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Providing Primary General Medical Care in University Hospitals: Efficiency and Cost
- JACQUELINE KOSECOFF, Ph.D.;
- ROBERT H. BROOK, M.D. Sc.D.;
- ARLENE FINK, Ph.D.;
- CAREN KAMBERG, M.S.P.H.;
- CAROL PINDAR ROTH, R.N., M.P.H.;
- GEORGE A. GOLDBERG, M.D.;
- LAWRENCE S. LINN, Ph.D.;
- VIRGINIA A. CLARK, Ph.D.;
- JOSEPH P. NEWHOUSE, Ph.D.; and
- THOMAS L. DELBANCO, M.D.
- the GROUP PRACTICE PROJECT DIRECTORS *
- the NATIONAL PROGRAM STAFF †; Los Angeles and Santa Monica, California; and all of the program sites
Abstract
Data on efficiency, costs, and profits of 15 internal medicine outpatient group practices in university hospitals were collected for 9 months from interviews, a time-motion study, observations, and reviews of bills. Charges for a follow-up visit were about 25% higher than Medicare's allowable charges, but differed threefold across practices. Physicians spent more than half their allocated patient care or supervision time in other activities and 14% of nursing time was used for direct patient care. Visits to second- and third-year residents cost one half of those to faculty. Faculty supervision of second- and third-year residents was limited; it was, on average, 2 minutes per follow-up visit. Despite these inefficiencies, bad debts, and educational costs, practices appeared to break even financially. We conclude it is financially feasible for university hospitals to provide primary care to disadvantaged populations.
- ambulatory care
- cost benefit analysis
- cost control
- faculty, medical
- group practice
- hospitals, university
- internal medicine
- internship and residency
- medical indigency
- nurses
- physicians
- primary health care
- time and motion studies
Article and Author Information
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▸From the Departments of Medicine and Public Health, Center for Health Sciences, University of California, Los Angeles; and Fink and Kosecoff, Santa Monica, California.
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↵* The Group Practice Project Directors include Susan H. Bane, M.D.; Richard L. Byyny, M.D.; Dennis W. Cope, M.D.; Robert D'Allensandri, M.D.; Thomas Delbanco, M.D.; William S. Dunn, M.D.; Jerry M. Earll, M.D.; Suzanne Fletcher, M.D.; Paul Gilbert, M.D.; John T. Harrington, M.D.; Jack Hughes, M.D.; Carter L. Marshall, M.D., M.P.H.; Dennis Quinlan, M.D.; Steven A. Schroeder, M.D.; W. Anderson Spickard, M.D.; Raymond W. Turner, M.D.; John M. Witherspoon, M.D., M.P.H.; and Roy T. Young.
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↵† The National Program Staff includes Reisa Kahn, M.S.; H. Richard Nesson, M.D., and Wendy Everett Watson, Sc.D.
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Grant support: in part by grant 5318 from the Robert Wood Johnson Foundation. The views expressed herein do not necessarily represent those of the Robert Wood Johnson Foundation.
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▸Requests for reprints should be addressed to Robert H. Brook, M.D.; Department of Medicine, UCLA Center for Health Sciences; Los Angeles, CA 90024.
- © 1987 American College of Physicians
