Financing of care for fatal chronic disease: opportunities for Medicare reform

• Published in: The Western journal of medicine Vol. 175; no. 5; pp. 299 - 302
• Main Authors: Lynn, Joanne, Wilkinson, Anne, Etheredge, Lynn
• Format: Journal Article
• Language: English
• Published: United States Copyright 2001 BMJ Publishing Group 01-11-2001; BMJ Publishing Group LTD
• Series: Medicine and Money
• Subjects: Aged; Annual reports; Bioethics; Cancer; Chronic Disease - economics; Chronic illnesses; Death & dying; Health care expenditures; Health care policy; Health Care Reform - economics; Heart failure; Hospitals; Humans; Medical prognosis; Medicare; Nursing homes; Palliative care; Physicians; Professional education; Reimbursement Mechanisms; Stroke; United States; United States; Health Care and Public Health
• ISSN: 0093-0415; 1476-2978
• DOI: 10.1136/ewjm.175.5.299

Summary points Comprehensive and high-quality care for persons with eventually fatal chronic illness can be an adverse business strategy for providers Payment arrangements for hospice, comprehensive eldercare, and veterans offer promise of better policies Severity of illness and expectation of declining status should trigger tailored services and payment policies, rather than linking services to limited prognosis Wise policy reform requires commitment to testing innovations Better course of care Mrs Smith's physician recognized that the Smiths' situation was rife with risks. Medicare's capitation rate is not adjusted for the patient's condition, so people this sick cost their managed care provider much more than the provider receives. [...]capitated providers in Medicare have reason to enroll and retain "healthy" elderly and to make it disadvantageous for patients like the Smiths to be in their programs. 2 , 9 Indeed, a reputation for excellence in care of serious chronic illness would attract patients whose Medicare capitation would not pay for the expected costs of care.