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Academia and the Profession |

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.
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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.

▸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 PhysiciansAmerican College of Physicians


Ann Intern Med. 1987;107(3):399-405. doi:10.7326/0003-4819-107-2-399
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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.

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