Medicare and Medicaid

This is a timely, comprehensive examination of the history, current status, and future prospects of Medicare. It provides an analysis of Medicare's accomplishments and failings, an assessment of alternative approaches to remedying the problems, a discussion of the principles that can guide the choice among options, and the authors' recommendations for reform. The book is based on a careful consideration of the health care needs of the elderly, and reflects the work of physicians, gerontologists, lawyers, former Medicare administrators, health economists, political scientists, and experts on government and public policy. Professionals and policy-makers will appreciate this thoughtful examination of the Medicare program.

Although it does not seem unusual to us that professionals be compensated for the product or service they provide, there are some professions that make us feel uncomfortable with the necessity of payment. Paying the Doctor explores this dilemma as it relates to the health care field. It analyzes and explains the influence of the health care provider, patient, and market influences in cost and reimbursement. Part introductions to each section familiarize the reader with the specific concerns of each section, and an overall conclusion describes the major points of a planned future payment system.

Social Security and Medicare are of compelling concern to virtually all Americans because they impact lives so enduringly and directly through the protection they afford and the costs they entail. It is, indeed, the extraordinary social welfare commitment these programs represent and their concomitant expense that provoke such determined support and such fiscal concern. Kingson and Berkowitz provide a thorough, balanced, and highly accessible explanation of Social Security and Medicare. They explain the dilemmas facing policymakers and describe, through historical development, how the programs evolved and their present status. The authors superbly convey the complexity of issues while also clearly presenting the factual information essential to the understanding and discussion. Such key considerations as the adequacy of protection, the financing problems, issues of fairness, the response to disability, and the health care needs of the elderly are particularly focused on--the authors' are sensitive to the social welfare nature of the programs. A truly essential book not only for the classroom but the offices and living rooms of writers, administrators, planners, policymakers, social service practitioners, and the general public.

Blevins examines the program's origins, its evolution, and future policy options.

This report analyzes four types of special payments that Medicare has been making rural hospitals and physicians. These special payments are intended to support the rural health care infrastructure to help ensure access to care for Medicare beneficiaries. The research provides a comprehensive overview of these payments, including documentation.

This brilliantly argued book shows that the gloom and doom that surround so much public discussion about America's welfare state stem from simple, attractive-- and false-- ideas about social welfare programs and how they work.

This book focuses on how a distinctly American product--managed care--got its start, how it works, and what needs to be adjusted in the future. As Birenbaum makes clear, this book is about social change. It is about doctors contracting with health maintenance organizations (HMOs) and being subject to their rules; about the limited access to specialty care; and about the frugal use of hospital admissions and stays. Consumers and providers have had mixed experiences in these health-delivery systems. Birenbaum, a health-policy analyst, has created a synthesis of research studies and analyses of trends to chronicle these developments and to suggest remedies to correct the most unjust aspects of managed care.

Fraud and abuse bleeds more than 100 billion dollars each year out of the U.S. health system. This detailed examination shows the problem is worse than almost anyone knows, mostly invisible, and still far from controlled. Sparrow reveals that current control systems fail by presenting fraud perpetrators with a safe, easy-to-hit target: fully automated check-printing systems, which only require thieves to bill "correctly", regardless of whether or not any medical service is provided. This target attracts an extraordinary range of criminal entrepreneurs, from low-life hoods who sign on as Medicare or Medicaid providers equipped with nothing more than beepers and mailboxes, to drug trafficking organizations, organized crime syndicates, even major hospital chains. Sparrow's research examines the much-misunderstood effects of managed care on the problem, the government's recent attempts to grapple with fraud, and the campaign by various provider associations to undermine those efforts.