Once just a small part of the Medicare program, private managed care plans now cover over one-third of all Medicare beneficiaries and cost the Federal government ~$210 billion each year. Importantly, the evolution of Medicare managed care policy has been far from linear; for several decades there have been dramatic shifts in the payment and regulatory policies facing private Medicare managed care plans.
This article presents a critical review of the history of Medicare managed care payment and regulatory policies and discusses the role of political ideology and stakeholder influence in shaping the direction of policy over time.
As Medicare Advantage
becomes an increasingly prominent area of focus for the health services, health policy
, and medical research communities, it is important to bear in mind the highly political history of the program, the role of stakeholder influence in shaping the direction of policy, and to understand the historic barriers to evidence-based policymaking.