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This paper is the text of a talk given at a symposium on the occasion of Harvard University's 350th anniversary, September 1986. In it, the author reviews the history of changes in Medicare payment policies, and notes how those changes have affected efficiency (cost containment) and access, two key aspects of the Medicare program. The author suggests that efforts to improve both efficiency and access, and to adjust the balance between them, are likely to continue well into the future.

This report is part of the RAND Corporation paper series. The paper was a product of the RAND Corporation from 1948 to 2003 that captured speeches, memorials, and derivative research, usually prepared on authors' own time and meant to be the scholarly or scientific contribution of individual authors to their professional fields. Papers were less formal than reports and did not require rigorous peer review.

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