Are university-run medical centers the tail that wags the dog?

Universities have played a vital role in the fight against the coronavirus that has swept the world – their research seeks to prevent the disease or mitigate its effects, their classrooms and laboratories train the future doctors and others who want to save lives, as well their hospitals and clinics try to cure those who have not only this disease but all sorts of other serious diseases that afflict humanity. About 100 facilities with medical schools and hospitals are particularly critical.

With this in mind, I recently met with Dr. Harold Paz, executive vice president and chancellor of health affairs for Ohio State (OSU) and CEO of Wexner Medical Center. Dr. Paz has also directed university hospitals in Rutgers and Penn State, and served as Aetna’s chief health executive for several years. He also has close professional ties with several private schools including Rochester, Johns Hopkins and Yale. He is an articulate, intelligent person.

The health care component at large universities like Ohio State, as measured by spending, now sometimes exceeds 50% – it’s about $ 4.5 billion a year ($ 500,000 an hour) at OSU, larger than any other part this huge school together – an institution with about 60,000 students in Columbus alone. Dr. Paz spends 20 times the sports director overseeing the OSU’s superstar status sports programs.

I have dr Paz asked if opening and operating huge new outpatient centers (spanning a million square feet) in the suburbs of Columbus competing with competing health care providers or building a new nearly $ 2 billion high-rise hospital will distract from traditional goals like teaching French or the Bookkeeping for new students. Does institutional hubris trump common sense?

I remember decades ago a distinguished Duke economist (a past president of the American Economics Association) told me that my university would regret the day it opened a medical school. Dr. Paz politely but firmly opposed this line of thinking, suggesting that the synergies of the medical faculties in combination with other university operations constitute an effective model that ultimately serves the good of society.

Dr. Paz notes that health spending in the US is approaching 18% of national production – much more than in most other countries, and he believes there are ways to reduce future costs by restructuring health care. Big changes in healthcare are imminent when Dr. Paz is right. However, he made no comment on his own observation: a large percentage of health care costs are related to heroic end-of-life endeavors, which are extremely expensive but usually only add a few weeks or perhaps months to life. Medical ethicists and theologians discuss: When does life begin? Perhaps we should ask: When should life end, knowing that some people can be kept alive for years in a vegetative state? It occurred to me that university hospitals might get a large part of their income here.

If ever there is one area where compromise, the choice between alternatives, is particularly important, it is medical education. Could we save a lot of money by shortening medical training but training more doctors? Should we cut off insurance coverage for patients who are clearly incurable and in the last days or weeks of their lives? Should we continue to expand the capabilities of non-medical healthcare providers?

Since teaching French for 18-year-olds is different from high-level medical training for 25-year-olds, and since caring for hospital patients is a long way from traditional “college educationâ€, should we perhaps divide medical operations into very different institutions? with cooperations with each other? Or, as Dr. Paz seemed to admit a more viable option could be separating the clinical functions of the medical schools from the educational functions? Is bigger better?

An aging population, low economic growth, high debt – these are attributes of America today. We are probably overwhelmed as a nation. Our extremely high health care costs need to be reassessed and reform is clearly needed, as Dr. Paz seems to believe it will come. University provision of medical education and care will be part of this exam in the years to come.

My latest book is Restoring the Promise: Higher Education in America.