To further inform debates on this topic, the Fund is supporting the Medicare Rights Center in the development of narrative case histories describing the experiences of individuals in the waiting period, as well as retrospective case histories of those who have completed the waiting period and currently have Medicare coverage. The collection of narratives will be disseminated to policymakers and the media.

More than 80 percent of Medicare beneficiaries have at least one chronic condition, and the 23 percent of beneficiaries with five or more conditions account for 68 percent of all Medicare spending.⁽¹²⁾ In addition to efforts to ensure access to needed care, Fund work seeks to promote quality and efficiency within the Medicare program. Under a Fund grant, Robert Berenson, M.D., has been working to identify ways of integrating pay-for-performance efforts in the private and public sectors and bringing stakeholder groups—providers, consumers, and purchasers—together to address key issues. Marilyn Moon, Ph.D., is receiving Fund support to investigate mechanisms to improve Medicare's cost-effectiveness, including enhanced use of primary care management.

The Fund will continue to conduct analyses and develop policy recommendations to ensure that Medicare meets the health care needs of the elderly and disabled. With rising health costs, concerns about the quality and appropriateness of care, and a population increasingly dealing with chronic conditions, Medicare faces considerable challenges. In coming years, the Program on Medicare's Future will focus on strengthening Medicare's ability to perform its traditional roles and identifying ways in which Medicare can ensure that beneficiaries receive appropriate, effective, and efficient health services and better outcomes.