Commentary: health care reform and the finances of academic medical centers.

Academic medical centers (AMCs; i.e., teaching hospitals) play a vital role in the U.S. health care system by pursuing a four-part, synergistic mission of clinical care, research, education, and community health. Historically, AMCs have used margins from clinical care to subsidize the cost of the other three missions. As a result, the clinical cost structure of AMCs is higher than other hospitals. The study by McCue and Thompson in this issue of Academic Medicine identifies certain factors (such as Medicaid payer mix) that are associated with the financial success of AMCs. For national health care reform to be successful and for health care to be affordable, all providers across the United States, including AMCs, must aggressively identify and implement opportunities to make care better and more efficient. Policies that shape national health care reform must account for AMCs' higher cost structures. If policy makers ignore these higher cost structures, the ability of AMCs to provide highly specialized services, to care for vulnerable populations, to advance knowledge through biomedical research, to educate the next generation of health professionals, and to improve community health will be at risk.