given the leverage of the federal government, this leadership will result in improvements in the safety and quality of health care provided to all americans. in 2002, about 87 percent of medicare beneficiaries were covered by the medicare fee-for-service (ffs) program; 13 percent of beneficiaries were enrolled in medicare+choice and cost-based health maintenance organizations (hmos) (centers for medicare and medicaid services, 2002b). over half of medicaid expenditures are for long-term care services, with the majority going to institutional long-term care providers (centers for medicare and medicaid services, 2000a). at the core of the program is a direct care system of military treatment facilities (mtfs), which provide most of the care delivered to active-duty personnel and over half of that provided to tricare beneficiaries overall. trends in the epidemiology of health and disease and in medical science and technology have profound implications for health care delivery. thus, the majority of u.s. health care resources is now devoted to the treatment of chronic disease (anderson and knickman, 2001). effective care of a person with a chronic condition is a collaborative process, involving extensive communication between the patient and the multidisciplinary team (wagner et al., 2001). at the program level, the predilection of each government program to design and operate its health care quality enhancement processes independently is a serious problem. medicaid provides residential care to the disabled and mentally retarded and long-term care for the elderly as a major part of program spending. capitation is a payment arrangement in which health plans are paid a fixed amount for each enrollee under their care, regardless of the level of services needed by and actually provided to the person. the medicare+choice program has initiated demonstration projects to pilot the application of capitated payments adjusted for health status (centers for medicare and medicaid services, 2000d). the committee believes enhancements can be made in both capitated and ffs payment approaches to encourage the provision of quality health care. the design and financing of some government health care programs result in frequent changes in eligibility and delivery system options that disrupt patterns of care delivery. the current practice of promulgating separate regulations for each type of provider (e.g., hospital, home health agency, nursing home, ambulatory care provider) has produced excessive burdens and barriers to the provision of coordinated care.
“testimony before the subcommittee on health of the house committee on ways and means hearing on promoting disease management in medicare.” online. 2001. health information on the internet: accessibility, quality, and readability in english and spanish. washington dc: u.s. department of health and human services. “program information on medicare, medicaid, schip, and other programs of the centers for medicare & medicaid services.” online. department of health and human services. 2000. secretary of the department of health and human services, report to congress: safeguards for individuals with special health care needs enrolled in medicaid managed care. baltimore md : u.s. department of health and human services. 2000. health and health care, 2010: the forecast, the challenge. 2000. update on the nation’s health care system: 1997-1999. health aff (millwood) 19 (6):206-16. lindberg, d., and b. humphreys. 2001. one-third at risk: the special circumstances of medicare beneficiaries with health problems. 1998. how good is the quality of health care in the united states? health serv res 26 (1):53-74. stewert, m. 1995. effective physician-patient communication and health outcomes: a review. 1997. satisfaction and choice: a view from the plans. 2001. the quality of care for depressive and anxiety disorders in the united states. the third in the series of books from the quality of health care in america project, this well-targeted volume will be important to all readers of to err is human and crossing the quality chasm – as well as new readers interested in the federal government’s role in health care.
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