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Medical Care Research and Review
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Graduate Medical Education Costs in Nonacademic Health Center Teaching Hospitals: Evidence from Maryland

Sarah Q. Duffy

Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Sduffy{at}samhsa.gov

Jane E. Ruseski

Federal Trade Commission

Sean Cavanaugh

Maryland Health Services Cost Review Commission

As managed care has grown, much concern has been expressed about the potential plight of the nation’s 125 academic health centers (AHCs). Less concern has focused on non-AHC teaching hospitals, although most studies of graduate medical education (GME) costs include these hospitals in their estimates. While most studies have found that costs increase positively with various measures of "teaching intensity," some have concluded that hospitals with smaller programs have costs that are the same or less than comparable nonteaching hospitals. However, few studies have tested whether AHCs’ cost structures are sufficiently similar to those of other hospitals to reliably include them in the same estimation. This article tests that assumption for Maryland hospitals, finds it violated, and presents results for non-AHC teaching hospitals. The results reveal that, at least in Maryland, even small teaching programs add to hospital costs.

Medical Care Research and Review, Vol. 57, No. 1, 3-23 (2000)
DOI: 10.1177/107755870005700101
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