Medicare-Designated Centers for Cardiac Transplantation

On June 27, 1986, the U.S. Department of Health and Human Services (HHS) announced that Medicare would soon begin to provide reimbursement for heart transplantations.1 Although HHS is to be commended for recognizing the nonexperimental nature of these procedures, despite their inherent cost, and for attempting a rational matching of national resources with the needs of U.S. citizens,2 , 3 this landmark decision is certain to generate lively debate both within and outside the medical community.The purpose of this article is not to debate the correctness of the HHS decision but rather to address how regulation should best be implemented. The . . .