| Details | Annual Ann F. Baum Lecture Traditionally, medical care has been understood to function under a professional paradigm; medical decisions are considered purely scientific under a standard of “medical necessity.” Medicare and Medicaid were based on this model, where economics has little sway. Over time, an alternative model, an economic paradigm, has gained traction. Under the alternative model, economics plays an important role in medical decision-making. The professional model had a strong influence on the design and structure of Medicare and Medicaid, with significant consequences in terms of cost escalation. Medicaid, in particular, has been an uncapped entitlement program of federal/state spending. About 20 years ago, Medicaid introduced managed care, which allowed for consideration of economic factors in medical decision-making. And, at the same time, the Children’s Health Insurance Program (CHIP) developed a competing model for federal/state healthcare spending. The Affordable Care Act (ACA) relied on cost savings from projected Medicare spending to fund increased access to care, a clear recognition of the salient role of economics in supporting expanded access to care. Most recently, the federal government has approved a Tennessee Medicaid waiver, essentially transferring the CHIP funding model to the context of Medicaid. The interplay of economics and program design/structure in healthcare programs, culminating in the recent Medicaid waiver for Tennessee, will form the centerpiece of this year’s Baum Memorial Lecture.
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