Medicare at 25: better value and better care

Article Abstract:

How have the payment charges mandated by the Medicare Prospective Payment System (PPS), implemented in 1983, affected health care for hospitalized patients? The PPS, which gives hospitals a fixed-fee prospective payment for each patient based on the patient's diagnostic related group (DRG), is evaluated in a series of studies, reported in the October 17, 1990 issue of JAMA, The Journal of the American Medical Association. It has had (not surprisingly) a major impact on hospitals: Medicare patients stay in the hospital a shorter time post-PPS (8.5 days in 1989 versus 10 days in 1983), and the number of Medicare admissions declined after implementation. In the broad sense, the PPS is associated with an improvement in the quality of hospital care (although such results may not be directly the result of the system). Mortality within 30 days of hospital admission declined from 16.5 percent to 15.6 percent; at the same time, fewer discharged patients received poor care after PPS (12 percent of discharges in 1986, compared with 25 percent in 1982). However, all is not rosy; discharged patients were more medically unstable after PPS, undoubtedly as a result of the emphasis the payment system places on early discharge. To improve care for patients during the transition from hospital patient to outpatient, the Health Care Financing Administration, which sponsored the PPS studies, will evaluate posthospital care. The PPS itself is dynamic; new diagnosis related groups have been added and the wage index was adjusted. Moreover, the environment changes; Medicare now operates at the same financial margin as prior to the PPS. This could have a negative effect on the quality of care. The results show that health care quality does not have to be sacrificed when costs are reduced. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Mortality, Statistics, Hospitalization, Hospital patients, Hospital care, Prospective payment systems (Medical care), editorial

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Medicare reform -- now is the time

Article Abstract:

The Federal Employees Health Benefits Program may be a good model for Medicare. It is a premium-support plan; in other words, the federal government pays the same portion of the premium regardless of which health care plan the beneficiary chooses.

Health care reform

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Medicare

Article Abstract:

By the year 2010, Medicare may require increased amounts of public funds. The benefits package is already inadequate for most elderly people, 85% of whom have supplemental coverage.

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