population has enjoyed rapidly declining mortality rates at all ages and for both sexes. This was an unanticipated phenomenon; it followed two decades (the 1950s and 1960s) of virtually stationary rates for males and slowly declining ones for females. Reasons for the new decline are not known with certainty, but scientists believe that early diagnosis and treatment of life-threatening chronic diseases has been a major factor. If people's chances of survival improve, especially at middle and older ages, what happens to the health profile of the population? Does it worsen because the people "rescued" from death are ill, and their retention in the living population boosts prevalence rates of chronic conditions?
{"title":"Longer life but worsening health? Trends in health and mortality of middle-aged and older persons.","authors":"L. Verbrugge","doi":"10.2307/3349861","DOIUrl":"https://doi.org/10.2307/3349861","url":null,"abstract":"population has enjoyed rapidly declining mortality rates at all ages and for both sexes. This was an unanticipated phenomenon; it followed two decades (the 1950s and 1960s) of virtually stationary rates for males and slowly declining ones for females. Reasons for the new decline are not known with certainty, but scientists believe that early diagnosis and treatment of life-threatening chronic diseases has been a major factor. If people's chances of survival improve, especially at middle and older ages, what happens to the health profile of the population? Does it worsen because the people \"rescued\" from death are ill, and their retention in the living population boosts prevalence rates of chronic conditions?","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"131 1","pages":"475-519"},"PeriodicalIF":0.0,"publicationDate":"1984-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77734487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Some appealing aspects of a voucher program--promise of promoting efficiency while respecting individual preference, and capping federal expenditures--may be illusory. Adverse selection, administrative and regulatory complexity, and serious inequities are not likely to meet tests of feasibility or desirability.
{"title":"On the use of vouchers for Medicare.","authors":"H. Luft","doi":"10.2307/3349826","DOIUrl":"https://doi.org/10.2307/3349826","url":null,"abstract":"Some appealing aspects of a voucher program--promise of promoting efficiency while respecting individual preference, and capping federal expenditures--may be illusory. Adverse selection, administrative and regulatory complexity, and serious inequities are not likely to meet tests of feasibility or desirability.","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"22 1","pages":"237-50"},"PeriodicalIF":0.0,"publicationDate":"1984-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75713135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although hospital care forms the largest expenditure under Medicare, long-term reforms in the basic reimbursement system should be approached cautiously. The effects of newly mandated changes--prospective payment and DRGs--have yet to be evaluated, but some modifications should be considered for the near term. Uniform, national payment rates and adjustments for teaching are especially critical areas.
{"title":"Hospital reimbursement under Medicare.","authors":"J. Lave","doi":"10.2307/3349827","DOIUrl":"https://doi.org/10.2307/3349827","url":null,"abstract":"Although hospital care forms the largest expenditure under Medicare, long-term reforms in the basic reimbursement system should be approached cautiously. The effects of newly mandated changes--prospective payment and DRGs--have yet to be evaluated, but some modifications should be considered for the near term. Uniform, national payment rates and adjustments for teaching are especially critical areas.","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"1 1","pages":"251-68"},"PeriodicalIF":0.0,"publicationDate":"1984-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83547808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Restoring the reality of a budget constraint in the health care plans of all patients and providers--not only in the Medicare program--is the most important issue of domestic social policy in the remainder of this century. There is no case for major new earmarked taxes to "fix" Medicare unless they are elements of an overall tax structure adequate to pay for the expenditures which our political process deems necessary.
{"title":"Comment on \"Alternative Medicare financing sources\".","authors":"H. Aaron","doi":"10.2307/3349833","DOIUrl":"https://doi.org/10.2307/3349833","url":null,"abstract":"Restoring the reality of a budget constraint in the health care plans of all patients and providers--not only in the Medicare program--is the most important issue of domestic social policy in the remainder of this century. There is no case for major new earmarked taxes to \"fix\" Medicare unless they are elements of an overall tax structure adequate to pay for the expenditures which our political process deems necessary.","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"25 1","pages":"349-55"},"PeriodicalIF":0.0,"publicationDate":"1984-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81453909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Medicare program faces serious financing problems for both hospital and physician services. Spending on medical care is growing more rapidly than national income. The sources and magnitude of the problems are outlined, and a range of approaches explored. Resolution will come from coordination and interaction among several of these approaches to reducing outlays and increasing revenues.
{"title":"An introduction to the Medicare financing problem.","authors":"P. Ginsburg, M. Moon","doi":"10.2307/3349822","DOIUrl":"https://doi.org/10.2307/3349822","url":null,"abstract":"The Medicare program faces serious financing problems for both hospital and physician services. Spending on medical care is growing more rapidly than national income. The sources and magnitude of the problems are outlined, and a range of approaches explored. Resolution will come from coordination and interaction among several of these approaches to reducing outlays and increasing revenues.","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"151 1","pages":"167-82"},"PeriodicalIF":0.0,"publicationDate":"1984-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85615319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Medicare's system of paying physicians is criticized as being costly, inflationary , inefficient, inequitable , and confusing. Yet when alternative methods--to change practice arrangements, units of service, fee levels, and the assignment option--are examined, no one seems ideal. A fee-for-service system combined with a prospective payment schedule may offer the best compromise.
{"title":"How should Medicare pay physicians?","authors":"J. Hadley","doi":"10.2307/3349829","DOIUrl":"https://doi.org/10.2307/3349829","url":null,"abstract":"Medicare's system of paying physicians is criticized as being costly, inflationary , inefficient, inequitable , and confusing. Yet when alternative methods--to change practice arrangements, units of service, fee levels, and the assignment option--are examined, no one seems ideal. A fee-for-service system combined with a prospective payment schedule may offer the best compromise.","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"50 1","pages":"279-99"},"PeriodicalIF":0.0,"publicationDate":"1984-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83047935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Medicare is financed principally by taxes--some of which burden the general population and others the elderly beneficiaries. Proposals to adjust these revenue sources are evaluated for equity, efficiency, stability, and administrative costs. A package is offered to redistribute the tax burden among all groups; it may also be good health policy.
{"title":"Alternative Medicare financing sources.","authors":"S. H. Long, T. Smeeding","doi":"10.2307/3349832","DOIUrl":"https://doi.org/10.2307/3349832","url":null,"abstract":"Medicare is financed principally by taxes--some of which burden the general population and others the elderly beneficiaries. Proposals to adjust these revenue sources are evaluated for equity, efficiency, stability, and administrative costs. A package is offered to redistribute the tax burden among all groups; it may also be good health policy.","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"1 1","pages":"325-48"},"PeriodicalIF":0.0,"publicationDate":"1984-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78958959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Concern for equity of financing among the elderly must not ignore questions of equity between the needs of Medicare beneficiaries and those of the nonelderly . Modest income-related cost-sharing, combined with the merger advocated, might improve fairness , efficiency, and coverage. But fundamental reform must involve new tax policies.
{"title":"Comment on \"Medicare financing reform: a new Medicare premium\".","authors":"J. A. Meyer","doi":"10.2307/3349831","DOIUrl":"https://doi.org/10.2307/3349831","url":null,"abstract":"Concern for equity of financing among the elderly must not ignore questions of equity between the needs of Medicare beneficiaries and those of the nonelderly . Modest income-related cost-sharing, combined with the merger advocated, might improve fairness , efficiency, and coverage. But fundamental reform must involve new tax policies.","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"1 1","pages":"317-24"},"PeriodicalIF":0.0,"publicationDate":"1984-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74346049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The original and continuing promise of Medicare can be preserved only through a complex package of fiscal reforms. Central to this should be a merger of Hospital Insurance and Supplementary Medical Insurance into a single Medicare trust fund, financed in part through income-related beneficiary premiums. Benefits could be expanded, while improving access and equity.
{"title":"Medicare financing reform: a new Medicare premium.","authors":"K. Davis, D. Rowland","doi":"10.2307/3349830","DOIUrl":"https://doi.org/10.2307/3349830","url":null,"abstract":"The original and continuing promise of Medicare can be preserved only through a complex package of fiscal reforms. Central to this should be a merger of Hospital Insurance and Supplementary Medical Insurance into a single Medicare trust fund, financed in part through income-related beneficiary premiums. Benefits could be expanded, while improving access and equity.","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"14 1","pages":"300-16"},"PeriodicalIF":0.0,"publicationDate":"1984-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81976641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The federal plan to establish uniform national rates under DRGs is a triumph of conceptual neatness over sound policy; it will produce no net savings to the Medicare trust fund. Proposals to contain hospital costs have yet to deal with uncompensated care, quality assurance, and the explicit integration of long-term care.
{"title":"Comment on \"Hospital reimbursement under Medicare\".","authors":"B. Vladeċk","doi":"10.2307/3349828","DOIUrl":"https://doi.org/10.2307/3349828","url":null,"abstract":"The federal plan to establish uniform national rates under DRGs is a triumph of conceptual neatness over sound policy; it will produce no net savings to the Medicare trust fund. Proposals to contain hospital costs have yet to deal with uncompensated care, quality assurance, and the explicit integration of long-term care.","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"72 1","pages":"269-78"},"PeriodicalIF":0.0,"publicationDate":"1984-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87652805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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