Introduction to U.S. Health Policy

by Barr, Donald

• ISBN13: 9780205324194
• ISBN10: 0205324193
• Edition: 1st
• Format: Paperback
• Copyright: 2001-11-01
• Publisher: Benjamin Cummings

Summary

Provides a clear description of all key aspects of the health care system to make iteasierfor the reader to evaluate the potential impact of proposals for health care reform.Using case studies and simplified presentations of major issues, this book gives the reader an appreciation of the dilemma confronting policy makers, providers, and patients: how to balance cost, quality, and access. It examines specific health care organization aspects such as the medical profession, hospitals, managed care organizations, and government health care programs. It also discusses policy changes that have had major impacts on American health care in the past decade.For health care providers, policy makers, consumers and others interested in health care in the U.S.

Author Biography

Donald A. Barr received his M.D. from the University of California, San Francisco and his Ph.D. in sociology from Stanford University. His is an associate professor of sociology and human biology at Stanford and is the founder and director of Stanford's undergraduate health policy curriculum. His research focuses on the effect of the organizational structure of the medical care delivery system on the quality of primary care.

Dr. Barr has a unique perspective of being both a practicing physician and an academic sociologist. He has experienced first hand the sweeping changes that have occurred in the organizing and financing of health care through 25 years of medical practice in Northern California. As an experienced researcher and writer in the area of health policy, he is able to combine a broad understanding of the social and economic factors affecting health care with an appreciation of the effects of these changes on the quality of care experienced by patients and practitioners alike.

Dr. Barr is a member of the American Public Health Association, the Academy for Health Services Research and Health Policy, and the American Sociological Association.

Table of Contents

Foreword	xi
Preface	xii
Acknowledgments	xxi
Health, Health Care, and the Market Economy	1	(15)
The Unique History of Health Care in America	2	(3)
The Rising Cost of Health Care in America	5	(3)
The Growing Number of Uninsured Americans	8	(1)
The Health of Our Society: What Do We Get for Our Money?	9	(3)
What Determines the Overall Health of a Society?	12	(4)
Health Care in America as a Reflection of Underlying Cultural Values and Institutions	16	(23)
The Cultural Basis of Health Care Delivery: Comparing the United States and Canada	17	(1)
The Historical Development of the Canadian Health Care System	18	(6)
The Organizing Principles of the Canadian Health Care System	24	(2)
The Organizing Principles of the U.S. Health Care System	26	(1)
Cultural Institutions That Drive Health Care in the United States	27	(9)
How Differing Cultural Institutions Affect the Cost of Health Care	36	(3)
The Health Professions and the Organization of Care	39	(28)
Physicians and the American Medical Profession	40	(6)
Nursing in the United States	46	(1)
Primary Care and the Role of Primary Care Physicians	47	(4)
Nurse Practitioners and Other Advanced Practice Nurses	51	(2)
Secondary Care---Specialist Physicians	53	(3)
Foreign Medical Graduates and Their Effect on the Medical Profession	56	(2)
Future Policy Directions for Physician Supply and Specialty	58	(2)
Secondary Care---The Hospital	60	(4)
Tertiary Care, Quaternary Care, and the Academic Medical Center	64	(3)
Paying for Health Care: Health Insurance and the Birth of the HMO	67	(22)
Federal Policies that Boosted Employee Health Insurance	68	(6)
Insurance Plans, Service Plans, and Capitation	74	(2)
Kaiser-Permanente and the Development of Health Maintenance Organizations	76	(4)
The HMO Act of 1973 and the Expansion of HMOs	80	(4)
Other Types of Managed Care Plans	84	(5)
Medicare	89	(19)
Medicare: Universal Health Insurance for the Elderly	91	(5)
Medigap Insurance	96	(2)
The Extension of Medicare to the Disabled and to Those with Kidney Failure	98	(1)
The Rising Cost of Medicare	99	(1)
Changes in the Way Medicare Pays Physicians	100	(2)
Taking Care of the Few: The Skewed Nature of the Medicare Population	102	(2)
Strange Bedfellows: Medicare and Paying for Graduate Medical Education	104	(1)
Major Policy Questions Facing Medicare	105	(3)
Medicaid	108	(18)
Services Provided Under the Medicaid Program	110	(1)
Eligibility for Medicaid	111	(3)
The Rising Costs of the Medicaid Program	114	(3)
The Move to Managed Care	117	(1)
The Oregon Plan: Explicit Health Care Rationing	118	(3)
Tennessee: Managed Care for All Medicaid Beneficiaries---Overnight	121	(1)
California: Incremental Shift to Medicaid Managed Care	122	(1)
The Long-Term Outlook for Medicaid	123	(1)
Appendix 6.1	124	(2)
The Managed Care Revolution	126	(25)
Managed Competition: An Idea Whose Time Had Come	128	(5)
Putting Managed Competition into Action: The Clinton Health Reform Proposal	133	(2)
The Shift to for-Profit, Managed Care: The Market Does What the Government Would Not	135	(1)
Concerns About the Effects of Managed Care and Managed Competition	136	(15)
Recent Changes to the Medicare Program	151	(19)
The Initial Move to Medicare HMOs: Getting More for Less for Medicare Beneficiaries	152	(3)
Problems in HMO Risk Contracting: Favorable Selection and the Average Cost of Care	155	(3)
The Balanced Budget Act of 1997 and its effect on Medicare	158	(7)
The Best-Laid Plans...: Unintended Consequences of the Balanced Budget Act	165	(3)
Why Did Medicare HMOs Have So Little Success in Holding Down Costs?	168	(2)
Long-Term Care	170	(17)
The Growing Need for Long-Term Care Among the Frail Elderly	171	(1)
Nursing Home Care	172	(4)
Home Health Care	176	(4)
Hospice Care	180	(2)
Life-Care Communities as an Alternative to Long-Term Care	182	(1)
Future Policy Issues in Long-Term Care	183	(4)
The Uninsured	187	(17)
The Creation and Expansion of Health Insurance in the Twentieth Century	188	(2)
The Issue of the Uninsured Finds the American Mainstream: Wofford Versus Thornburgh, 1991	190	(1)
Understanding the Uninsured: Who Are They, and Why Are They Uninsured?	191	(4)
The Source of the Uninsured: Low-Wage Workers and Small Employers	195	(3)
Two Programs to Reduce the Number of Uninsured	198	(6)
Factors Other Than Health Insurance That Impede Access to Care	204	(19)
Type of Health Insurance Coverage and Access to Care for Urgent Problems	205	(2)
The Effect of Out-of-Pocket Expenses on the Rate at Which Patients Access Care	207	(1)
The Effect of Medicaid Coverage on Patients' Access to Care	208	(1)
Racial Barriers to Health Care Access	209	(6)
Living Conditions and Care	215	(1)
Other Factors That May Affect Access to Care	216	(1)
The Increasing Organizational Complexity of Health Care as a Barrier to Care	216	(7)
Where Do We Go from Here?	223	(16)
Health Care Rationing: Is It Inevitable? Can It Be Acceptable?	227	(5)
Profit as a Competitor to Cost, Quality, and Access	232	(2)
Physician Heal Thyself: Physicians and the Profit Motive	234	(5)
Index	239