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Medicare, the Aging of America, and the Balanced Budget

  • Chapter
Cardiovascular Health Care Economics

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

Medicare is the United States’ health insurance program for people over the age of 65 (85%), those with certain disabilities (10%), and those with end-stage renal disease requiring dialysis or transplant (5%). In 1965, it was established with Title XVIII of the Social Security Act to provide elderly Americans access to health care, regardless of their socioeconomic status, and now enrolls approximately 35 million elderly (see Fig. 1). In 1999, Medicare spent $214 billion, which accounts for 18% of all national health care expenditures and 39% of all US public health care spending. For comparison, private health insurance accounted for $401 billion in expenditures, whereas Medicaid expenditures were $188 billion.

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References

  1. McClellan M. Medicare reform: fundamental problems, incremental steps. J Econ Perspectives 2000; 14: 21–44.

    Article  CAS  Google Scholar 

  2. Medicare Payment Advisory Commission. Report to Congress: Selected Medicare Issues, June 1999.

    Google Scholar 

  3. Fuchs V. Medicare reform: the larger picture. J Econ Perspectives 2000; 14: 57–70.

    Article  CAS  Google Scholar 

  4. Newhouse J. Medicare. Conference on Economic Policy During the 1990s. Kennedy School of Government, 2001.

    Google Scholar 

  5. Physician Payment Review Commission. Annual Report to Congress 1996.

    Google Scholar 

  6. Riley G, Tudor C, Chiang YP, Ingber M. Health status of Medicare enrollees in HMOs and fee-for-service in 1994. Health Care Financ Rev 1996; 17: 65–76.

    Google Scholar 

  7. Guadagnoli E, Landrum MB, Peterson EA, et al. Appropriateness of coronary angiography after myocardial infarction among Medicare beneficiaries. Managed care versus fee for service. N Engl J Med 2000; 343: 1460–1466.

    Article  PubMed  CAS  Google Scholar 

  8. Every NR, Cannon CP, Granger C, et al. Influence of insurance type on the use of procedures, medications and hospital outcome in patients with unstable angina: results from the GUARANTEE Registry Global Unstable Angina Registry and Treatment Evaluation. J Am Coll Cardiol 1998; 32: 387–392.

    Article  PubMed  CAS  Google Scholar 

  9. Carlisle DM, Siu AL, Keeler EB, et al. HMO vs fee-for-service care of older persons with acute myocardial infarction. Am J Public Health 1992; 82: 1626–1630.

    Article  PubMed  CAS  Google Scholar 

  10. Heidenreich P, McClellan M, Frances C, Baker L. The relation between managed care market share and the treatment of elderly fee-for-service patients with myocardial infarction. Am J Med 2002; 112: 176–182.

    Article  PubMed  Google Scholar 

  11. Baker LC. The effect of HMOs on fee-for-service health care expenditures: evidence from Medicare. J Health Econ 1997; 16: 453–481.

    Article  PubMed  CAS  Google Scholar 

  12. Baker LC. Association of managed care market share and health expenditures for fee-for-service Medicare patients. JAMA 1999; 281: 432–437.

    Google Scholar 

  13. Medicare Payment Advisory Commission. Report to Congress: Medicare Payment Policy, March 2000.

    Google Scholar 

  14. Silversmith J. The impact of the 1997 Balanced Budget Act on Medicare, Part II. Minn Med 2001; 84: 47–54.

    Google Scholar 

  15. Skinner J, Wennberg J. How much is enough? Efficiency and medicare spending in the last six months of life. In: Cutler D (ed.) The Changing Hospital Industry. University of Chicago Press; Chicago, IL, 1999, pp. 169–193.

    Google Scholar 

  16. Cutler D. Walking the tightrope on medicare reform. J Econ Perspectives 2000; 14: 45–56.

    Article  CAS  Google Scholar 

  17. Medicare Payment Advisory Commission. Report to Congress: Medicare Payment Policy, March 1999.

    Google Scholar 

  18. Schoenman JA, Hayes KJ, Cheng CM. Medicare physician payment changes: impact on physicians and beneficiaries. Health Aff 2001; 20: 263–273.

    Article  CAS  Google Scholar 

  19. Dickler R, Shaw G. The Balanced Budget Act of 1997: its impact on U.S. teaching hospitals. Ann Intern Med 2000; 132: 820–824.

    PubMed  CAS  Google Scholar 

  20. Iglehart JK. Support for academic medical centers-revisiting the 1997 Balanced Budget Act. N Engl J Med 1999; 341: 299–304.

    Article  PubMed  CAS  Google Scholar 

  21. Marwick C. AAMC analyzes 1997 Balanced Budget Act. Association of American Medical Colleges. JAMA 1999; 281: 1781 - 1782. http://www.medpac.gov.

  22. Gold M. Medicare+Choice: An Interim Report Card. Health Aff 2001; 20: 121–138.

    Google Scholar 

  23. Laschober MA, Neuman P, Kitchman MS, et al. Medicare HMO withdrawals: what happens to beneficiaries? Health Aff 1999; 18: 150–157.

    Article  CAS  Google Scholar 

  24. Medicare Payment Advisory Commission. Report to Congress: Improving Risk Adjustment in Medicare, June 1999.

    Google Scholar 

  25. Medicare Payment Advisory Commission. Report to Congress: Medicare Savings Accounts and the Medicare Program, November 2000.

    Google Scholar 

  26. Stanton T. Fraud And Abuse Enforcement in Medicare: Finding Middle Ground. Health Aff 2001; 20: 28–42.

    CAS  Google Scholar 

  27. Slade S. The False Claims Act and Health Care Fraud: How Far Does the Act Reach? 2000. www.fraudbuster.com/page10.html.

    Google Scholar 

  28. Anderson G, Hussey P. Health and Population Aging: A Multinational Comparison. The Commonwealth Fund, New York, NY, 1999.

    Google Scholar 

  29. Reinhardt U. Health Care for the Aging Baby Boom: Lessons from Abroad. J Econ Perspectives 2000; 14: 71–83.

    Article  CAS  Google Scholar 

  30. Cutler D. Declining Disability Among the Elderly. Health Affairs 2001; 20: 11–27.

    Google Scholar 

  31. Stuck AE, Walthert JM, Nikolaus T, et al. Risk factors for functional status decline in community-living elderly people: a systematic literature review. Soc Sci Med 1999; 48: 445–469.

    Article  PubMed  CAS  Google Scholar 

  32. Pinsky JL, Jette AM, Branch LG, et al. The Framingham Disability Study: relationship of various coronary heart disease manifestations to disability in older persons living in the community. Am J Public Health 1990; 80: 1363–1367.

    Article  PubMed  CAS  Google Scholar 

  33. Croft JB, Giles WH, Pollard RA, et al. Heart failure survival among older adults in the United States: a poor prognosis for an emerging epidemic in the Medicare population. Arch Intern Med 1999; 159: 505–510.

    Article  PubMed  CAS  Google Scholar 

  34. Heidenreich P, Kagay K, McClellan M. Trends in survival following a new admission for heart failure. J Am Coll Cardiol 2001; 37 (Abstract) 502A.

    Article  Google Scholar 

  35. Pashos CL, Newhouse JP, McNeil BJ. Temporal changes in the care and outcomes of elderly patients with acute myocardial infarction, 1987 through 1990. JAMA 1993; 270: 1832–1836.

    Google Scholar 

  36. Krumholz HM, Radford MJ, Ellerbeck EF, et al. Aspirin in the treatment of acute myocardial infarction in elderly Medicare beneficiaries. Patterns of use and outcomes. Circulation 1995; 92: 2841–2847.

    Article  PubMed  CAS  Google Scholar 

  37. Krumholz HM, Radford MJ, Wang Y, et al. National use and effectiveness of beta-blockers for the treatment of elderly patients after acute myocardial infarction: National Cooperative Cardiovascular Project. JAMA 1998; 280: 623–629.

    Google Scholar 

  38. Krumholz HM, Chen J, Murillo JE, et al. Clinical correlates of in-hospital costs for acute myocardial infarction in patients 65 years of age and older. Am Heart J 1998; 135: 523–531.

    Article  PubMed  CAS  Google Scholar 

  39. Krumholz HM, Chen J, Murillo JE, et al. Admission to hospitals with on-site cardiac catheterization facilities: impact on long-term costs and outcomes. Circulation 1998; 98: 2010–2016.

    Article  PubMed  CAS  Google Scholar 

  40. Weintraub WS, Craver JM, Jones EL, et al. Improving cost and outcome of coronary surgery. Circulation 1998;98(19 Suppl):1I23–1128.

    Google Scholar 

  41. Otto CM, Lind BK, Kitzman DW, et al. Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med 1999; 341: 142–147.

    Article  PubMed  CAS  Google Scholar 

  42. Morell VO, Daggett WM, Pezzella AT, et al. Aortic stenosis in the elderly: result of aortic valve replacement. J Cardiovasc Surg (Torino) 1996; 37 (6 Suppl 1): 33–35.

    CAS  Google Scholar 

  43. Mullany CJ. Aortic Valve Surgery in the Elderly. Cardiol Rev 2000; 8: 333–339.

    Article  PubMed  CAS  Google Scholar 

  44. Olsson M, Granstrom L, Lindblom D, et al. Aortic valve replacement in octogenarians with aortic stenosis: a case-control study. J Am Coll Cardiol 1992; 20: 1512–1516.

    Article  PubMed  CAS  Google Scholar 

  45. Goldsmith I, Lip GY, Kaukuntla H, Patel RL. Hospital morbidity and mortality and changes in quality of life following mitral valve surgery in the elderly. J Heart Valve Dis 1999; 8: 702–707.

    PubMed  CAS  Google Scholar 

  46. Grossi EA, Zakow PK, Sussman M, et al. Late results of mitral valve reconstruction in the elderly. Ann Thorac Surg 2000; 70: 1224–1226.

    Article  PubMed  CAS  Google Scholar 

  47. Hlatky M, McDonald K, Saynina O, Garber A, McClellan M. Utilization and Outcomes of the Implantable Cardioverter Defibrillator, 1987–1995. Am Heart J.

    Google Scholar 

  48. Moss AJ, Hall WJ, Cannom DS, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med 1996; 335: 1933–1940.

    Article  PubMed  CAS  Google Scholar 

  49. Every NR, Hlatky MA, McDonald KM, et al. Estimating the proportion of post-myocardial infarction patients who may benefit from prophylactic implantable defibrillator placement from analysis of the CAST registry. Cardiac Arrhythmia Suppression Trial. Am J Cardiol 1998;82: 683–685, A8.

    Google Scholar 

  50. Heidenreich PA, McClellan M. Trends in treatment and outcomes for acute myocardial infarction: 1975–1995. Am J Med 2001; 110: 165–174.

    Article  PubMed  CAS  Google Scholar 

  51. Zipes DP, Roberts D. Results of the international study of the implantable pacemaker cardioverterdefibrillator. A comparison of epicardial and endocardial lead systems. The Pacemaker-CardioverterDefibrillator Investigators. Circulation 1995; 92: 59–65.

    Article  Google Scholar 

  52. Owens DK, Sanders GD, Harris RA, et al. Cost-effectiveness of implantable cardioverter defibrillators relative to amiodarone for prevention of sudden cardiac death. Ann Intern Med 1997; 126: 1–12.

    PubMed  CAS  Google Scholar 

  53. Selton-Suty C, Hoen B, Grentzinger A, et al. Clinical and bacteriological characteristics of infective endocarditis in the elderly. Heart 1997; 77: 260–263.

    Article  PubMed  CAS  Google Scholar 

  54. Gagliardi JP, Nettles RE, McCarty DE, et al. Native valve infective endocarditis in elderly and younger adult patients: comparison of clinical features and outcomes with use of the Duke criteria and the Duke Endocarditis Database. Clin Infect Dis 1998; 26: 1165–1168.

    Article  PubMed  CAS  Google Scholar 

  55. Agnihotri AK, McGiffin DC, Galbraith AJ, O’Brien MF. The prevalence of infective endocarditis after aortic valve replacement. J Thorac Cardiovasc Surg 1995; 110: 1708–1720.

    Article  PubMed  CAS  Google Scholar 

  56. Glower DD, Landolfo KP, Cheruvu S, et al. Determinants of 15-year outcome with 1119 standard Carpentier-Edwards porcine valves. Ann Thorac Surg 1998; 66 (6 Suppl): S44 — S48.

    Article  PubMed  CAS  Google Scholar 

  57. Roddy SP, O’Donnell TF, Jr., Wilson AL, et al. The Balanced Budget Act: potential implications for the practice of vascular surgery. J Vasc Surg 2000; 31: 227–236.

    Article  PubMed  CAS  Google Scholar 

  58. Davis M, Poisal J, Chulis G, et al. Prescription drug coverage, utilization, and spending among Medicare beneficiaries. Health Aff (Millwood) 1999; 18: 231–243.

    Article  CAS  Google Scholar 

  59. Smith S, Heffler S, Freeland M. The next decade of health spending: a new outlook. The National Health Expenditures Projection Team. Health Aff 1999; 18: 86–95.

    Article  CAS  Google Scholar 

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Authors
  1. Paul Heidenreich MD, MS
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Editors and Affiliations

  1. Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA

    William S. Weintraub MD

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© 2003 Humana Press Inc., Totowa, NJ

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Heidenreich, P. (2003). Medicare, the Aging of America, and the Balanced Budget. In: Weintraub, W.S. (eds) Cardiovascular Health Care Economics. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-398-9_22

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  • DOI: https://doi.org/10.1007/978-1-59259-398-9_22

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-4684-9784-7

  • Online ISBN: 978-1-59259-398-9

  • eBook Packages: Springer Book Archive

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