Medicare Reform
Administrative Challenges in Managing the Medicare Program
Research Report
Richard Sorian, Georgetown University Health Policy Institute
Michael E. Gluck, Ph.D, Georgetown University Health Policy Institute
December 2004
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As the federal health care program for over 40 million older Americans and certain persons with disabilities, Medicare is large and complicated, and effective management is critical to its success. Policymakers discussing how to continue meeting the needs of Medicare beneficiaries would be well served by recognizing the range of responsibilities that are involved in administering the program.
In this AARP Public Policy Institute Issue Paper, Michael E. Gluck, Ph.D. and Richard Sorian describe the scope of activities necessary for managing the Medicare program and identify challenges faced by federal administrators in performing these tasks. The study was conducted while the authors were at Georgetown University's Health Policy Institute.
The authors focus primarily on administrative tasks of particular importance to beneficiaries:
- educating and informing Medicare beneficiaries
- using information technology as a tool in performing functions such as paying claims
- making national coverage determinations for Medicare
- administering private health plans
The paper also includes discussion of other administrative tasks, such as combating waste, fraud and abuse in Medicare and ensuring that Medicare beneficiaries receive high quality care. The report is based in part on interviews in the fall of 2001 with individuals knowledgeable about Medicare management and policy. (93 pages)
Pub ID: 2004-15