Resolving the tug-of-war between medicare's national and local coverage

Susan Bartlett Foote, Douglas R Wholey, Todd H Rockwood, Rachel Halpern

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Medicare's decentralized local coverage policy process leads to policy variation, raising serious equity and quality issues. The policy debate resembles a tug-of-war, with advocates favoring nationalization of all local policies or arguing for the status quo. We extensively analyzed thousands of local policies and surveyed Medicare's contractors. We found that all local policies are not the same. We classified them based on where they fall on the diffusion curve. The classification by type allows for reallocation to the national or local process to improve the decisions and satisfy Medicare's equity and quality goals.

Original languageEnglish (US)
Pages (from-to)108-123
Number of pages16
JournalHealth Affairs
Issue number4
StatePublished - Jul 2004


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