American Political Science Review · 1998 · 286 citations · 43 references
Public AffairsHealth AdministrationHealth PolicyAdministrative ProcedureHealthcare PolicyMedicare PolicyAdministrative ReformBureaucracyBureaucratic BehaviorBureaucratic ControlMedicare FinancingMedicare RegulationAdministrative PoliticsHealth Care Financing PolicyHealth Care PoliticsMedicare Physician Services CoveragePhysician Payment SystemsPolitical Control Of AgenciesPolitical Control Of BureaucracyPolitical Oversight Of Bureaucracy
Administrative procedures are theorized to strengthen political control by steering agencies toward legislators' preferred policy choices, yet this deck‑stacking claim has rarely been empirically tested. This study evaluates how the notice‑and‑comment procedure functions during Medicare physician payment reform. The authors analyze the notice‑and‑comment process within the Medicare physician payment reform, a major overhaul of Medicare’s payment system. The results show HCFA responded more to physicians anticipating fee cuts than to the program’s beneficiaries, indicating that notice‑and‑comment may not function as a political control tool.
Positive theorists have argued that administrative procedures enhance political control of the bureaucracy, in part by predisposing agencies toward policy choices preferred by legislators' favored constituents. Although this “deck-stacking” argument has been both influential and controversial, few scholars have subjected it to empirical examination. This article assesses the operation of a prominent administrative procedure—the notice and comment process—in the context of Medicare physician payment reform, a fundamental restructuring of the way in which the Medicare program pays for physician services. I find, contrary to the deck-stacking thesis, that the Health Care Financing Administration (HCFA) was more responsive to physicians expecting reductions in fees than to the intended beneficiaries of the new payment system. Although these results do not necessarily imply that Congress exerted little influence over HCFA decision making, they suggest that certain administrative procedures do not operate as instruments of political control.
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Bureaucracy: what government agencies do and why they do it
Choice Reviews Online · 1990 · 3.9K citations
The Social Transformation of American Medicine
Judith Walzer Leavitt, Paul Starr · The American Historical Review · 1984 · 3.3K citations