Medicare Prospective Payment and the Shaping of U.S. Health Care

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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. Drawing on interviews with more than sixty-five major policy makers, Rick Mayes and Robert A. Berenson 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."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 Better: A Surgeon's Notes on Performance"Whether discussing the Social Security Amendments of 1972 or the Balanced Budget Act of 1997, Mayes and Berenson entertain readers with insider anecdotes about the ideological and practical battles government policymakers fought with powerful provider lobbies."--New England Journal of Medicine"This slender volume offers value on several dimensions. First, it is an explication of recent history that connects the dots from prospective payment to Medicare-based deficit reduction to cost shifting to managed care. By the same token, the story here serves as a bracing corrective to the mythology of market-based reform and the assumption that government's role in health is inescapably a negative one."--Health Affairs"A highly readable book that traces the history of Medicare prospective payment systems from their enactment in 1983 until today."--Journal of Health Politics, Policy and LawRick Mayes, Ph.D., is an associate 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 Pediatric 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).