some manner. This has implications for how the information infrastructure is developed and disseminated for this group.

Several members of the committee noted that the term beneficiary may be inappropriate in a more market-oriented health care system. In today's competitive choice environment, beneficiaries will be regarded increasingly as consumers and customers who can vote with their feet and who will need to be satisfied. The thrust of this report focuses on identifying accountability systems, resources, and the knowledge base that will help beneficiaries to become informed and effective consumers, even as it applies to traditional Medicare.

Study Approach

In considering the best way to accomplish its task, the committee arrived at a number of approaches and conclusions that shaped its agenda.

  • The committee's focus was on beneficiaries/consumers (rather than plan managers, clinicians, or payers of care). The committee used the analogy of wholesale and retail information that had been well-described in a recent paper by Lynn Etheredge (Etheredge, 1995). The success of the choice paradigm will require Medicare beneficiaries to act as consumers and individual purchasers and to move from having a passive role to having an active voice, a new role and responsibility that succeeds only if information and standards of accountability that are directly relevant, meaningful, and accessible to them are developed. Until now most of the information on quality and performance has been developed for private group purchasers, managers, clinicians, and some public payers.
  • The present study was initiated with the expectation that Medicare legislation providing broader beneficiary choice would pass the U.S. Congress before the study was completed. The committee used the Medicare provisions of H.R. 2491, the Balanced Budget Act of 1995, as a template for its work agenda and for the focus and structure for its deliberations. Although, President Clinton vetoed the final bill, the committee believes that the bill's Medicare reform provisions still provide a useful and relevant framework for reform.

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