A new approach to Medicare: Implications for health care reform and for medical education

Medicare Parts A and B engender a system of payment and delivery at odds with that of health maintenance organizations (HMOs). Most evident in the conflicting incentives and requirements levied on primary care physicians participating today in both traditional Medicare and HMOs, the dichotomy has vitiated the promise of managed care and constitutes a significant factor in both the rising cost inflation in health care and the growing dissatisfaction of patients, physicians, payers, and insurers. The resulting impact affects the robustness and quality of medical education as well as the character and quality of health care delivery. An innovative incentive-based system of payment and delivery is proposed as an alternative option for Medicare, with expectation that the system, which the authors title Medicare-New, or Part N, could trigger a more effective approach to health care reform for Medicare, foster more rational support for medical education and the care of the indigent, and benefit private insurance programs as well. Positive changes in both public and private sectors would strengthen both medical education and the access to and quality of health care throughout the nation.