Developments in aging, 1967 : a report of the special committee on aging United States Senate pursuant to S. Res. 20, February 17, 1967 resolution authorizing a study of the problems of the aged and aging together with minority views.

  • United States Senate Special Committee on Aging
Date:
1968
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Licence: Public Domain Mark

Credit: Developments in aging, 1967 : a report of the special committee on aging United States Senate pursuant to S. Res. 20, February 17, 1967 resolution authorizing a study of the problems of the aged and aging together with minority views. Source: Wellcome Collection.

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    A still more fundamental point was made by Dr. Martin Cherkasky, the same hospital administrator who had found so much to praise in part A:” | | It is becoming increasingly obvious that the way services are paid for has direct and immediate implications on the way services are delivered and organized. There is really no such thing as just a program for financing health care. Part B of medicare, although making specific allowances for prepaid group practice, really-is a payment system designed to ex- pand and enrich solo, fee-for-service practice. In one stroke it effectively sabotages the movement toward broad, compre- hensive total coverage for the aged. Among its major defects is the lack of payment for preventive health examination. Further, it separates doctor services from hospital, from ex- tended care and nursing home service. Payment is made to physicians on the basis of charges or fees, and to institutions on the basis of costs. The aged patient is confused and harassed by deductibles and coinsurance. Still in the early stages of its inquiry, the Subcommittee on Health of the Elderly cannot now make recommendations on deductibles, coinsurance, and reimbursement. It would draw the attention of those now studying aspects of the program, however, to these observa- tions from Dr. Cherkasky: ” ge You know, all of us * * * thought that part B was going to pay for medical costs, for doctors’ costs. When.one con- siders the hospital benefit deductible and coinsurance, the lack of coverage for drugs and dental care, it is safe to say, I believe, that less than 50 percent of the total medical-care costs incurred by the aged are being covered by title 18, parts A and B. This is a far cry from what we thought we were doing with this legislation. | The main message, however, that I wish to bring to your attention this morning is one of principle and concept. Structurally, the fundamental defect in title 18 1s the separation of part A and part B. This separation is unfortunate not only because of rts administrative difficulties which have turned out to be legion but because it has tended to freeze existing modes of medical practice and prevented major innovative developments in the delivery of health services. [Emphasis added.] The implications of Dr. Cherkasky’s statement are vast, but certainly well worth careful attention in the continuing evaluation of the vitally needed, historic medicare program. Three-day hospitalization requirement.—Title 18 requires ** that a beneficiary be hospitalized for a minimum of 3 days as a condition to eligibility for extended care and home health care benefits. Testi- mony received by the subcommittee leads to the conclusion that instead of saving medicare funds, this requirement results in unnec- essary hospitalization and unnecessary expenditures in order to qualify elderly patients for that which many of them really need, extended care or home health care benefits, beth of which. are less costly than hospitalization. 1QORROS 44 Sage 2 P, 394, hearings cited px 39; footnote 2. ven 23 Page 387, hearmgs cited p. 39, footnote 2. a 24 Subsecs, (i) and (nm), sec. 1861, Social Security Act.
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