In invited testimony before the House Energy and Commerce Committee's Subcommittee on Health in July 2006, the Fund's Stuart Guterman emphasized that Medicare can use its role in financing health care to improve the performance of the Medicare program and the health care system as a whole.⁽¹⁴⁾ "Determining how much to pay physicians certainly is an important issue," Guterman said, "but determining how to pay physicians so Medicare beneficiaries get the best care possible is of at least equal importance." Noting the marked deficiencies in quality and coordination of care throughout health care, he argued for paying greater attention to what the nation receives for the money it devotes to health care.

In addition to financial incentives to support quality improvement in Medicare, there is a need for objective, reliable evidence of the benefits, risks, and costs of new medical procedures and technologies to support decision-making on the part of patients, clinicians, payers, and policymakers. In a Fund-supported Health Affairs Web Exclusive, Gail Wilensky, Ph.D., called for the creation of an entity to generate, collect, and disseminate comparative information about the effectiveness of health care treatments.⁽¹⁵⁾ Wilensky will next examine the necessary policy conditions for realizing such a vision. The Fund will also support the development of a framework for identifying, disseminating, and applying better evidence for coverage, payment, and clinical decision-making.

Columbia University's William Sage, M.D., J.D., and Indiana University's Eleanor Kinney, J.D., M.P.H., meanwhile, argue for Medicare taking a leadership role in malpractice reform. In a Fund-supported article, they propose that malpractice disputes be adjudicated by Medicare's existing administrative appeals system, in conjunction with the program's quality improvement regulation and payment policy, to decrease errors and provide compensation for injured patients.⁽¹⁵⁾ Congress has taken note of this issue; Sage testified on the subject before the Senate's Committee on Health, Education, Labor, and Pensions in June 2006.⁽¹⁶⁾

The Fund will continue to conduct analyses and develop policy recommendations to ensure that Medicare beneficiaries receive appropriate, effective, and efficient health care. With rising health care costs, concerns about the quality and appropriateness of care, and a population increasingly dealing with multiple chronic conditions, Medicare faces considerable challenges. In coming years, the Program on Medicare's Future will focus on strengthening the program's effectiveness for its beneficiaries and building Medicare's role in achieving a high performing health system.