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Author Moon, Marilyn.
Title Medicare now and in the future / Marilyn Moon.
Imprint Washington, D.C. : Urban Institute Press ; Lanham, MD : Distributed by University Press of America, [1993]

Author Moon, Marilyn.
Subject Medicare.
Medicare -- Forecasting.
Medicare -- Cost control.
Description xvi, 263 pages : illustrations ; 23 cm
Bibliography Note Includes bibliographical references (p. [245]-257) and index.
ISBN 0877665915 (pbk. : alk. paper)
0877665907 (casebound : alk. paper)
OCLC # 27186142
Table of Contents
1Placing Medicare in Context1
  Why Examine Medicare Now?1
  Economic Status of Older Americans5
   Prospects for the Future9
   Burdens from Health Spending10
  The Economic Status of Disabled Persons13
  The Problem of Rising Healthcare Costs13
   Use of Services16
  Medicare as Part of Federal Budget20
  Rethinking Medicare Policy21
2Assuring Access25
  The Genesis26
   Evolution of the Legislation26
   Medicare and Its Goals29
  Expansion in 197231
  Other Changes in Access33
  Who Gets What?35
   Rising Burdens of Medicare Cost Sharing36
   Geographic Variation38
3Containing Costs: impacts on Providers41
  Sources of Growth in Medicare Spending42
  Changing Medicare's Relationship with Providers45
  Hospitals Take the First Hit47
   How PPS Works50
   The Immediate Response in Delivery of Care54
   Impacts on Hospitals56
   Impact on Medicare Administration60
   Changes to Improve Hospital Payment62
  Physician Payment Reform63
   Details of the Medicare Fee Schedule66
   The Likely Impact69
  Other Provider Changes72
   Home Health Services72
   Skilled Nursing Facility Care75
4Containing Costs: impacts on Beneficiaries81
  Direct Changes in Beneficiary Cost Sharing82
   Sources of Higher Beneficiary Burdens82
   Offsetting Reductions in Beneficiary Burdens84
  Distribution of the Impact88
  PPS and Indirect Burdens on Beneficiaries91
   Effects of Shorter Hospital Stays92
   Shifting the Site of Service95
   Effects of Less Inpatient Care96
  Quality of Care96
   Medicare Physician Payment Reform and Quality97
   HMOs and Quality98
   Peer Review Organizations99
   Using Effectiveness Studies to Improve Quality100
   Program Satisfaction101
5The Medicare Catastrophic Coverage Act107
  Recognizing the Need for Catastrophic Protection107
   Setting the Stage for the Legislation109
  Evolution of the Legislation110
   Defining the Benefits111
  The Medicare Catastrophic Coverage Act: Passage and Repeal115
   Overall Beneficiary Impact119
   Winners and Losers121
   The Beginning of the End124
   The Repeal126
  Lessons for Health Policy127
   Politics of the Supplemental Premium127
   Marginal Nature of the Benefits130
   Meaning of Catastrophic Coverage131
   Role of Private Coverage132
   Ignoring the Need for Simplicity133
   Changed View of the Elderly134
6Marginal Changes and the Future139
  Restructuring Cost Sharing139
  Cost-Containment Strategies142
   HMOs and Other Managed-Care Approaches148
   Effectiveness Studies149
   Cuts Directed at Beneficiaries151
  Modest Benefit Expansions156
   Administrative Improvements and Simplifications157
   Hospice Care and the Last Year of Life159
   Preventive Services160
7Reducing the Cost of Medicare165
  Shifting Risks166
   Capitated Care Options169
  Reducing Coverage170
   Restructuring the Medicare Program171
   Substantial Increases in Medicare's Premium172
   Taxing the Value of Medicare Benefits175
  Limiting Eligibility176
   Increasing the Age of Eligibility176
   Age Rationing177
   Means-Testing Medicare180
8Expanding Medicare185
  Improving Acute Care185
   Moving an Expanded QMB Program to Medicare186
   Adding Stop-Loss Protection187
   Expanding Eligibility for Medicare188
   Adding Prescription Drug Benefit to Medicare191
  Adding Long-Term Care192
   Comprehensive Long-Term Care Coverage194
   An Income-Related Benefit196
   Limited Expansion of Medicare Benefits for Long-Term Care196
   Changing the Composition of Medicare Services198
   An Optional Long-Term Care Benefit199
9How Should Medicare Change?207
  Medicare and Broader Reform208
   Lessons from Medicare for Reform208
   Enhancing Cost Containment through Health Reform210
   Determining the Comprehensiveness of Healthcare Coverage211
  Recommendations for Getting "Here" to "There"213
  First Steps214
   Revise Cost Sharing214
   Expand the QMB Program215
   Create an Income-Related Premium216
   Expand the Hospice Program217
   Streamline Billing and Administration217
  Next Steps218
   All-Payer Regulation219
   Improve Acute-Care Coverage220
   Expand Long-Term Care Coverage221
   Require Financial Contributions Based on Ability to Pay222
 Appendix: The Mechanics of Medicare229
 About the Author265

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