The elusive quest for quality and cost savings in the Medicare program.

Medicare is a dominant force in the health care system of the United States. When it was launched as a national social insurance program for elderly and disabled Americans in 1965, Medicare was grafted onto the existing health care delivery system. Over the past 40 years, most physicians and hospitals have continued to receive regulated payments from Medicare with no limits on the volume of services provided and minimal oversight or coordination of care. In 2009, Medicare expenditures will exceed $400 billion, representing 13% of the federal budget and about one-fifth of all US expenditures on health care. (February 2009)