Collective Accountability for Medical Care — Toward Bundled Medicare Payments

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Abstract
Medicare's projected spending growth is unsustainable. The program already strains the resources of beneficiaries and taxpayers alike and will someday crowd out other public- and private-sector priorities, given that Medicare spending as a percentage of the gross domestic product is expected to nearly double in the next 20 years. At the same time, neither beneficiaries nor taxpayers are getting good value from the program. Per-beneficiary spending in high-spending regions of the country exceeds that in low-spending regions by one third, and yet beneficiaries in high-spending regions receive no better quality of care.1 The incentives inherent in the dominant fee-for-service payment . . .