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Full-Text Articles in Health Policy
The Reverberating Risk Of Long-Term Care, Allison K. Hoffman
The Reverberating Risk Of Long-Term Care, Allison K. Hoffman
All Faculty Scholarship
The Fiftieth Anniversary of Medicare and Medicaid offers an opportunity to reflect on how American social policy has conceived of the problem of long-term care. In this essay, based on a longer forthcoming article, I argue that current policies adopt too narrow a conception of long-term care risk, by focusing on the effect of serious illness and disability on people who need care and not on the friends and family who often provide it. I propose a more complete view of long-term care risk that acknowledges how illness and disability reverberates through communities, posing insecurity for people beyond those in …
Strategies For Health Care Cost Containment (1980s-Present), Rick Mayes
Strategies For Health Care Cost Containment (1980s-Present), Rick Mayes
Political Science Faculty Publications
The U.S. health care system during the past three decades has been over two interrelated questions: first, who will control the manner in which medical care is paid for, and, second, how much will it cost? Many health care experts believe that Medicare's efforts at cost control, primarily in the form of the program's seminal transition to and continual modification of prospective payment of health care providers, has both triggered and repeatedly intensified the economic restructuring of the U.S. health care system. Medicare is an almost $600 billion public health insurance program for individuals sixty-five years of age and older; …
Medicare: What Is In Store For Future Generations?, Karen L. Poon
Medicare: What Is In Store For Future Generations?, Karen L. Poon
Honors Scholar Theses
Medicare is the health insurance coverage provided to all senior citizens over the age of 65. It has been around since 1965. This paper takes an in-depth look into the Medicare program. First, the history behind Social Security is introduced. The Medicare program was created as an addition to Social Security, and its history follows. Although the ideas and goals of the Medicare program have good intentions, there are many issues with it. These problems are discussed in detail in the current issues portion of the paper. As a follow up, I have expanded upon and come up with some …
Postmortems On The Affordable Care Act (Book Review), Rick Mayes
Postmortems On The Affordable Care Act (Book Review), Rick Mayes
Political Science Faculty Publications
Nearly two years after the Affordable Care Act became law, books are appearing by Washington insiders who detail how the legislation came about. The two reviewed here discuss and dissect topics related to the health reform law from decidedly different points of view.
Pay-For-Performance Reimbursement In Health Care: Chasing Cost Control And Increased Quality Through "New And Improved" Payment Incentives, Rick Mayes, Jessica Walradt
Pay-For-Performance Reimbursement In Health Care: Chasing Cost Control And Increased Quality Through "New And Improved" Payment Incentives, Rick Mayes, Jessica Walradt
Political Science Faculty Publications
Pay-for-performance (P4P) reimbursement has become a popular and growing form of health care payment built on the belief that payment incentives strongly affect medical providers' behavior. By paying more to those providers who are deemed to deliver better care, the goal is to increase quality and, hopefully restrain cost growth. This article provides a brief explanation of: (1) how previous P4P plans in the U.S. have fared, along with their special relationship to primary care, and (2) how England's experience with P4P and newer versions of these kinds of plans being pursued in places such as Massachusetts might provide valuable …
The Way It Was In Health Policy, And Probably Will Be: Learning Lessons By Rashi Fein (Book Review), Rick Mayes
The Way It Was In Health Policy, And Probably Will Be: Learning Lessons By Rashi Fein (Book Review), Rick Mayes
Political Science Faculty Publications
Learning Lessons by Rashi Fein is an enjoyable memoir from a scholar and policy adviser unlike any other. Fein’s influential involvement in health care policy dates back to John F. Kennedy’s administration, and his career as a leading health economist paralleled the significant growth in the political influence of health economists following the enactment of Medicare and Medicaid in 1965. Now an emeritus professor of the economics of medicine at Harvard Medical School, Fein writes here about the lessons he learned in medicine, economics, and public policy. His view of the policy process, as a way of coming to …
Pursuing Cost Containment In A Pluralistic Payer Environment: From The Aftermath Of Clinton’S Failure At Health Care Reform To The Balanced Budget Act Of 1997, Rick Mayes, Robert E. Hurley
Pursuing Cost Containment In A Pluralistic Payer Environment: From The Aftermath Of Clinton’S Failure At Health Care Reform To The Balanced Budget Act Of 1997, Rick Mayes, Robert E. Hurley
Political Science Faculty Publications
Following a decade in which Medicare operated as the leading ‘change agent’ within the US health care system, the private sector rose to the fore in the mid 1990s. The failure of President Clinton’s attempt at comprehensive, public sector-led reform left managed care as the solution for cost control. And for a period it worked, largely because managed care organizations were able to both squeeze payments to selective networks of medical providers and significantly reduce inpatient hospital stays. There was a lot of ‘fat’ in the nation’s convoluted health care system that could be (and was) eliminated through competitive negotiations …
The Origins Of And Economic Momentum Behind "Pay For Performance" Reimbursement, Rick Mayes
The Origins Of And Economic Momentum Behind "Pay For Performance" Reimbursement, Rick Mayes
Political Science Faculty Publications
"Pay for performance," a reimbursement method under which some physicians and hospitals are paid more than others for the same services because they have been deemed to deliver better quality care and their patients appear to have better outcomes, is enormously controversial. Disputes invariably arise over how "quality" should (or even can) be measured. Nevertheless, differentiating between medical providers, financially, lies at the heart of this new reimbursement innovation developed by insurance companies and employers. Its two main objectives are: (1) to increase the overall quality of health care that patients receive, and (2) to encourage behavioral change on the …
Medicare And America's Healthcare System In Transition: From The Death Of Managed Care To The Medicare Modernization Act Of 2003 And Beyond, Rick Mayes
Political Science Faculty Publications
This article traces the transition-in Medicare, specifically, and in the American healthcare system, generally-from the aftermath of the Balanced Budget Act of 1997 to the passage of the Medicare Modernization Act of 2003. During this time, restrictive managed care died under an onslaught of resurgent cost pressures, legislative and legal attacks, and a vehement physician and consumer backlash. The subsequent reversion to more generous (and more expensive) health plans coincided with a recession in 2001 to trigger a return to rapidly escalating healthcare spending and yet another in the Nation's series of healthcare crises. Current trends suggest that future policymakers …
Universal Coverage And The American Health Care System Crisis (Again), Rick Mayes
Universal Coverage And The American Health Care System Crisis (Again), Rick Mayes
Political Science Faculty Publications
Ten years after President Clinton’s ambitious attempt at comprehensive health care reform died, several old and new issues with the health care system have emerged. First, the number of uninsured Americans rose to 43.6 million in 2002—and the numbers have since increased. Also, the costs for those who do not have insurance are rapidly increasing. In addition health care related problems are one of the leading causes of personal bankruptcy in the United States. Finally, the government’s two primary health insurance programs—Medicare and Medicaid—are experiencing considerable financial strain. Dr. Mayes examines these problems in depth before and revisits President Clinton’s …