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Journal of Health Politics, Policy and... Feb 2001The Medicare program incorporates a number of functions that go beyond providing health insurance to its beneficiaries. These activities, which we refer to as... (Review)
Review
The Medicare program incorporates a number of functions that go beyond providing health insurance to its beneficiaries. These activities, which we refer to as "collateral" functions, may have important health consequences but are also an increasing source of controversy. In this essay we develop a conceptual framework for categorizing these involvements, introduce some additional options that might complement Medicare's current collateral functions, assess the reaction of policy elites and Medicare's current beneficiaries to these alternatives, and evaluate the role that collateral activities play for Medicare's core mission. A case can be made for expanding some collateral involvements, but only if the Health Care Financing Administration has the strategic direction and administrative capacity to effectively implement these activities.
Topics: Aged; Centers for Medicare and Medicaid Services, U.S.; Education, Medical, Graduate; Health Policy; Hospitals, Rural; Humans; Information Services; Insurance Benefits; Medicare; Politics; Program Evaluation; Research Support as Topic; Social Responsibility; Social Welfare; United States
PubMed: 11253454
DOI: 10.1215/03616878-26-1-37 -
Medicare Brief May 1999Despite the enactment of significant changes to the Medicare program in 1997, Medicare's Hospital Insurance trust fund is projected to be exhausted just as the baby boom...
Despite the enactment of significant changes to the Medicare program in 1997, Medicare's Hospital Insurance trust fund is projected to be exhausted just as the baby boom enters retirement. To address Medicare's financial difficulties, a number of reform proposals have been offered, including several to individualize Medicare financing and benefits. These proposals would attempt to increase Medicare revenues and reduce Medicare expenditures by having individuals bear risk--investment market risk before retirement and insurance market risk after retirement. Many fundamental aspects of these proposals have yet to be worked out, including how to guarantee a baseline level of saving for health insurance after retirement, how retirees might finance unanticipated health insurance price increases after retirement, the potential implications for Medicaid of inadequate individual saving, and whether the administrative cost of making the system fair and adequate ultimately would eliminate any rate-of-return advantages from allowing workers to invest their Medicare contributions in corporate stocks and bonds.
Topics: Financing, Personal; Health Care Reform; Humans; Medicare; United States
PubMed: 10915458
DOI: No ID Found -
Applied Health Economics and Health... Oct 2015
Topics: Accountable Care Organizations; Delivery of Health Care; Health Care Reform; Humans; Medicare; United States; Value-Based Purchasing
PubMed: 26179939
DOI: 10.1007/s40258-015-0186-1 -
Health Affairs (Project Hope) Jun 2015
Topics: Humans; Insurance Coverage; Medicare; United States
PubMed: 26056214
DOI: 10.1377/hlthaff.2015.0445 -
Health Affairs (Project Hope) 2004The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 introduces means-testing of premiums and benefits in two ways. It will means-test the...
The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 introduces means-testing of premiums and benefits in two ways. It will means-test the Part B premium, setting higher premiums for better-off seniors. More importantly, it will offer much more generous drug benefits, at low or zero premiums, to lower-income beneficiaries. This paper argues that additional means-testing could improve Medicare's financial picture. It proposes a strategy in which future Medicare beneficiaries with higher incomes will pay for cost-increasing but quality-improving new technology, possibly with prefunding that begins before retirement.
Topics: Aged; Fees and Charges; Health Services Accessibility; Humans; Insurance Benefits; Insurance, Pharmaceutical Services; Medicare Part B; Middle Aged; United States
PubMed: 15590720
DOI: 10.1377/hlthaff.w4.546 -
Issue Brief (Commonwealth Fund) Jun 2015The Affordable Care Act (ACA) has provided the Medicare program with an array of tools to improve the quality of care that beneficiaries receive and to increase the...
The Affordable Care Act (ACA) has provided the Medicare program with an array of tools to improve the quality of care that beneficiaries receive and to increase the efficiency with which that care is provided. Notably, the ACA has created the Center for Medicare and Medicaid Innovation, which is developing and testing promising new models to improve the quality of care provided to Medicare beneficiaries while reducing spending. These new models are part of an effort by the U.S. Department of Health and Human Services to increase the proportion of traditional Medicare payments tied to quality or value to 85 percent by 2016 and 90 percent by 2018. This issue brief, one in a series on Medicare's past, present, and future, explores the evolution of Medicare payment policy, the potential of value-based payment to improve care for beneficiaries and achieve savings, and strategies for accelerating its adoption.
Topics: Accountable Care Organizations; Centers for Medicare and Medicaid Services, U.S.; Forecasting; Health Care Reform; Humans; Medicare; Organizational Innovation; Patient Protection and Affordable Care Act; Quality Improvement; United States; Value-Based Purchasing
PubMed: 26151988
DOI: No ID Found -
Journal of Health Economics Jul 2022Medicare pricing is known to indirectly influence provider prices and care provision for non-Medicare patients; however, Medicare's regulatory externalities beyond...
Medicare pricing is known to indirectly influence provider prices and care provision for non-Medicare patients; however, Medicare's regulatory externalities beyond fee-setting are less well understood. We study how physicians' outpatient surgery choices for non-Medicare patients responded to Medicare removing a ban on ambulatory surgery center (ASC) use for a specific procedure. Following the rule change, surgeons began reallocating both Medicare and commercially insured patients to ASCs. Specifically, physicians became 70% more likely to use ASCs for the policy-targeted procedure among their non-Medicare patients. These novel findings demonstrate that Medicare rulemaking affects physician behavior beyond the program's statutory scope.
Topics: Ambulatory Surgical Procedures; Humans; Medicare; United States
PubMed: 35580506
DOI: 10.1016/j.jhealeco.2022.102624 -
Ophthalmology Mar 2006
Topics: Humans; Insurance, Pharmaceutical Services; Medicare; Ophthalmology; Patient Education as Topic
PubMed: 16513454
DOI: 10.1016/j.ophtha.2005.12.009 -
Issue Brief (Commonwealth Fund) Oct 2018Out-of-pocket expenses are capped for enrollees in Medicare Advantage (MA) plans but not for beneficiaries in traditional Medicare, which also requires a high deductible...
ISSUE
Out-of-pocket expenses are capped for enrollees in Medicare Advantage (MA) plans but not for beneficiaries in traditional Medicare, which also requires a high deductible for hospital care. The need for supplemental Medigap coverage adds to traditional Medicare’s complexity and administrative costs. Shortfalls in financial protection also make it difficult to offer traditional Medicare as a choice for people under age 65, as some have proposed.
GOALS
Describe alternative benefit designs that would limit out-of-pocket costs for traditional Medicare’s core services, assess their cost, and illustrate financing mechanisms.
METHODS
Analysis of a $3,500 ceiling on annual out-of-pocket expenses for Parts A and B benefits and options for replacing Part A hospital cost-sharing with a $350 or $100 copayment per admission.
KEY FINDINGS
Estimates of the costs of the reforms are $36–$44 per beneficiary per month, assuming no behavioral or supplemental coverage changes. This could be financed by a $9–$11 increase in premiums combined with a 0.3-to-0.4-percentage-point increase in the Medicare payroll tax (split between employer and employees). Medicaid costs would decrease, while employers, retirees, and Medigap enrollees would see reduced premiums.
CONCLUSION
The reforms would improve affordability and put traditional Medicare on a more equal footing with MA plans. They would also make it easier to open traditional Medicare to people under age 65.
Topics: Cost Sharing; Financing, Personal; Humans; Insurance Benefits; Medicare; Medicare Part B; Medicare Part C; United States
PubMed: 30358960
DOI: No ID Found -
Health Services Research Aug 2016To describe the amount of hospital outpatient care provided to the uninsured and its association with Medicare payment rate cuts following the implementation of...
OBJECTIVE
To describe the amount of hospital outpatient care provided to the uninsured and its association with Medicare payment rate cuts following the implementation of Medicare's Outpatient Prospective Payment System.
DATA SOURCES/STUDY SETTING
We use hospital outpatient discharge records from Florida from 1997 through 2008.
STUDY DESIGN
We estimate multivariate regression models of hospital outpatient care provided to the uninsured in separate samples of nonprofit and for-profit hospitals.
PRINCIPAL FINDINGS
Hospital outpatient departments provide significant amounts of care to the uninsured. As Medicare payment rates fall, total charges and the share of charges for outpatient visits by the uninsured decrease at nonprofit hospitals. At for-profit hospitals, the share of outpatient care provided to uninsured patients increases, but there is no significant change in the number of uninsured discharges.
CONCLUSIONS
Nonprofit and for-profit hospitals respond differently to reductions in Medicare payments; thus, studies of the impact of legislated Medicare payment cuts on care of the uninsured should account for differences in hospital ownership in communities. Given that outpatient care to the uninsured includes preventive and diagnostic care procedures, reductions in this care following payment cuts may adversely affect long-run health and health care costs in communities dominated by nonprofit hospitals.
Topics: Ambulatory Care; Health Expenditures; Hospitals; Humans; Medically Uninsured; Medicare; Patient Discharge; Prospective Payment System; United States
PubMed: 26780966
DOI: 10.1111/1475-6773.12433