Medicare's governance and structure: A proposal

Health Affairs

Volumn 19, Issue 5, 2000, Pages 60-71

  Etheredge, Lynn ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

FORECASTING; GOVERNMENT; HEALTH CARE PLANNING; HEALTH CARE POLICY; HUMAN; MEDICAID; MEDICARE; ORGANIZATION; ORGANIZATION AND MANAGEMENT; REVIEW; UNITED STATES;

DECISION MAKING, ORGANIZATIONAL; FORECASTING; HEALTH CARE REFORM; HEALTH POLICY; HUMANS; MEDICAID; MEDICARE; ORGANIZATIONAL INNOVATION; ORGANIZATIONAL OBJECTIVES; STATE HEALTH PLANS; UNITED STATES; UNITED STATES CENTERS FOR MEDICARE AND MEDICAID SERVICES; UNITED STATES DEPT. OF HEALTH AND HUMAN SERVICES;

EID: 0034263285     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.19.5.60     Document Type: Article

References (8)

1. In 1991 a blue-ribbon report noted that without strengthened management "HCFA's responsibilities gradually will be carried out less and less effectively until the lack of organizational effectiveness is generally recognized as having reached crisis proportions. At that point, reaction will likely involve reorganizing and shifting responsibilities away from HCFA - poor remedies for the failure to build and maintain HCFA's institutional strength and effectiveness." National Academy of Public Administration, An Agency at Risk (Washington: NAPA, June 1991), xvi. Also see U.S. General Accounting Office, Medicare: HCFA Faces Multiple Challenges to Prepare for the Twenty-first Century, Pub. no. GAO/T-HEHS-98-85 (Washington: GAO, 1998).
2. Medicare Preservation and Improvement Act of 1999, S. 1895, cosponsored by Sen. John Breaux (D-LA) and Sen. Bill Frist (R-TN), available online at rs9.loc.gov.
3. Current funding levels: NIH ($18 billion), HRSA ($300 million), and Medicare graduate medical education funding ($6.2 billion).
4. The Departments of Agriculture and Interior have 98,000 and 68,000 employees, respectively. The Social Security Administration has 60,000 permanent positions. HHS, excluding HCFA, has 57,000 full-time-equivalent positions. For sources for budet and employment estimates cited, see The President's FY 2001 Budget for the Department of Health and Human Services (Washington: DHHS, January 2000), 55-92; Budget of the United States Government, Fiscal Year 2001, various tables (Washington: U.S. Government Printing Office, 2000); and Congressional Budget Office, The Budget and Economic Outlook: Fiscal Years 2001-2010, Table 4-6 (Washington: CBO, January 2000).
5. The Departments of Agriculture and Interior have 98,000 and 68,000 employees, respectively. The Social Security Administration has 60,000 permanent positions. HHS, excluding HCFA, has 57,000 full-time-equivalent positions. For sources for budet and employment estimates cited, see The President's FY 2001 Budget for the Department of Health and Human Services (Washington: DHHS, January 2000), 55-92; Budget of the United States Government, Fiscal Year 2001, various tables (Washington: U.S. Government Printing Office, 2000); and Congressional Budget Office, The Budget and Economic Outlook: Fiscal Years 2001-2010, Table 4-6 (Washington: CBO, January 2000).
6. Over time, a number of other responsibilities have been added, including implementing the Health Insurance Portability and Accountability Act (HIPAA) of 1996 (regulation of state insurance markets) and the Clinical Laboratory Improvement Act (CLIA) Amendments of 1997 (regulation of clinical laboratories).
7. The SHPA would also be a logical home for the HIPAA state insurance market regulation responsibilities HCFA now has.
8. HCFA, A Profile of Medicare (Washington: HCFA, May 1998), 32.