Epidemiologic oversight of the medical care provided to Medicare beneficiaries

The Health Care Financing Administration is charged by law with the assurance of the quality of the medical care rendered to Medicare beneficiaries, a function carried out through the Peer Review Organizations. To guide and support this activity, a programme of epidemiologic surveillance of the health of such persons has been devised and is being implemented. Its focus is on the objective measures of health-mortality, morbidity, disability and expenditures for health care. Its principal components are analyses of trends in those measures over time and of their variations among geographic areas, as problem-finding techniques, and evaluations of the comparative effectiveness of strategies of management of patients, as problem-solving tools. Examples of the feasibility and utility of this strategy include an evaluation of the longitudinal impact of administrative changes undertaken in 1983-1984, the assessment of variations in patient mortality rates among hospitals, the characterization of the management of patients with ischemic heart disease, and a demonstration of a methodology for the observational evaluation of revascularization in various types of patients hospitalized for acute myocardial infarction. The objectives of the programme are the improvement of review of medical practices as carried out by the Peer Review Organizations, assistance to clinicians in the management of patients, and guidance to planners in the allocation of resources.