Physician Payment Reform and the Implementation of the Medicare Fee Schedule: AnInstitutional and Resource Dependency Perspective

摘要

The purpose of this thesis was to gain an understanding of the formation andimplementation of the objectives of the Medicare Fee Schedule as set forth in the Omnibos Budget Reconciliation Acts of 1989 and 1990. The research for this thesis was approached by employing the methodology suggested by the institutional and resource dependency theories of organizational behavior. Archival research was the primary technique used to obtain data describing behavioral and fiscal trends associated with Medicare Part B and the Medicare Fee Schedule. Analytic and empirical research techniques were also applied to facilitate identification of organizations active in the reform environment. Research findings were used to construct the model of the Department of Health and Human Services organizational environment on which the analysis was based. Findings include: (a) a fragmented pre-reform organizational environment, (b) general consensus regarding the concept of physician payment reform among the Department of Health and Human Services and organizations active in the environment, (c) disagreement and coalition building in the organizational environment in response to the Department of Health and Human Services proposed rule and (d) effective pressure group politics by special interest groups in gaining the congressional support needed to convince the reform administrator to engage in major payment reform rule revisions.