Medicare accounts for 20 % of all personal health services in 1991

Letter of the law was not to interfeare with the physicians at all--ignored

1992--Medicare outlay of $130 billion--more than most governments

Benefits

physicians are encouraged to accept assignemtns and participate in the 80% of fees medicare schedule. by 1992 more than 50% were.

Financing

Significantly from current income rather than trust funds--part a is paid from trust finds, part b is paid mostly from current income--amount paid in is only 1/4 to 1/10 of the value taken out

Payment

1983 Congress acted to prevent continued price inflation by setting fixed cost-per-case rates for Medicare

1989 Congress acted to use a resource-based relative-value scale

Quality

Peer patient review has proved too un-uniform--move towards channels of care for certian conditions

The Future