Teaching Hospitals

Johns Hopkins Hospital might be the best in the nation, as one survey suggests, but that's no guarantee of success in a marketplace where insurers are demanding lower prices as well as high quality. Last week Hopkins announced it would "re-engineer" itself over the next three to five years to compete more effectively. It won't be easy. Academic medical centers face unique problems because they also teach young doctors, do research and care for large numbers of indigent patients, costs that push their charges higher than community hospitals.

WASHINGTON -- The nation's research and teaching hospitals got good news last week from congressional committees that are beginning to shape health care legislation.Two Senate plans and a House proposal provide more money than President Clinton's initial proposal for hospitals that are responsible for training doctors.Under the Clinton plan, many of the hospitals would lose funds because of recommended cuts in the Medicare program that allocates about $5.8 billion annually for the training of physicians.

President Clinton's call to increase the supply of family doctors could force hospitals such as Johns Hopkins and the University of Maryland into a battle to preserve their roles as specialty centers.For Mr. Clinton's reform to work, teaching hospitals would have to train more than double the current number of physicians planning careers in primary care, a field that has been derided as low-paying and lacking the intellectual allure of the medical specialties.The administration wants to reverse that perception, recognizing that specialists order more tests and perform costlier procedures than do generalists.