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Reforma de la educación médica de posgrado. Los costos de transición de la prestación de servicios a la prestación de
J J Stoddard1, D A Kindig, D Libby
1Department of Pediatrics, University of Wisconsin-Madison Medical School 53706-1532.
JAMA
|July 6, 1994
Resumen
La reforma de la educación médica de posgrado puede conducir a ahorros significativos a largo plazo, pero incurrirá en costos iniciales. Se proyecta que la sustitución del personal doméstico costará a los hospitales docentes entre 1.400 y 1.800 millones de dólares anuales.
Área de la Ciencia:
- Economía de la salud economía de la salud.
- Política de Educación Médica y Educación Médica
- Análisis de la fuerza laboral en el cuidado de la salud.
Sus antecedentes:
- El sistema actual de educación médica de posgrado (GME) se enfrenta a un escrutinio en cuanto a su rentabilidad y eficiencia.
- Se están considerando reformas en GME para optimizar la capacitación y la asignación de recursos dentro de los hospitales universitarios.
- Comprender las implicaciones financieras de la sustitución del personal doméstico es crucial para el éxito de la reforma de GME.
Objetivo del estudio:
- Analizar estrategias potenciales para la sustitución del personal de la casa (residentes y becarios) en un sistema reformado de GME.
- Estimar los costos asociados de estas estrategias de sustitución para los hospitales universitarios de los Estados Unidos.
- Proporcionar perspectivas económicas para los responsables políticos y administradores de hospitales que están considerando la reforma de la GME.
Principales métodos:
- Se desarrolló un modelo económico para simular dos escenarios distintos para la sustitución del personal doméstico.
- Escenario 1: Un modelo de bajo costo que involucra a proveedores no médicos, médicos del personal, enfermeras y personal auxiliar.
- Escenario 2: Un modelo tradicional de mayor costo que depende en mayor medida de los médicos del personal.
- El modelo proyectó los costos netos de sustitución por funcionario doméstico equivalente a tiempo completo (ETP) y las estimaciones de costos nacionales agregados.
Principales resultados:
- Los costos netos anuales de sustitución se estimaron en $58,000 por FTE en el modelo de menor costo y $77,000 por FTE en el modelo de mayor costo.
- Con una eliminación estimada de 23.200 puestos de personal doméstico, los costos totales de sustitución nacional se proyectaron entre $ 1.4 mil millones y $ 1.8 mil millones anuales.
- Estas cifras representan los costos netos incurridos por los hospitales docentes durante el período de transición.
Conclusiones:
- La reforma de la educación médica de posgrado presenta una oportunidad para un ahorro sustancial de costos a largo plazo.
- Sin embargo, la transición en la prestación de servicios requiere nuevos gastos a corto plazo.
- La planificación estratégica es esencial para gestionar el impacto financiero de la reforma de GME y la sustitución del personal de la casa.
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