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You are here > Home > Reading Lists > Healthcare Policy & Politics > Medicare Prospective Payment and the Shaping of U.S. Health Care Medicare Prospective Payment and the
Shaping of U.S. Health Care Hardcover: 264 pages
Here, Rick Mayes and Robert A. Berenson, M.D., explain how Medicare’s innovative payment system triggered shifts in power away from the providers (hospitals and doctors) to the payers (government insurers and employers) and how providers have responded to encroachments on their professional and financial autonomy. Mayes and Berenson draw from interviews with more than sixty-five major policy makers — including former Treasury secretary Robert Rubin, U.S. Representatives Pete Stark and Henry Waxman, former White House chief of staff Leon Panetta, and former administrators of the Health Care Financing Administration Gail Wilensky, Bruce Vladeck, Nancy-Ann DeParle, and Tom Scully — to explore how this payment system worked and its significant effects on the U.S. medical landscape in the past twenty years. This is the definitive work on Medicare’s prospective payment system (PPS), which had its origins in the 1972 Social Security Amendments, was first applied to hospitals in 1983, and came to fruition with the Balanced Budget Act of 1997. They conclude with a discussion of the problems with the Medicare Modernization Act of 2003 and offer prescriptions for how policy makers can use Medicare payment policy to drive improvements in the U.S. health care system. They argue that, although managed care was an important agent of change in the 1990s, the private sector has not been the major health care innovator in the United States; rather, Medicare’s transition to PPS both initiated and repeatedly intensified the economic restructuring of the U.S. health care system. "An exhaustively researched and provocative tale of the politics behind how doctors and hospitals are paid in America—and the roots of our health care morass." —Atul Gawande, MacArthur Fellow, author of Complications: A Surgeon’s Notes on an Imperfect Science "An invaluable resource on the political history of why Medicare is the 800 pound gorilla of U.S. health care. Mayes and Berenson skillfully challenge the assumptions of those convinced that Medicare should be restructured around private health plans. They've produced a policy book that is actually enjoyable to read." —David Durenberger, chair, National Institute of Health Policy at the University of St. Thomas "Thoughtful, scholarly, and analytically
powerful, this book is important for understanding and evaluating the
prospective payment system and its impact on Medicare and the health care
industry. A good read, with a wealth of historical anecdote and interview
material. The final recommendations should be required reading for anyone
seeking to reform Medicare or move toward national health insurance."
—David G. Smith, Swarthmore College "Quite simply a must read for students of U.S. health care. For those who want to understand what Medicare has done to control its spending, how federal payment policies affect the private sector in health care, and what Medicare can do now to strengthen its cost controls, there is no better place to start." —Jonathan Oberlander, University of North Carolina, Chapel Hill, author of The Political Life of Medicare "Mayes and Berenson tell a fantastic, ironic story about how a price-regulatory reform in our government-run Medicare program drastically changed private-sector health care to be more commercialized and profit driven. This is a must read for anyone wanting to understand the managed care revolution, the managed care backlash, and why the competitive strategy is viewed with great skepticism today." —Colleen M. Grogan, University of Chicago "A brilliant history of Medicare's success in taming medical inflation by controlling prices and a sobering account of the challenge of runaway expenditures caused by inflation in the volume and intensity of utilization. This book sets the stage for the debate over Medicare's role in ensuring the quality and efficiency of health care." —John E. Wennberg, director, Center for the Evaluative Clinical Sciences, Dartmouth Medical School "The story of Medicare's futile struggle to control its costs, and a convincing demonstration of the need for major reform of the health insurance system. This is an important contribution." —Arnold S. Relman, Harvard Medical School, former editor-in-chief, New England Journal of Medicine "For trans-Atlantic spectators of the U.S.
scene, this book provides an invaluable analysis of the role of Medicare in
shaping U.S. health care. Reading it made me realize that seeing Medicare
simply as a program for elderly people is to miss its wider impact and its
potential for the future development of health care in the United States.
Its willingness to question conventional wisdom and shrewd analysis make it
an important contribution to the literature." —Rudolf Klein, London
School of Economics and London School of Hygiene Rick Mayes, Ph.D., is an assistant professor of public policy at the University of Richmond and a faculty research fellow at the Petris Center on Healthcare Markets and Consumer Welfare at the UC-Berkeley School of Public Health. He is the author of Universal Coverage: The Elusive Quest for National Health Insurance and the coauthor of Medicating Children: ADHD and the Politics of Mental Health. Robert A. Berenson, M.D., is a senior fellow at the Urban Institute and coauthor of The Managed Care Blues and How to Cure Them . From 1998 to 2000, he was in charge of Medicare payment policy and managed care contracting in the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services). If you are interested in policy or books about health care reform, please see our up-to-date collection here: Politics, Policy & Reform. (information provided by the publisher) You may also be interested in / The Directory of Healthcare Recruiters / Jump to a List / Health Administration & Leadership / Physician Executive, Medical Staff & Practice Management / Finance, Accounting, Economics, Billing & Reimbursement / Coding for Hospital, Physician & Clinical Services / Law, Malpractice, Ethics, Accreditation & Compliance / Quality Improvement, Outcomes & Customer Service / Risk Management, Security, Error Reduction & Patient Safety / Information Systems, Technology & Medical Records / Clinical Management & Executive Nursing / Behavioral Health, Social Work & Psychiatry Management / Human Resources, Management & Supervision / Directories, Data, Trends & Benchmarks / Software & CD-ROMs / Gift Ideas & Recommended Gifts / Journals, Magazines & Newsletters / Politics, Policy & Reform / Search for Books / Books Index / Go to / Home Page / Toolbox for Health Administrators / Bookstore |
