Teaching students the relationship between quality and cost of medical care.

The usefulness of hospital charges as a means of teaching medical students the relationship between the quality of the cost of medical care provided by primary care physicians (internists and family physicians) is presented. The comparative role of these two types of primary care physicians as "generators of costs" is described. The cost of hospital care provided by primary care physicians is also compared with the cost of care provided by the cardiologist, a prototype of the highest quality of secondary and tertiary care for cardiovascular diseases. Data indicate that internists generated hospital costs that were consistently higher than family physicians. Moreover, a comparison of costs generated by internists, family physicians, and cardiologists in managing patients with cardiovascular diseases revealed that cardiologists generated lower costs than the other two types of specialists. It is believed that case studies such as this will provide evidence that will enable undergraduate medical students to reflect upon their own attitudes toward their developing role as "generators of cost".