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9781567930672

The Future U.S. Healthcare System

by ; ;
  • ISBN13:

    9781567930672

  • ISBN10:

    1567930670

  • Format: Paperback
  • Copyright: 1997-10-01
  • Publisher: Health Administration Pr

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Table of Contents

Foreword xiii(4)
Steven A. Schroeder
Acknowledgments xvii
1. Healthcare for the Poor and Uninsured: An Uncertain Future
1(24)
Stuart H. Altman
Uwe E. Reinhardt
Alexandra Shields
Introduction
1(1)
The Number of Uninsured in the United States: What Is the Magnitude of the Problem?
2(3)
The Implications of Being Without Health Insurance
5(2)
Why Has the Problem Persisted?
7(5)
Increasingly Less Healthcare Available for the Uninsured
12(3)
Concrete Proposals for Change
15(1)
Incremental Reforms at the National and State Levels
15(3)
Looking to the Future
18(7)
Part I The Problem of the Uninsured--It's Real and Getting Worse 25(74)
2. Uninsured in America: The Causes and Consequences
25(20)
Diane Rowland
Judith Feder
Patricia Seliger Keenan
Introduction
25(1)
Who Are the Uninsured?
26(4)
What Is Happening to Health Insurance Coverage?
30(6)
What Are the Consequences of Lack of Insurance?
36(5)
Conclusion
41(4)
3. All Uninsured Are Not the Same
45(22)
Katherine Swartz
Characteristics of the Uninsured at a Specific Point in Time
46(6)
Dynamics of Being Without Health Insurance
52(2)
Policy Choices
54(10)
Conclusion
64(3)
4. The Changing Role of Medicaid
67(20)
John F. Holahan
Medicaid Growth Explosion, 1988-92
67(6)
Slowdown in Medicaid Expenditure Growth, 1992-95
73(4)
Medicaid Spending in the Near Future
77(3)
Implications
80(4)
Acknowledgments
84(3)
5. The Medically Uninsured--Will They Always Be With Us?
87(12)
Steven A. Schroeder
Why We Tolerate Having So Many Uninsured
88(4)
What Lies Ahead?
92(7)
Part II Traditional Safety Net Providers: Showing Signs of Strain 99(90)
6. The Challenges Facing Health Centers in a Changing Healthcare System
99(24)
Daniel R. Hawkins
Sara Rosenbaum
Introduction
99(1)
Background and Overview
100(6)
Trends Affecting Health Centers
106(8)
Conclusion
114(9)
7. The Future of Safety-Net Hospitals
123(28)
Larry S. Gage
Characteristics of Safety-Net Health Systems
125(3)
Safety-Net Hospitals Provide a Large Volume of Inpatient and Outpatient Care
128(6)
Safety-Net Hospitals Provide Disproportionate Levels of Medicaid, Medicare, and Uncompensated Care
134(2)
Safety-Net Hospitals Rely Disproportionately on Medicare, Medicaid, and Local Subsidies to Cross-Subsidize Uncompensated Care
136(3)
The Impact of Managed Care
139(2)
Options for Protecting Safety-Net Health Systems
141(1)
The Need to Reform DSH
142(1)
The Need for Managed Care Safeguards
143(1)
The Need for a Level Playing Field for Safety-Net Health Systems
144(3)
Conclusion
147(1)
Acknowledgments
148(3)
8. The Role of Academic Health Centers and Teaching Hospitals in Providing Care for the Poor
151(16)
James Reuter
Darrell J. Gaskin
Academic Health Centers and Care to the Poor
152(3)
Academic Health Centers and the New Medical Market
155(5)
The Impact of the Market on AHCs' Missions
160(2)
Looking to the Future
162(5)
9. The Hidden U.S. Healthcare Safety Net: Will It Survive?
167(22)
Stuart H. Altman
Stuart Guterman
Financing the American Hospital
167(5)
The Funding That Supports the Safety-Net Hospital
172(4)
The Critical Role of Private Patient Revenues
176(2)
Distribution of Uncompensated Care Burden across Hospitals
178(3)
The Effect of Increasing Financial Pressure on the Distribution of Uncompensated Care
181(2)
A Worst-Case Scenario
183(1)
Conclusions
184(5)
Part III Changes in Hospital Ownership and Care for the Uninsured 189(44)
10. The Impact of Hospital Conversions on the Healthcare Safety Net
189(18)
David Schactman
Stuart H. Altman
Introduction
189(1)
The Provision of Charity Care and Community Benefits
190(10)
The Provision of Health Services
200(1)
The Price of Health Services
201(2)
Conclusion
203(4)
11. Hospital Ownership Form and Care of the Uninsured
207(16)
Bradford H. Gray
The Significance of Ownership Form
208(3)
Ownership Form and Care of the Poor
211(2)
Uncompensated Care and Tax Exemptions
213(3)
Conclusion
216(7)
12. The Role of Investor-Owned and Not-for-Profit Organizations in Providing Healthcare to the Poor and Uninsured: A Perspective
223(10)
Thomas A. Scully
Introduction
223(1)
The Changing Healthcare Market
224(1)
Why the Concern?
225(1)
Is the Concern Justified?
226(4)
Conclusion
230(3)
Part IV The Search for Solutions I: The Road Is Paved with Incremental Reforms at the Federal and State Levels 233(76)
13. Less Is More: After the Clinton Plan, Let's Think Small
233(14)
Henry J. Aaron
Introduction
233(2)
Lessons from the Past
235(3)
Looking Forward
238(1)
A Brief Sketch of U.S. Healthcare Financing
239(5)
Postscript
244(1)
Acknowledgments
244(3)
14. Incremental Health Insurance Coverage: Building on the Current System
247(18)
Karen Davis
Cathy Schoen
Increased Risks for the Uninsured
247(2)
Prioritizing Coverage
249(2)
Low-and Modest-Income Families
251(2)
Building on Existing Administrative Mechanisms
253(2)
Expanding Medicaid
255(2)
Making Medicare Available to Older Adults
257(2)
Financing Options
259(1)
Trust Fund
260(1)
Summary
260(5)
15. Incremental Reform: The Health Insurance Portability and Accountability Act of 1996
265(8)
Gail R. Wilensky
Incremental Reform: The Way Change Occurs
265(1)
The Uninsured: A Heterogeneous Group
266(1)
Implications for Incremental Reform
267(1)
The Health Insurance Portability and Accountability Act as an Example of Incremental Reform
268(1)
The Remaining Problems
269(4)
16. Can We Count on the States to Cover the Poor and Uninsured?
273(12)
Trish Riley
Introduction
273(1)
Comprehensive Reforms and Access Initiatives
273(7)
The Challenge of Financing Incremental Reform
280(3)
Conclusion
283(2)
17. The State Health Agenda: Austerity, Efficiency, and Monitoring the Emerging Market
285(24)
Raymond C. Scheppach
Introduction
285(1)
The Recent Past
286(1)
The Federal Framework
287(5)
Obstacles to Comprehensive State Healthcare Reform
292(2)
State Challenges
294(3)
State Fiscal and Regulatory Climates
297(1)
Increased Access--State Action
297(3)
The New State Health Agenda
300(3)
Conclusion
303(1)
Acknowledgments
304(5)
Part V The Search for Solutions II: Considerations for Comprehensive Reforms 309(96)
18. Where Will Americans Obtain Their Health Insurance? The Job Link Revisited
309(16)
Alain C. Enthoven
Consumer Choice Health Plan
309(1)
Critique of Employment-Based Health Insurance
310(8)
Employers Do a Better Job than Government Monopolies
318(1)
A Program to Extend the Benefits of Employment-Based Coverage to Nearly All Americans
319(6)
19. Employer-Based Health Insurance: R.I.P.
325(28)
Uwe E. Reinhardt
Introduction
325(3)
Pricing Kindness out of a Nation's Soul
328(4)
Government as a Cost Driver in Healthcare
332(5)
Employer-Based Health Insurance: Merits and Shortcomings
337(11)
Alternatives to Employment-Based Health Insurance
348(5)
20. Trading Cost, Quality, and Coverage of the Uninsured: What Will We Demand and What Will We Supply?
353(22)
Mark V. Pauly
Introduction
353(1)
What Competitive Markets Will and Will Not Do
354(1)
How Healthcare Used to Be: Myth and Reality
354(3)
An Invidious Distinction
357(5)
How Far Will It Go and How Long Can It Go On?
362(3)
Limits on Equity
365(1)
What to Do in Theory
365(2)
So Who Pays?
367(2)
How to Pay
369(1)
What to Do?
370(2)
What Will It Take?
372(3)
21. Seeking More Efficient Healthcare Subsidies
375(12)
Robert B. Helms
Do Not Increase Taxes or Budget Deficits
378(2)
Give Consumers a Stronger Role in Seeking Cost-Effective Medical Care
380(1)
Public Subsidies Should Be Explicit
381(2)
Minimize the "Woodwork Effect"
383(1)
Conclusion
383(4)
22. The Case for Universal Health Insurance Coverage
387(18)
Thomas Rice
Utilitarianism versus Alternative Philosophies
388(10)
Implications for Universal Coverage
398(4)
Acknowledgments
402(3)
Index 405(14)
About the Authors 419(5)
About the Editors 424

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