in the last decade. Major shifts have occurred in the settings in which care is delivered. Payment modes have changed for hospital services and are expected to change for physician services. New, capitated alternatives to fee-for-service care are emerging. We do not know, and may never know, the full impact of these and other changes on the quality of health care.

The basic purpose of this study has been to develop a quality assurance program, and a strategy for implementing that program, that will permit rapid identification of any threats to the quality of care for the elderly, and, indeed, will be able continuously to improve the quality of that care.



Appendix A briefly describes the Medicare Catastrophic Coverage Act of 1988 (MCCA) (P.L. 100–360), which was enacted in July of that year and represented the most significant expansion of Medicare benefits since the inception of the program in 1965. The MCCA was repealed in November 1989 as a result of pressure from the elderly concerning the financing of the new benefits.


By comparison, the Consumer Price Index, a general measure of inflation, has increased from a base of 100 in 1967 to 340.4 in 1987. Similarly, the Medical Care Price Index rose from 100 in 1967 to 462.2 in 1987 (NCHS, 1989).


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Christensen, S. and Kasten, M. Covering Catastrophic Expenses Under Medicare. Health Affairs 7:79–93, Winter 1988.

Committee on Ways and Means, U.S. Congress, House of Representatives. Background Material on Programs Within the Jurisdiction of the Committee on Ways and Means. Washington, D.C.: U.S. Government Printing Office, March 1989.

CRS (Congressional Research Service, U.S. Library of Congress). Catastrophic Health Insurance: Medicare. CRS IB-87–106. Washington, D.C.: U.S. Government Printing Office, June 1988.

CRS. Medicare: Its Use, Funding, and Economic Dimensions. 89–143 EPW. Washington, D.C.: U.S. Government Printing Office, March 1989.

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GAO (General Accounting Office). Medicare Catastrophic Act. Options for Changing Financing and Benefits. GAO/HRD-89–156. Washington, D.C.: General Accounting Office, September 1989.

Gornick, M., Greenberg, J.N., Eggers, P.W., et al. Twenty Years of Medicare and Medicaid: Covered Populations, Use of Benefits, and Program Expenditures. Health Care Financing Review (Annual Supplement): 13–58, 1985.

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