Medicare’s shift from passive payer to active purchaser of health care

Dr Robert Hrisak head shot

I submitted the following letter to the editors of local newspapers on September 1, 2009.  Events over the past fours years have done nothing to convince me that the government has changed their approach to health care.

While the debate on health care reform rages in Washington, D.C. and around the country, an important change is already underway in government-funded health care, specifically Medicare.  In the Fall 2008 edition of “The Pulse of CMS” published by the Philadelphia Regional Office of the Centers for Medicare and Medicaid Services (CMS), “…CMS reiterates its commitment to implementing Value Based Purchasing and transforming Medicare from a passive payer to a prudent purchaser of health care.”  An August 20, 2009 e-mail entitled “Medicare Demonstrations Show Paying for Quality Health Care Pays Off” states that “[t]he CMS value-based purchasing (VBP) initiative is designed to tie Medicare payments to performance on quality and efficiency and is part of CMS’ effort to transform Medicare from a passive payer to an active purchaser of higher quality, more efficient health care.”

Improving the quality of health care is a noble goal, but what are the implications of Medicare’s shift from “passive payer” to “active purchaser?”  What is the role of the individual patient when the government assumes the role of purchaser of health care?  I submit that the government is assuming the parental role in making health care decisions, relegating the patient to the status of dependent child.

I have been a doctor for 30 years.  I have seen the government and insurance companies assume a larger and larger role in health care decisions.  While they certainly have the right to decide what services they will cover, I believe that the patient should have the final decision in matters of health care.  Patient choice and the patient-doctor relationship are vital for good health care; they will be diminished when Medicare becomes the active purchaser of health care.

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