Cost and value in health professions education: key underlying theoretical perspectives

Background: Health professions education is expensive. There has been a growing realization of this cost, and this realization has led many educators to explore new models of health professions education that could be both low cost and high value. This, in turn, has led to a small but growing research base in the field. However, until now, new research and practice has largely proceeded in the absence of theory. Studies of the cost-effectiveness, cost benefit, and cost utility of health professions education have been carried out with little consideration of potential theoretical underpinnings. This article attempts to redress this current shortcoming in the literature. It outlines a number of economic theories that are likely to be most relevant to health professions education. Theories: A number of theories are available that can underpin thinking, research, and practice in the field of cost and value in health professions education. The most relevant theories include human capital theory, signaling or screening theory, the cost-of-production theory of value, the theory of supply and demand, and cost and productivity theory. These different theories offer contrasting approaches to illuminate and understand the complex nature of cost and value in health professions education. However, given the different perspectives of educational stakeholders (e.g., learners, teachers, institutions, and governments), no single theory is likely to address all their contrasting needs. Indeed, some of the theories complement each other (e.g., human capital theory and supply and demand theory) insofar as human capital is a resource that is subject to the forces of supply and demand. Conclusions: Theories that relate to cost and value in health professions education should influence research methodology and practice in this field. In turn, research findings should feed thinking about theory and should enable the development of more profound theoretical underpinnings of research.