title: A tale of four cities: Medicare reform and competitive pricing.
abstract: The current payment system for Medicare + Choice (M + C) plans is based on prices calculated from administrative records. This system has been criticized as arbitrary, inefficient, and unfair. Most Medicare reform proposals would replace the current payment system with some form of competitive pricing. However, efforts over the past five years to demonstrate competitive pricing for M + C plans have been blocked repeatedly by Congress, even when the demonstrations were directly responsive to a congressional mandate. In the absence of political support, a demonstration of competitive pricing may be infeasible, and Congress could be forced to take the risky step of implementing broad Medicare reforms with very little information about their effects.
authors.affiliation: Division of Health Services Research and Policy, University of Minnesota, USA.
authors.forename: B
authors.initials: B
authors.lastname: Dowd
authors.forename: R
authors.initials: R
authors.lastname: Coulam
authors.forename: R
authors.initials: R
authors.lastname: Feldman
mesh_terms: D001130:Arizona; D015142:Baltimore; D014487:Centers for Medicare and Medicaid Services, U.S.; D003120:Colorado; D016536:Competitive Medical Plans / Q000458:organization & administration*; D018166:Health Care Reform / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D007615:Kansas; D018854:Managed Competition; D020398:Medicare Part C / Q000458:organization & administration*; D010865:Pilot Projects; D011057:Politics; D011445:Prospective Payment System / Q000458:organization & administration*; D014481:United States