Redesigning the Medicare Contract: Politics, Markets, and AgencyUniversity of Chicago Press, 2003 M12 6 - 269 pages Recent debates on Medicare reform focus on prescription drug coverage, expanding managed-care choices, or technical issues of payment policy. Despite all the heat generated by these issues, Edward F. Lawlor's new book, Redesigning the Medicare Contract, demonstrates that fundamental questions of purpose and policy design for Medicare have been largely ignored. Challenging conventional ideas, Lawlor suggests that we look at Medicare as a contract between the federal government, the program's beneficiaries, and health care providers. Medicare reform, then, would involve rewriting this contract so that it more successfully serves the interests of both beneficiaries and taxpayers. To do this, Lawlor argues that we must improve the agency of the program—the informational, organizational, and incentive elements that assure Medicare program carries out beneficiary and taxpayer interests in providing the most appropriate, high-quality care possible. The book includes a chapter devoted solely to concepts and applications that give definition to this brand of agency theory. Lawlor's innovative agency approach is matched with lucid explanation of the more comprehensive groundwork in the history and politics of the Medicare program. Lawlor's important and timely book reframes the Medicare debate in a productive manner and effectively analyzes alternatives for reform. Lawlor argues that effective policy design for Medicare requires greater appreciation of the vulnerability of beneficiaries, the complexity of the program itself, its wide geographical variations in services and financing, and the realistic possibilities for government and private sector roles. Tackling difficult problems like end-of-life and high-tech care—and offering sensible solutions—Redesigning the Medicare Contract will interest political scientists, economists, policy analysts, and health care professionals alike. |
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Contents
Chapter Two Medicares Politics and the Incomplete | 25 |
Chapter Three Agency and Medicare Policy Design | 53 |
Chapter Four Medicare Managed Care | 84 |
Technology | 119 |
Chapter Six A Medicare Contract for EndofLife | 146 |
Chapter Seven Principals and Agents Realities | 181 |
Notes | 211 |
237 | |
257 | |
Common terms and phrases
administrative advance directives agency theory agent analysis approach arrangements behavior benefits budget chapter clinical Congress congressional copayments costs decisions delivery devices economic effective end-of-life enrollees enrollment example fee-for-service financing guidelines HCFA Health Affairs health care Health Insurance Health Maintenance Organization health plans Health Politics health services HMOs home health hospice care hospital implementation incentives individual Institute interests interventions Kaiser Family Foundation long-term managed care plans Medi Medicaid Medicare beneficiaries Medicare contract Medicare managed Medicare payment Medicare policy Medicare program Medicare reform Medicare's Medicare+ Choice Medigap MedPAC ment moral hazard National organizational organizations outcomes palliative care patients payers payment policy percent physicians plans and providers potential practice principal problems purchasing regional reimbursement require responsibility risk adjustment role S/HMOs significant social contract structure technology assessment tion tive total artificial heart treatment ventricular assist devices Washington