Care Delivery Options Research Articles

Medicare+Choice Appeal Procedures: Reconciling Due Process Rights and Cost Containment

By signing the Balanced Budget Act of 1997 (BBA) on August 5, 1997, President Clinton made the most significant changes to Medicare, since its inception in 1965, by adopting market-driven reforms in an effort to balance the federal budget. One of the most significant Medicare reforms in the BBA was the creation of the Medicare+Choice program that provides Medicare beneficiaries access to a wide array of private health plan choices as well as traditional fee-for-service (FFS) Medicare. In addition, Medicare+Choice enables Medicare to further utilize delivery innovations, including preferred provider organizations (PPOs), openended health maintenance organizations (HMOs), point-of-service plans, provider sponsored organizations (PSOs), integrated delivery systems (IDSs) and primary care case management, that have helped the private sector contain costs and expand health care delivery options.

Health Care Delivery

The effective delivery of comprehensive health care service to young handicapped children is a challenge for physicians and the health care profession. The field has attempted to respond to this need by expanding the options for health care delivery beyond single-physician services. New organizational arrangements—such as Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Tax Supported Direct Service Programs, Hospital-Based Services, Ambulatory Care Organizations, and others—have emerged to broaden the available options. This article reviews these emerging health care delivery options and compares cost structures, quality of care, and future prospects.