VLADIMIRHACHINSKIMD, FRCPC, DScFrom Neurology Associates, Billings, Mont.
THE US Medicare program was established in the 1960s as a collaboration between government and physicians to make health care more accessible and affordable to the elderly and disabled. For the first 20 years or so, the program worked relatively well. However, with advances in medical technology and therapeutics in the 1980s, costs skyrocketed. Government responded with increasingly complex regulations and restraints on reimbursements. In the 1990s, the quest for savings in health care costs has gone from lean to mean. The private sector has entered a painful era of draconian cuts in services and aggressive mergers and acquisitions. Government has progressed beyond price controls and regulatory red tape to aggressive investigation and prosecution of putative fraud and abuse of the federal largess. The relationship between Medicare's government stewards, the Health Care Financing Administration (HCFA), and medical providers has increasingly become adversarial. The thrust of each new set of regulations is met by a parry of changes in the behavior of providers.
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