Health affairs
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Medicare and Medicaid need new organizational structures. At the start of a new administration, the Health Care Financing Administration (HCFA) should be replaced by separate agencies to administer Medicare (a Federal Health Programs Administration) and Medicaid plus other state grant programs (a State Health Programs Administration). A new Medicare management agency should have different centers for beneficiary services, provider payments, health plans, prescription drugs, and program development/special populations. The future Department of Health and Human Services (HHS) should have an assistant secretary for prevention and health care quality, and a new Congress should establish a Joint Health Committee.
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Under legal pressure, discussion has quickly shifted from whether health plans should disclose how they pay their physicians to how, when, and what should be disclosed and by whom. This paper describes health plans' disclosure practices and evaluates their adequacy and likely impact. It begins by explaining how different reasons for disclosure alter the form and content of disclosure, illustrating these approaches with actual examples. The paper concludes with a recommended approach that attempts to layer and stage disclosures so that people have as much information as they want, when they need it.