Table of Contents

Acknowledgments1 IntroductionThe Policy Environment2 Prospective Payment System: DevelopmentHospital Cost ContainmentA Decisive Turning PointA Decade of DevelopmentDeveloping a ProposalLegislating the Prospective Payment SystemInitial ImplementationChronology: Prospective Payment SystemNotes3 Prospective Payment System: ImplementationImplementation ActivitiesSubstantive PolicyPPS: The FutureChronology: ImplementationNotes4 Physician Payment Reform: BackgroundMedicare: Early ImplementationThe Reagan AdministrationAction by CongressChronological: Physicians Payment: BackgroundNotes5 Physicians Payment: Designing the SystemIntroduction— The PPRCPolitics and the DeficitElements of a Fee ScheduleLegislating the Medicare Fee ScheduleChronology: Physician Payment: Designing the SystemNotes6 ConclusionTwo Payment Reforms: Alike and Not AlikeMedicare and the American Political SystemNotesGlossaryTermsMajor LegislationSelected BibliographyIndex

About the Author

David G. Smith is Richter Professor Emeritus of Political Science at Swarthmore College. He is the author of The Children's Health Insurance Program and Paying for Medicare. His book, Paying for Medicare, won the Elizur Wright Award from the American Risk and Insurance Association.

Reviews

-This is two books in one. The first reviews forces that shaped Medicare hospital reimbursement policy during the 1980s. In 1983, Congress adopted the prospective payment system (PPS), a radical departure from the retrospective, cost-based approach by which Medicare had paid hospitals since the program began in 1966. Using primary and secondary sources, Smith weaves a compelling narrative that explains how Congress, the Health Care Financing Administration (which administers Medicare), and the nation's hospitals worked together to develop and implement the new system. Although concerned primarily with the political context, Smith does an excellent job of explaining the technical complexities of PPS. The result is a first-rate political history that can be recommended to any serious student of health policy. The second half of the book deals with physician payment reform, specifically the Medicare Resource-Based Relative Value Scale (RBRVS) enacted in 1989 and implemented in January 1992... Upper-division undergraduate and up.- --B. C. Stuart, Choice

"This is two books in one. The first reviews forces that shaped Medicare hospital reimbursement policy during the 1980s. In 1983, Congress adopted the prospective payment system (PPS), a radical departure from the retrospective, cost-based approach by which Medicare had paid hospitals since the program began in 1966. Using primary and secondary sources, Smith weaves a compelling narrative that explains how Congress, the Health Care Financing Administration (which administers Medicare), and the nation's hospitals worked together to develop and implement the new system. Although concerned primarily with the political context, Smith does an excellent job of explaining the technical complexities of PPS. The result is a first-rate political history that can be recommended to any serious student of health policy. The second half of the book deals with physician payment reform, specifically the Medicare Resource-Based Relative Value Scale (RBRVS) enacted in 1989 and implemented in January 1992... Upper-division undergraduate and up." --B. C. Stuart, Choice

"This is two books in one. The first reviews forces that shaped Medicare hospital reimbursement policy during the 1980s. In 1983, Congress adopted the prospective payment system (PPS), a radical departure from the retrospective, cost-based approach by which Medicare had paid hospitals since the program began in 1966. Using primary and secondary sources, Smith weaves a compelling narrative that explains how Congress, the Health Care Financing Administration (which administers Medicare), and the nation's hospitals worked together to develop and implement the new system. Although concerned primarily with the political context, Smith does an excellent job of explaining the technical complexities of PPS. The result is a first-rate political history that can be recommended to any serious student of health policy. The second half of the book deals with physician payment reform, specifically the Medicare Resource-Based Relative Value Scale (RBRVS) enacted in 1989 and implemented in January 1992... Upper-division undergraduate and up." --B. C. Stuart, Choice