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Delivering Health Care in America : A Systems Approach

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Jones & Bartlett
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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

Forewordp. ix
Prefacep. xi
List of Exhibitsp. xv
List of Figuresp. xvii
List of Tablesp. xxi
List of Abbreviations/Acronymsp. xxiii
A Distinctive System of Health Care Deliveryp. 1
Introductionp. 2
An Overview of the Scope and Size of the Systemp. 2
A Broad Description of the Systemp. 4
Basic Components of a Health Services Delivery Systemp. 5
A Disenfranchised Segmentp. 7
Transition from Traditional Insurance to Managed Carep. 8
Primary Characteristics of the US Health Care Systemp. 9
Trends and Directionsp. 19
Significance for Health Care Practitioners and Policymakersp. 19
Significance for Health Care Managersp. 20
Health Care Systems of Other Countriesp. 21
The Systems Frameworkp. 28
Summaryp. 31
Test Your Understandingp. 32
Review Questionsp. 32
System Foundations
Beliefs, Values, and Healthp. 37
Introductionp. 38
Significance for Managers and Policymakersp. 38
Basic Conceptsp. 39
Health Promotion and Disease Preventionp. 44
Developmental Healthp. 45
Public Healthp. 45
Health Protectionp. 46
Quality of Lifep. 48
Determinants of Healthp. 49
Overarching Factors and Implications for Health Care Deliveryp. 53
A Social Model of Healthp. 56
Equitable Distribution of Health Carep. 56
Justice in the US Health Delivery Systemp. 60
Equality in the US Health Care Delivery Systemp. 61
Integration of Individual and Community Healthp. 64
Measures of Health Statusp. 68
Evaluation of Health Statusp. 68
Demographic Changep. 71
Measures of Mental Healthp. 72
Measures of Social Healthp. 72
Measures of Spiritual Healthp. 73
Measures of Health Services Utilizationp. 73
Summaryp. 74
Test Your Understandingp. 74
Review Questionsp. 75
The Evolution of Health Services in the United Statesp. 83
Introductionp. 84
Medical Services in Preindustrial Americap. 85
Medical Services in Postindustrial Americap. 89
Medical Care in the Corporate Erap. 109
Summaryp. 113
Test Your Understandingp. 114
Review Questionsp. 115
System Resources
Health Services Professionalsp. 119
Introductionp. 120
Physiciansp. 122
Some Key Issues in Medical Practice Involvement in the Development of Clinical Practice Guidelinesp. 128
International Medical Graduatesp. 136
Dentistsp. 137
Pharmacistsp. 138
Other Doctoral-Level Health Professionalsp. 139
Nursesp. 140
Nonphysician Practitionersp. 142
Allied Health Professionalsp. 146
Health Services Administratorsp. 148
Summaryp. 150
Test Your Understandingp. 150
Review Questionsp. 151
List of Professional Associationsp. 152
Medical Technologyp. 161
Introductionp. 162
What Is Medical Technology?p. 163
Information Technology and Informaticsp. 163
Innovation, Diffusion, and Utilization of Medical Technologyp. 168
Managed Care and Technology Diffusionp. 173
The Government's Role in Technology Diffusionp. 173
The Impact of Medical Technologyp. 177
The Assessment of Medical Technologyp. 182
Current and Future Directions in Health Technology Assessmentp. 186
Summaryp. 189
Test Your Understandingp. 190
Review Questionsp. 190
Health Services Financingp. 197
Introductionp. 198
The Role and Scope of Health Services Financingp. 198
Financing and Cost Controlp. 199
The Insurance Functionp. 201
Private Financingp. 202
Public Financingp. 207
Miscellaneous Private and Public Programsp. 222
The Payment Functionp. 224
National Health Care Expendituresp. 229
Trends, Problems, and Issues in Insurance and Financingp. 233
Summaryp. 237
Test Your Understandingp. 238
Review Questionsp. 238
System Processes
Outpatient and Primary Care Servicesp. 243
Introductionp. 244
What Is Outpatient Care?p. 244
The Scope of Outpatient Servicesp. 245
Primary Carep. 245
Community-Oriented Primary Carep. 251
Primary Care Providersp. 251
Growth in Outpatient Servicesp. 253
Reasons for the Growth in Outpatient Servicesp. 255
Types of Outpatient Care Settings and Methods of Deliveryp. 257
Utilization of Outpatient Servicesp. 275
Summaryp. 281
Test Your Understandingp. 282
Review Questionsp. 283
Inpatient Facilities and Servicesp. 289
Introductionp. 290
Transformation of the Hospital in the United Statesp. 290
The Expansion Phase: Late 1800s to Mid-1980sp. 294
The Downsizing Phase: Mid-1980s Onwardp. 297
Some Key Utilization Measures and Operational Conceptsp. 299
Hospital Employmentp. 304
Types of Hospitalsp. 305
What Makes a Hospital Nonprofit?p. 315
Some Management Conceptsp. 317
Licensure, Certification, and Accreditationp. 319
Ethical and Legal Issues in Patient Carep. 321
Hospitals and Public Trustp. 323
Summaryp. 324
Test Your Understandingp. 325
Review Questionsp. 326
Managed Care and Integrated Organizationsp. 333
Introductionp. 334
What Is Managed Care?p. 336
Evolution of Managed Carep. 338
Growth of Managed Carep. 341
Efficiencies and Inefficiencies in Managed Carep. 343
Cost Control Methods in Managed Carep. 344
Types of Managed Care Organizationsp. 349
Trends in Managed Carep. 355
Impact on Cost, Access, and Qualityp. 358
Managed Care Backlash, Regulation, and the Aftermathp. 360
Consolidation, Expansion, Diversification, and Integrationp. 362
Integrated Delivery Systemsp. 363
Types of Integrationp. 364
Issues Related to Integrationp. 368
Summaryp. 370
Test Your Understandingp. 371
Review Questionsp. 371
Long-Term Carep. 379
Introductionp. 380
The Nature of Long-Term Carep. 383
Long-Term Care Servicesp. 385
The Clients of Long-Term Carep. 392
Types of Community-Based Long-Term Care Servicesp. 396
Institutional Long-Term Carep. 403
Specialized Facilitiesp. 408
Nursing Home Industry and Patient Demographicsp. 409
Patient Assessment and Prospective Payment for SNFsp. 418
Requirements of Participationp. 418
Summaryp. 420
Test Your Understandingp. 421
Review Questionsp. 421
Health Services for Special Populationsp. 427
Introductionp. 428
Racial/Ethnic Minoritiesp. 428
The Uninsuredp. 441
Childrenp. 443
Womenp. 446
Rural Healthp. 450
The Homelessp. 453
Mental Healthp. 456
The Chronically Ill and Disabledp. 460
HIV/AIDSp. 462
Summaryp. 474
Test Your Understandingp. 474
Review Questionsp. 475
System Outcomes
Cost, Access, and Qualityp. 483
Introductionp. 484
Cost of Health Carep. 484
Reasons for Cost Escalationp. 491
Cost Containment-Regulatory Approachesp. 498
Cost Containment-Competitive Approachesp. 504
Access to Carep. 505
Quality of Carep. 514
Dimensions of Qualityp. 515
Quality Assurancep. 518
Quality Assessmentp. 519
Quality Report Cardsp. 524
Summaryp. 525
Test Your Understandingp. 526
Review Questionsp. 526
Health Policyp. 533
Introductionp. 534
What Is Health Policy?p. 534
The Principal Features of US Health Policyp. 536
The Development of Legislative Health Policyp. 544
Critical Policy Issuesp. 548
The Future of Health Policyp. 555
Summaryp. 558
Test Your Understandingp. 559
Review Questionsp. 559
System Outlook
The Future of Health Services Deliveryp. 561
Introductionp. 562
Trends in Private and Public Health Insurancep. 563
Future Options in Financing and Insurancep. 566
Future Challenges for Managed Carep. 569
Comprehensive Reform: If and When It Occursp. 570
National and Global Challengesp. 574
Bioterrorism and the Transformation of Public Healthp. 579
The Future Outlook for US Hospitalsp. 580
Future of the Health Care Workforcep. 581
Work Organizationp. 584
Enhanced Focus on Customer Servicep. 585
New Frontiers in Clinical Technologyp. 586
The Era of Evidence-Based Health Carep. 587
Summaryp. 589
Test Your Understandingp. 590
Review Questionsp. 590
Glossaryp. 595
Selected Web Sitesp. 621
Indexp. 625
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