Does Economic Theory Justify Changing Policy That Works?
The paper by Joseph Newhouse and Gail Wilensky encapsulates much of the discussion by the Medicare Payment Advisory Commission (MedPAC) in 1999, which added a new and unique perspective to the dialogue about Medicare s role in helping to finance the postgraduate (residency) education of this country s future physician workforce. We appreciate and agree with the authors observation that “teaching institutions provide enhanced quality of care and that payments to these institutions need to reflect their higher costs.” We also agree that there is confusion about the distinct purposes of Medicare direct graduate medical education (GME) payments and the indirect medical education (IME) adjustment to Medicare per case payments. However, we oppose the authors contention, as well as MedPAC s recommendation, that Medicare should recharacterize the educational costs associated with direct GME payments as patient care costs and combine the two historically separate funding streams direct GME and
The paper by Joseph Newhouse and Gail Wilensky encapsulates much of the discussion by the Medicare Payment Advisory Commission (MedPAC) in 1999, which added a new and unique perspective to the dialogue about Medicare’s role in helping to finance the postgraduate (residency) education of this country’s future physician workforce. We appreciate and agree with the authors’ observation that “teaching institutions provide enhanced quality of care and that payments to these institutions need to reflect their higher costs.” We also agree that there is confusion about the distinct purposes of Medicare direct graduate medical education (GME) payments and the indirect medical education (IME) adjustment to Medicare per case payments. However, we oppose the authors’ contention, as well as MedPAC’s recommendation, that Medicare should recharacterize the educational costs associated with direct GME payments as patient care costs and combine the two historically separate funding streams—direct GME an
