Doctoral Dissertation Research: Elected Politicians and Unelected Bureaucrats: Agency Rulemaking and Medicare Physician Payment Reform

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9409300 Aldrich This Doctoral dissertation Research Support project examines congressional oversight of federal bureaucratic agencies. It aims to answer several questions, including: To what extent do members of Congress engage in supervision of bureaucratic behavior themselves, as opposed to delegating oversight authority to interest groups affected by agency decisions? How effective are various forms of oversight in constraining agency discretion? The project's central hypothesis is that political influence on bureaucratic behavior is most prevalent and effective not through formal mechanisms such as congressional subcommittee hearings, but through informal channels such as meetings between bureaucrats and interest groups affected by agency rules. The project tests this theoretical proposition by focusing on a major health care issue: payments by the Medicare program to physicians treating Medicate patients. In 1989, Congress mandated the development of a fee schedule, a payment mechanism which prospectively sets the amounts that Medicate pays for all physician services. Through a series of regression equations, this project assesses the impact of various types of formal and informal oversight on the setting of payment levels. These results are significant in that they represent one of the first empirical examinations of congressional oversight and provide insight into the politics of health care reform.