Delivering Health Care in America

by Shi, Leiyu; Singh, Douglas A.

• ISBN13: 9780763745127
• ISBN10: 076374512X
• Edition: 4th
• Format: Paperback
• Copyright: 2007-09-01
• Publisher: Jones & Bartlett

Summary

In a clear, cohesive format, Delivering Health Care in America provides a comprehensive overview of the basic structures and operations of the US health system—from its historical origins and resources, to its individual services, cost, and quality. Using a unique systems” approach, it brings together an extraordinary breadth of information into a highly accessible, easy-to-read text that clarifies the complexities of health care organization and finance, while presenting a solid overview of how the various components fit together. The fourth edition has been thoroughly updated with the latest information on: The global threat of avian influenza Health policy agenda of the Bush administration Progress towards Healthy People 2010 goals The effects of corporatization, information revolution, and globalization on health care delivery. The role of hospitals in the U.S. healthcare system The continuing nursing shortage Prospective payment initiatives for inpatient psychiatric facilities and inpatient rehabilitation facilities Pay-for-performance initiatives Trends in home health care services The role of long-term care hospitals and reimbursement for their services Disease management as a strategy to manage utilization The role of inpatient rehabilitation facilities Updated information on health services for special populations State strategies to provide universal coverage State Children’s Health Insurance Plan reauthorization issues The President’s Emergency Plan for AIDS Relief High-deductible health plans Insurance restructuring in Massachusetts Challenges in long-term care The era of evidence-based medicine Mandates of recent legislation such as the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and the Deficit Reduction Act of 2005

Table of Contents

Foreword	p. ix
Preface	p. xi
List of Exhibits	p. xv
List of Figures	p. xvii
List of Tables	p. xxi
List of Abbreviations/Acronyms	p. xxiii
A Distinctive System of Health Care Delivery	p. 1
Introduction	p. 2
An Overview of the Scope and Size of the System	p. 2
A Broad Description of the System	p. 4
Basic Components of a Health Services Delivery System	p. 5
A Disenfranchised Segment	p. 7
Transition from Traditional Insurance to Managed Care	p. 8
Primary Characteristics of the US Health Care System	p. 9
Trends and Directions	p. 19
Significance for Health Care Practitioners and Policymakers	p. 19
Significance for Health Care Managers	p. 20
Health Care Systems of Other Countries	p. 21
The Systems Framework	p. 28
Summary	p. 31
Test Your Understanding	p. 32
Review Questions	p. 32
System Foundations
Beliefs, Values, and Health	p. 37
Introduction	p. 38
Significance for Managers and Policymakers	p. 38
Basic Concepts	p. 39
Health Promotion and Disease Prevention	p. 44
Developmental Health	p. 45
Public Health	p. 45
Health Protection	p. 46
Quality of Life	p. 48
Determinants of Health	p. 49
Overarching Factors and Implications for Health Care Delivery	p. 53
A Social Model of Health	p. 56
Equitable Distribution of Health Care	p. 56
Justice in the US Health Delivery System	p. 60
Equality in the US Health Care Delivery System	p. 61
Integration of Individual and Community Health	p. 64
Measures of Health Status	p. 68
Evaluation of Health Status	p. 68
Demographic Change	p. 71
Measures of Mental Health	p. 72
Measures of Social Health	p. 72
Measures of Spiritual Health	p. 73
Measures of Health Services Utilization	p. 73
Summary	p. 74
Test Your Understanding	p. 74
Review Questions	p. 75
The Evolution of Health Services in the United States	p. 83
Introduction	p. 84
Medical Services in Preindustrial America	p. 85
Medical Services in Postindustrial America	p. 89
Medical Care in the Corporate Era	p. 109
Summary	p. 113
Test Your Understanding	p. 114
Review Questions	p. 115
System Resources
Health Services Professionals	p. 119
Introduction	p. 120
Physicians	p. 122
Some Key Issues in Medical Practice Involvement in the Development of Clinical Practice Guidelines	p. 128
International Medical Graduates	p. 136
Dentists	p. 137
Pharmacists	p. 138
Other Doctoral-Level Health Professionals	p. 139
Nurses	p. 140
Nonphysician Practitioners	p. 142
Allied Health Professionals	p. 146
Health Services Administrators	p. 148
Summary	p. 150
Test Your Understanding	p. 150
Review Questions	p. 151
List of Professional Associations	p. 152
Medical Technology	p. 161
Introduction	p. 162
What Is Medical Technology?	p. 163
Information Technology and Informatics	p. 163
Innovation, Diffusion, and Utilization of Medical Technology	p. 168
Managed Care and Technology Diffusion	p. 173
The Government's Role in Technology Diffusion	p. 173
The Impact of Medical Technology	p. 177
The Assessment of Medical Technology	p. 182
Current and Future Directions in Health Technology Assessment	p. 186
Summary	p. 189
Test Your Understanding	p. 190
Review Questions	p. 190
Health Services Financing	p. 197
Introduction	p. 198
The Role and Scope of Health Services Financing	p. 198
Financing and Cost Control	p. 199
The Insurance Function	p. 201
Private Financing	p. 202
Public Financing	p. 207
Miscellaneous Private and Public Programs	p. 222
The Payment Function	p. 224
National Health Care Expenditures	p. 229
Trends, Problems, and Issues in Insurance and Financing	p. 233
Summary	p. 237
Test Your Understanding	p. 238
Review Questions	p. 238
System Processes
Outpatient and Primary Care Services	p. 243
Introduction	p. 244
What Is Outpatient Care?	p. 244
The Scope of Outpatient Services	p. 245
Primary Care	p. 245
Community-Oriented Primary Care	p. 251
Primary Care Providers	p. 251
Growth in Outpatient Services	p. 253
Reasons for the Growth in Outpatient Services	p. 255
Types of Outpatient Care Settings and Methods of Delivery	p. 257
Utilization of Outpatient Services	p. 275
Summary	p. 281
Test Your Understanding	p. 282
Review Questions	p. 283
Inpatient Facilities and Services	p. 289
Introduction	p. 290
Transformation of the Hospital in the United States	p. 290
The Expansion Phase: Late 1800s to Mid-1980s	p. 294
The Downsizing Phase: Mid-1980s Onward	p. 297
Some Key Utilization Measures and Operational Concepts	p. 299
Hospital Employment	p. 304
Types of Hospitals	p. 305
What Makes a Hospital Nonprofit?	p. 315
Some Management Concepts	p. 317
Licensure, Certification, and Accreditation	p. 319
Ethical and Legal Issues in Patient Care	p. 321
Hospitals and Public Trust	p. 323
Summary	p. 324
Test Your Understanding	p. 325
Review Questions	p. 326
Managed Care and Integrated Organizations	p. 333
Introduction	p. 334
What Is Managed Care?	p. 336
Evolution of Managed Care	p. 338
Growth of Managed Care	p. 341
Efficiencies and Inefficiencies in Managed Care	p. 343
Cost Control Methods in Managed Care	p. 344
Types of Managed Care Organizations	p. 349
Trends in Managed Care	p. 355
Impact on Cost, Access, and Quality	p. 358
Managed Care Backlash, Regulation, and the Aftermath	p. 360
Consolidation, Expansion, Diversification, and Integration	p. 362
Integrated Delivery Systems	p. 363
Types of Integration	p. 364
Issues Related to Integration	p. 368
Summary	p. 370
Test Your Understanding	p. 371
Review Questions	p. 371
Long-Term Care	p. 379
Introduction	p. 380
The Nature of Long-Term Care	p. 383
Long-Term Care Services	p. 385
The Clients of Long-Term Care	p. 392
Types of Community-Based Long-Term Care Services	p. 396
Institutional Long-Term Care	p. 403
Specialized Facilities	p. 408
Nursing Home Industry and Patient Demographics	p. 409
Patient Assessment and Prospective Payment for SNFs	p. 418
Requirements of Participation	p. 418
Summary	p. 420
Test Your Understanding	p. 421
Review Questions	p. 421
Health Services for Special Populations	p. 427
Introduction	p. 428
Racial/Ethnic Minorities	p. 428
The Uninsured	p. 441
Children	p. 443
Women	p. 446
Rural Health	p. 450
The Homeless	p. 453
Mental Health	p. 456
The Chronically Ill and Disabled	p. 460
HIV/AIDS	p. 462
Summary	p. 474
Test Your Understanding	p. 474
Review Questions	p. 475
System Outcomes
Cost, Access, and Quality	p. 483
Introduction	p. 484
Cost of Health Care	p. 484
Reasons for Cost Escalation	p. 491
Cost Containment-Regulatory Approaches	p. 498
Cost Containment-Competitive Approaches	p. 504
Access to Care	p. 505
Quality of Care	p. 514
Dimensions of Quality	p. 515
Quality Assurance	p. 518
Quality Assessment	p. 519
Quality Report Cards	p. 524
Summary	p. 525
Test Your Understanding	p. 526
Review Questions	p. 526
Health Policy	p. 533
Introduction	p. 534
What Is Health Policy?	p. 534
The Principal Features of US Health Policy	p. 536
The Development of Legislative Health Policy	p. 544
Critical Policy Issues	p. 548
The Future of Health Policy	p. 555
Summary	p. 558
Test Your Understanding	p. 559
Review Questions	p. 559
System Outlook
The Future of Health Services Delivery	p. 561
Introduction	p. 562
Trends in Private and Public Health Insurance	p. 563
Future Options in Financing and Insurance	p. 566
Future Challenges for Managed Care	p. 569
Comprehensive Reform: If and When It Occurs	p. 570
National and Global Challenges	p. 574
Bioterrorism and the Transformation of Public Health	p. 579
The Future Outlook for US Hospitals	p. 580
Future of the Health Care Workforce	p. 581
Work Organization	p. 584
Enhanced Focus on Customer Service	p. 585
New Frontiers in Clinical Technology	p. 586
The Era of Evidence-Based Health Care	p. 587
Summary	p. 589
Test Your Understanding	p. 590
Review Questions	p. 590
Glossary	p. 595
Selected Web Sites	p. 621
Index	p. 625
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