How do we understand and assess the health care sector of our economy? Where and how is health care provided? How well does the health care system perform? Where is the health care sector going in terms of the health of the people, the cost of care, access to care, and quality of care? And, what else do we need to know to answer the four previous questions?

Tables and Figures	p. xi
Foreword	p. xv
Organization of This Book	p. xix
Contributors	p. xxi
Perspectives
Overview: The State of Health Care Delivery in the United States	p. 2
Defining Characteristics of the U.S. Health Care System	p. 4
Major Issues and Concerns	p. 7
Prospects for Change and Improvement	p. 9
The Importance of Engagement at the Ground Level	p. 10
Supplement: Key Charts	p. 13
Good News About the U.S. Health Care System	p. 14
Influences on Health	p. 16
Getting the Preventive Care We Need	p. 18
The Changing U.S. Population	p. 22
Quality Versus Costs of Care	p. 24
Oral Health Care	p. 26
The Impact of Mental Disorders	p. 28
Costly Medical Conditions	p. 30
Dissatisfaction With the U.S. Health Care System	p. 32
Measuring Health Status	p. 34
Quantitative Perspectives	p. 37
Understanding Numbers and Rates	p. 40
Census Data	p. 41
Vital Statistics	p. 42
Morbidity	p. 46
Health Status and Health-Related Behavior	p. 49
Utilization and Cost of Health Care Services	p. 50
Conclusion	p. 53
Financing Health Care	p. 56
What the Money Buys	p. 59
How We Pay for Health Care	p. 61
Reimbursement Approaches	p. 73
Current Policy Issues	p. 76
Conclusion	p. 79
Public Health: Policy, Practice, and Perceptions	p. 84
Public Health Every Day	p. 86
Who Is in Charge of Public Health?	p. 90
Defining Characteristics of Public Health	p. 91
Core Functions of Public Health	p. 99
Governmental Authority for Public Health	p. 103
Challenges and Opportunities	p. 113
The Role of Government in U.S. Health Care	p. 126
The Government as Payer: The Health Insurance Safety Net	p. 129
The Government as Regulator	p. 140
The Government as Health Care Provider	p. 144
Key Issues on the Health Care Agenda	p. 148
Comparative Analysis of Health Systems Among Wealthy Nations	p. 152
The Evolution of Health Systems and Policy in Wealthy Nations	p. 154
Overview of Health System Models	p. 156
Comparative Analysis of Health Systems	p. 159
Common Problems of Health Care Organization and Policy in Three Nations	p. 164
The U.S. Health System in Comparative Perspective	p. 174
New Approaches to Comparing Health Systems	p. 179
Conclusion	p. 183
Providing Health Care
Acute Care	p. 190
The History of Acute Care	p. 192
Kinds of Acute Care Today	p. 194
Hospitals in the United States	p. 200
Current Issues in Acute Care	p. 212
Future Challenges	p. 217
Chronic Care	p. 220
Definition of and Prevalence of Chronic Conditions	p. 223
Chronic Conditions and Activity Limitations	p. 225
Paying for Chronic Care	p. 226
Dissatisfaction With the Current System	p. 227
The Evolving Health Care System	p. 230
International Trends	p. 236
Conclusion	p. 237
Long-Term Care	p. 238
Long-Term Care Needs and Demands	p. 241
Costs and Financing of Long-Term Care	p. 242
The Goals of Long-Term Care	p. 246
Providers of Long-Term Care	p. 246
Challenging Issues	p. 255
Conclusion	p. 263
Health-Related Behavior	p. 266
Behavioral Risk Factors: Overview and National Goals	p. 269
Changing Health Behavior	p. 274
Changing Provider Behavior	p. 287
Conclusion	p. 294
Pharmaceuticals	p. 298
Pharmaceuticals	p. 300
Biologic Products	p. 313
Medical Devices: Brief Overview	p. 313
Conclusion	p. 317
The Health Care Workforce	p. 320
Supply and Demand Factors	p. 324
Types of Health Care Workers	p. 335
Medical Practice	p. 336
Nursing Practice	p. 339
Mid-Level Professionals	p. 342
Other Health Care Workers	p. 344
Allied Health Professionals	p. 346
Health Care Workforce Issues	p. 348
Conclusion	p. 351
Information Management	p. 356
Improving Clinical Quality Through Information Technology	p. 361
Information Technology's Benefits for Patients	p. 368
Information Technology's Role in Controlling Health Care Costs	p. 370
Speeding Adoption of Health Care Information Technology	p. 373
Conclusion	p. 379
System Performance
Governance, Management, and Accountability	p. 382
Governance as a Process for Decision Making	p. 384
Measuring Organizational Performance	p. 386
Ownership of Health Care Organizations	p. 387
Current Governance Issues	p. 392
Management	p. 394
Managerial Work in Health Care Organizations	p. 397
Current Management Issues	p. 399
Accountability	p. 402
Conclusion	p. 405
The Complexity of Health Care Quality	p. 408
Health Care Quality: Fundamentals	p. 411
Complexity and the Health Care Quality Challenge	p. 412
Defining Quality of Health Care: Patients Versus Populations	p. 414
Pay for Performance (P4P): Make the Business Case for Quality	p. 423
Risk-Adjusted Quality Outcomes	p. 427
Trends in Quality Assessment	p. 429
Strategies for Managing Quality in the Health Care Zone of Complexity	p. 433
Access to Care	p. 444
Economic Barriers to Care	p. 448
Noneconomic and Quasi-Economic Barriers to Care	p. 454
Noneconomic and Quasi-Economic Barriers: Preventable Hospitalizations	p. 460
Health Care Reform: Improving Access	p. 464
The Future: Continuing and Emerging Issues	p. 470
Costs and Value	p. 478
The Problem: Rising Costs	p. 480
Why Do Costs Rise?	p. 483
Cost to Whom and for What?	p. 488
Potential Solutions to Rising Health Care Costs	p. 491
Dilemmas: Spending Is a Political Act	p. 502
Conclusion	p. 504
The Future
The Future of Health Care Delivery in the United States	p. 508
Forecasting: Definition and Approaches	p. 510
Forecasting Methods	p. 513
Drivers of Change in the New Millennium	p. 513
Where Change Is Likely to Occur	p. 517
Conclusion	p. 522
Appendices
Glossary	p. 527
A Guide to Sources of Data	p. 541
Useful Health Care Web Sites	p. 557
Index	p. 571
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