Why is medical education so expensive?

Dear Editor: The world currently spends $100 billion annually on medical education [1]. This seems like a massive amount at a macroeconomic level. At a microeconomic level, medical school tuition fees in many countries are now as high as $14,000 per year. This will seem like a massive amount to an 18-year-old school leaver from an average financial background. Economic depressions make both figures seem even larger-to the state and to the individual. With so much cost at stake-at a financial and human level-I believe that it is worth asking why medical education is so expensive. Searching for the answers leads to some unexpected places. When a product or service is expensive, we naturally assume that this is because it costs a lot to produce or provide it. However, that is not always the case. Tuition fees are a case in point. They have risen in recent years but it may be that the rise is not a real one. The fee rises but the size of low interest student loans rises with it-logic would suggest that the rising tuition fee is necessitating the rise of the student loan-but could the opposite be happening? What would happen to house prices if the government guaranteed very low interest loans to anyone who wanted to buy a house (and said that you only needed to pay it back when you got a job)? House prices would naturally rise. Could the ubiquitous availability of very low interest loans similarly be driving inflation in tuition fees? Another factor that can drive price and that is unrelated to the cost of production is demand. If the demand for goods or services increases, so will the price. Certainly, the demand for medical education is high. The ratio of applicants to medical school to accepted candidates is 16:1 [2]. It is unsurprising that with this level of competition prices will rise. Along with demand comes supply. Limited supply also drives price. Most medical schools are allowed to admit only a limited number of students each year and so the supply is constrained. Even if schools were allowed to admit more students, then the traditional model of education that is still used by many of them would mean that they could not deliver the same education to significantly more students. Only by rethinking the model of provision could they achieve this. The movement towards massive open online courses …