Improving the Medicare Market Adding Choice and Protections (1996) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-10
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This call for smaller government comes in the wake of a dramatic revolution that continues to take place in the private health care sector, characterized by the move to managed care, increased vertical and horizonal integration, and new partnerships and relationships among insurers, providers, and purchasers in an increasingly competitive marketplace. All of these changes and new dynamics have placed a special focus on the need to reform the Medicare program to make it more efficient and to secure its future viability.
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Strategies to reform and preserve Medicare focus on redesigning elements of the 31-year-old program to reflect some of the major financing and organizational changes revolutionizing the provision of health care services in the private sector. Chief among these changes has been a major influx of the population under age 65 into managed care, viewed by many researchers and policy specialists as holding the potential for providing more appropriate, quality services at costs lower than those of fee-forservice plans.
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The existing fee-for-service Medicare program, which consists of a traditional indemnity insurance arrangement, would remain available. As major efforts move forward to shift Medicare patients into managed care plans, many experts and patient advocates are concerned whether the necessary information and protections are in place to enable Medicare patients to select an appropriate health care plan wisely and to ensure that this group continues to have access to high-quality care.2 The potentially daunting scope and speed of the transition by elderly Americans into what for most beneficiaries remains uncharted waters makes the need for high-quality and trustworthy information and accountability particularly critical.
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Whether or not current Medicare reform legislation eventually becomes law, private industry and the Health Care Financing Administration (HCFA) are poised to lend a big boost to the managed care market for the elderly, a market already showing signs of rapid expansion.
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discuss options and strategies that can be used to help government and the private sector achieve the desired goals in this arena; and • to produce a report that will include the commissioned background papers, a summary of the symposium discussion, and recommendations on the major issues that need to be addressed to ensure public accountability and the availability of information for informed purchasing by and on behalf of Medicare beneficiaries in managed care and other health care delivery options. The study was initiated in the fall of 1995 with the expectation that Medicare legislation providing broader beneficiary choice would pass the U.S.
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In considering its work and statement of task, the committee had to be mindful of the relatively short time frame within which this report had to be completed and the limited resources available to support the commissioned papers/research syntheses and the symposium activity. Given the committee's broad charge and the many issues that potentially fall under the rubric of ensuring public accountability and informed purchasing in an environment of choice and managed care, the committee believed that it was important and essential to set some priorities, parameters, and caveats regarding its work agenda.
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The committee heard evidence that the move to a choice paradigm with an emphasis on managed care represents greater challenges and problems for the current generation of Medicare beneficiaries, particularly the older cohort. With the increasing role of managed care, there is every expectation that future Medicare beneficiaries will have had considerable experience with this new delivery structure and therefore will be better informed and more comfortable consumers of managed care.
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The committee's major charge and responsibility was to provide direction and guidance on how to promote public accountability and informed purchasing by and on behalf of Medicare beneficiaries in a new market-oriented environment characterized by choice and managed care. The committee was cognizant that in the new health care marketplace, Medicare beneficiaries as consumers or customers will be given both greater freedom and more responsibility for choosing their health plans and for making many of the important decisions associated with purchasing their health care and judging its value, adequacy, and responsiveness.
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This resource should be developed at the na 3For the purpose of this report, the term Medicare choices is an umbrella term for alternative health plans (including managed care) as well as traditional Medicare and Medigap plans.
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when they act in their professional role as advocates for their patients and carry out their contractual responsibilities and receive eco nomic incentives as health plan providers. The committee favors the abolition of payment incentives or other practices that may motivate providers to evade their ethical responsi bility to provide complete information to their patients about their illness, treatment options, and plan coverages.
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