Date of Award
Master of Science in Health Care Management
Charles W. Sampson
This thesis will evaluate several proposals to reform the Medicare system and how those proposals differ in terms of focus on either financial restructuring or care delivery redesign. This thesis proposes that an emphasis on managed care strategies will represent an effective way to reform the Medicare system.
The purpose of the study is to consider how a shift in focus from acute care treatment to illness prevention and chronic disease management would salvage the Medicare program. The thesis will further explore how an acute care focus has affected the Medicare program, turning a social policy into fuel that feeds spiraling of health care costs and enables a dysfunctional delivery system.
The Medicare program developed as a safety net to help the elderly and disabled pay for medically necessary medical care. Based on a fee-for-service model, the program quickly ran up costs and fueled the expansion of acute care in the health care delivery system . The naivete that supported a reimbursement system that rewarded overuse and dependency on acute care persisted for nearly thirty years, despite little evidence supporting that the Medicare program has significantly improved the health of Medicare beneficiaries, the majority of whom suffer from illness have chronic disease.
Medicare reform became a political hot button for several presidencies . Spiraling costs caused tax payers to question the efficacy of the fee-for-service system. The desire for freedom of choice versus increasing costs made managed care alternatives more popular. Those parties guilty of fraud and abuse of the Medicare system found increased government initiatives to curb their profiteering.
This study reviews the classic fee-for-service Medicare program and attempts to discern whether managed care hybrids will improve the system in terms of financial solvency, improved health outcomes, and/ or chronic disease management. Results of this study produced insufficient evidence to suggest that managed care alone could restore solvency to the Medicare trust fund and refocus providers on prevention and chronic disease management. A compromise of both financial restructuring over the short-term, and care delivery redesign focusing on chronic disease management and prevention over the long term, appears to represent the best hope for saving Medicare.
Barhoumy, Gina M., "The Medicare Program: Ripe for Reform" (1998). Theses. 348.
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