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1966 Medicare and Medicaid, Champus, and CPT - the Impact on Healthcare, Access, Technology, and Reimbursement.

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The program went into effect on July 1, 1966, to provide health insurance protection for the aged. The primary goal of the program was to increase access to health care services and to reduce the financial burden of the high costs of medical care

The 1972 Social Security Amendments expanded Medicare to provide coverage, beginning July 1, 1973, to two additional high-risk groups—disabled persons receiving cash benefits for 24 months under the social security program and persons suffering from end-stage renal disease.

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Medicaid operates primarily as a vendor payment program. Payments are made directly to providers of service for care rendered to eligible individuals. Methods for reimbursing physicians and hospitals vary widely among States, but providers must accept the Medicaid reimbursement level as payment in full

Medicaid physician reimbursement is generally more stringent than Medicare. In long-term care facilities, individuals are required to turn over income in excess of their personal needs and maintenance needs of their spouses to help pay for their care. States may require cost-sharing by Medicaid recipients, but they may not require the categorically eligible to share costs for mandatory services. As noted earlier, most State Medicaid programs have buy-in agreements with Medicare. Under these agreements, Medicaid assumes responsibility for the Medicare cost-sharing obligation of persons covered under both programs.

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In the early years of Medicare and Medicaid, there were relatively few data bases, statistical reports, and research studies to draw on for program analysis. In more recent years, a wealth of statistical information and studies have become available

These include the article on national health expenditures published in the Health Care Financing Review each year (Gibson et al., 1984); Medicare and Medicaid Data Book (Sawyer et al., 1983); Short-Term Evaluation of Medicaid: Selected Issues (Rymer, Burwell, and Madigan, 1984); reports from the National Medical Care and Expenditure Survey (National Center for Health Statistics and National Center for Health Services Research, 1977) and the National Medical Care Utilization and Expenditure Survey (National Center for Health Statistics and Health Care Financing Administration, 1980); data from the National Center for Health Statistics, the U.S. Bureau of the Census, and the Social Security Administration; hundreds of published articles analyzing many aspects of the programs; and surveys and reports from other governmental agencies and from the private sector on the sociodemographic characteristics of the populations covered by Medicare and Medicaid. In general, Medicare program data are more complete than those available for the Medicaid program. This fact is reflected in numerous indepth studies of the Medicare program experience that cannot be duplicated for Medicaid.

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Without a doubt, Medicare stimulated some forms of healthcare innovation, namely development and preponderance of medical devices, growth of hospitals, and creation and diffusion of imaging and diagnostic technologies—all innovations driven by Medicare’s generous reimbursements

But fueling investment in these forms of innovation had a high opportunity cost. In addition to its financial unsustainability and impending bankruptcy, Medicare crowds out development of cost-effective treatments, discourages organizational and care delivery innovation, and prevents development of personalized, patientcentered, and preventive care. Five decades of Medicare experiment offer one clear lesson: regulatory complexity overwhelms innovation and efficiency. Innovation involves learning to do the unknown, and efficiency involves learning to do the known better. To improve on either margin, entrepreneurs must be able to experiment with new ideas. And regulation is the killer of experimentation because it restricts the spectrum of possible solutions.

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Twenty years of Medicare and Medicaid: Covered populations, use of benefits, and program expenditures. Marian Gornick, Jay N. Greenberg, Ph.D., Paul W. Eggers, Ph.D., and Allen Dobson, Ph.D.

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