Contemporary high-level health care is at its most productive when there is interplay among clinical services, research and education. A service that provides access to patients for research and teaching, for instance, will attract high-quality practitioners to senior hospital positions. There is international variation in how these partnerships are sustained. For example, in Malaysia, the entire budget of its three principal teaching hospitals is provided by the Ministry of Higher Education (http://iiumedic.net/imjm/v1/download/Volume%2011% 20No%202/Vol11No2%20Pg01-02%20%28Editorial %29.pdf). In Australia, informal relations among universities, research workers (and institutes) and educators have been financed in mixed and informal ways by federal and state health budgets and universities. These arrangements have attracted critical attention in an era when support for activity-based funding of clinical services is gathering strength.
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