominate health care, does not work in that arena, despite that model's success in other industries. For example, mergers, vertical integration, and simplified payment systems (in contrast to Medicare) have failed for teaching hospitals and medical schools because those strategies do not take into account the complexity of those institutions. He concludes with five approaches that leaders in academic medicine should take to work for the public good and to strengthen public trust and support for academic medicine's role in patient care (e.g., work for success at the local level to have influence at the national level).