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September 15, 1999

Medicare Fee for Service: A Model of Managed Care?

Author Affiliations

Copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1999

JAMA. 1999;282(11):1037. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-11-jac90008

To the Editor: The American Heritage Dictionary1 defines the word managed as "to exert control over." I propose that Medicare fee-for-service (FFS) medicine is not only managed care, but managed care's best model.

Fee-for-service Medicare may appear unmanaged: patients go to whatever clinician they want, who then bills for each service rendered or diagnosis treated; the bill is then paid by Medicare. "Unmanaged" may have described yesterday's Medicare, but not today's. Medicare is a managed care system, although differently managed compared with preferred provider organizations and health maintenance organizations. Were it not, Part A would already be bankrupt, and the Part B premium would have escalated precipitously.

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