Medicare and Chronic Conditions

When the Medicare program became operational in 1966, its primary orientation was the treatment of acute, episodic illness.1,2 The design of the program's benefits, coverage policies, payments to providers, and criteria for determining medical necessity were all oriented toward the treatment of acute diseases. Medicare retained this orientation for the next 40 years in spite of the growing number of Americans with chronic conditions.3,4 The Medicare Prescription Drug Improvement and Modernization Act of 2003 was an important first step in the reorientation of the Medicare program toward the care of patients with chronic disorders. Additional changes, however, will . . .