WHY DO PUBLIC TEACHING
Larry S. Gage
A growing crisis faces many urban public teaching hospitals today. It is influenced by many factors and often takes different forms in different communities. What is certain, however, is that public teaching hospitals face the same fiscal and competitive pressures that confront the entire hospital industry in America today, while also bearing the unique burdens that result from their safety–net mission and governmental status. A landmark study released in March, 2000 by the Institute of Medicine (IOM) summarized their situation:
The funding and organization of the safety net have always been tenuous and subject to the changing tides of politics, available resources, and public policies. Despite their precarious and unstable infrastructure, these providers have proven to be resilient, resourceful, and adept at gaining support through the political process. Today, however, a more competitive health care marketplace and other forces of change are posing new and unprecedented challenges to the long-term sustainability of safety net systems and hold the potential of having a serious negative impact on populations that most depend on them for their care.1
The multiple missions of education, research and patient care for the uninsured and underinsured place many public teaching hospitals at great financial risk today. With cutbacks in the Medicaid and Medicare programs, these hospitals face an erosion in their traditional sources of funding. Recent changes in the competitive health marketplace, particularly the evolution of managed care, have added to the financial pressures on them.