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January 29, 2021 Friday 12:05:54 PM IST

Yale study finds link between GME funding and public health benefits

A new study by Yale researchers published in the online medical journal JAMA Network Open finds that graduate medical education (GME) spending is associated with improved patient outcomes and better academic performance by medical residents, but does not improve the financial standing of hospitals.

In an analysis of the nearly 1,300 hospitals that received GME funding in 2017, the researchers found that every $1 million increase in spending was associated with a lower 30-day mortality rate for heart failure, acute myocardial infarction, pneumonia, stroke, and chronic obstructive pulmonary disease. When they looked at data from previous years, this trend held, the authors say.

They found no association, however, between subsidies received and hospital profitability.

The study was led by Dr. Radoslav Zinoviev, an internist based in Baltimore who is affiliated with Yale New Haven Hospital and who first submitted the findings as an award-winning thesis at Yale five years ago.

Created in 1944 to offset the cost of resident training, the GME subsidy is primarily funded as part of Medicare, Medicaid, the Veterans Health Administration, and other smaller programs. Today more than $10 billion is spent annually to support the program. The 1,298 hospitals reviewed as part of the study received a median $2.64 million, with a median $100,500 for each trainee. The median number of residents per hospital was 32.

The researchers found a significant association between funds allocated to students and their internal medicine Board Certification Exam pass rates during the period studied.

Distribution of funds remains unequal, with larger teaching hospitals — particularly in the northeastern U.S. and on the coasts — receiving an inordinate share. However, the funding does not improve the profitability of these hospitals, the authors say. They speculate that in many cases the expenses of these academic hospitals — including the cost of training students — exceed the revenue benefit and leave these institutions less financially resilient.

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