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April 19, 1995

US Teaching Hospitals in the Evolving Health Care System

Author Affiliations

From the Section on Health Services and Policy Research, Division of General Medicine, Department of Medicine, Brigham and Women's Hospital; the Department of Health Care Policy, Harvard Medical School; and the Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass. Dr Epstein served as senior health care adviser to the Clinton administration in 1993 and 1994.

JAMA. 1995;273(15):1203-1207. doi:10.1001/jama.1995.03520390063034

AMONG the surprises in the last 2 years' health care debate was the extensive controversy engendered by proposals related to teaching hospitals and their associated academic health centers. Of more than 6500 hospitals nationwide, only some 300 nonfederal hospitals are generally considered to be "major teaching hospitals" (hospitals whose ratio of the number of interns and residents to the number of beds is ≥0.25)1 and fewer than 1250 participate in graduate medical education.2 Nevertheless, the importance of these institutions and their medical school partners in the national dialogue soon became clear. They play a central role in workforce training, research, and patient care, especially for disadvantaged populations. As centers of excellence, they epitomize the high-technology care that many US citizens associate with worldwide leadership in the quality of their medical care.

Most of the policy interest and controversy centered on two key issues: the financial viability of teaching

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