Delivering Health Care in America: A Systems Approach

by Leiyu Shi, Douglas A. Singh

Overview

Delivering Health Care in America, Eighth Edition is the most current and comprehensive overview of the basic structures and operations of the U.S. health system—from its historical origins and resources, to its individual services, cost, and quality. Using a unique “systems” approach, the text brings together an extraordinary breadth of information into a highly accessible, easy-to-read resource that clarifies the complexities of health care organization and finance while presenting a solid overview of how the various components fit together.The Eighth Edition of this highly current, forward-thinking text offers:- Updated new data for tables, charts, figures, and text based on the latest published data- New and emerging characteristics of the U.S. healthcare system such as ‘accountable care,’ ‘integrated delivery,’ and ‘pay for value’- Coverage of COVID-19 topics in chapters 2, 5, 6, and 14- The latest on the Affordable Care Act including its effects of insurance, access, and cost. - The latest in medical technology (artificial intelligence, electronic health records, Right to Try Act of 2018, etc.) along with integration of the digital environment throughout the text.- Current challenges and issues facing the U.S. health care system, such as care for populations with special needs and behavioral health services.- Navigate eBook access (included with each print text) provides entry to the enriched digital text, which includes chapter quizzes, interactive glossary and weblinks.

Product Details

ISBN-13:	9781284224610
Publisher:	Jones & Bartlett Learning
Publication date:	08/18/2021
Edition description:	8th ed.
Pages:	700
Sales rank:	417,649
Product dimensions:	7.01(w) x 8.90(h) x 1.02(d)

About the Author

Dr. Leiyu Shi is Professor of health policy and management from Johns'Hopkins University Bloomberg School of Public Health Department of Health'Policy and Management. He is also Director of Johns Hopkins Primary Care Policy'Center. He serves as Co-Editor-in-Chief of the International Journal for Equity in Health. He received his doctoral education from University of California'Berkeley majoring in health policy and services research. He also has a masters'in business administration focusing on finance. Dr. Shi’s research and practice focus on'primary care, hospitals, health care systems, community health centers, health disparities, and vulnerable'populations. He has conducted extensive studies about the association between'primary care and health outcomes, particularly on the role of primary care in'mediating the adverse impact of income inequality on health outcomes. Dr. Shi'is also one of the developers of the Johns Hopkins Primary Care'Assessment Tools that have been widely used internationally to measure primary'health care performance at the individual, practice, and system levels. Dr. Shi has consulted extensively for hospitals, health care systems, and international agencies. He is a well-known expert on innovative practices and systems change. Dr.'Shi is the author of twelve textbooks and over 250 scientific journal'articles. He is named by Thomson Reuters in 2014 as among the top cited (and therefore most influential) scientists in the world in the area of Social'Science general.

Dr. Singh teaches graduate and undergraduate courses in health care delivery, policy, finance, and management in the School of Business and Economics and in the Department of Political Science at Indiana University-South Bend. He has authored/coauthored four books and has published in peer-reviewed journals. Before pursuing an academic career, he spent over 15 years in the long-term care industry and held positions of administrator, regional manager, vice president, and consultant. He was awarded the long-term care research award by the Foundation of American College of Health Care Administrators in 1995.

Table of Contents

Preface vii

List of Exhibits xi

List of Figures xii

List of Tables xv

List of Abbreviations/Acronyms xvii

Chapter 1 An Overview of U.S. Health Care Delivery 1

Introduction 2

An Overview of the Scope and Size of the System 2

Major Characteristics of the U.S. Health Care System 10

Trends and Directions 18

Significance for Health Care Practitioners 22

Significance for Health Care Managers 22

Health Care Systems of Other Countries 24

The Systems Framework 37

Summary 39

Test Your Understanding 40

References 41

Part I System Foundations 49

Chapter 2 Beliefs, Values, and Health 51

Introduction 52

Significance for Managers and Policymakers 52

Basic Concepts of Health 53

Health Promotion and Disease Prevention 59

Public Health 64

Determinants of Health 74

Measures Related to Health 77

Anthro-Cultural Beliefs and Values 84

Healthy People Initiatives 92

Summary 99

Test Your Understanding 99

References 101

Chapter 3 The Evolution of Health Services in the United States 111

Introduction 112

Medical Services in the Preindustrial Era 113

Medical Services in the Postindustrial Era 119

Medical Care in the Corporate Era 137

Globalization of-Health Care 138

The Era of Health Care Reform 140

Summary 144

Test Your Understanding 144

References 146

Part II System Resources 151

Chapter 4 Health Services Professionals 153

Introduction 154

Physicians 156

Dentists 169

Pharmacists 170

Other Doctoral-Level Health Professionals 171

Nurses 172

Nonphysician Providers 174

Allied Health Piofessionals 176

Health Services Administrators 180

Evolving Trends in the Health Care Workforce 182

Summary 188

Test Your Understanding 189

References 190

Chapter 5 Medical Technology 199

Introduction 200

What Is Medical Technology? 201

Information Technology and Informatics 201

E-Health, M-Health, E-Therapy, and E-Visits 207

Telemedicine, Telehealth, and Remote Monitoring 208

Innovation, Diffusion, and Utilization of Medical Technology 210

The Government's Role in Technology Diffusion 216

The Impact of Medical Technology 223

The Assessment of Medical Technology 228

Summary 232

Test Your Understanding 232

References 234

Chapter 6 Health Services Financing 241

Introduction 242

The Role and Scope of Health Services Financing 242

Financing and Cost Control 244

The insurance Function 245

Private Health Insurance 246

Trends in Employment-Based Health Insurance 255

Public Health Insurance 256

The Payment Function 271

National Health Expenditures 279

COVID-19 and Health Care Financing 282

Summary 284

Test Your Understanding 285

References 286

Part III System Processes 291

Chapter 7 Outpatient and Primary Care Services 293

Introduction 294

What Is Outpatient Care? 294

The Scope of Outpatient Services 295

Primary Care 297

Growth in Outpatient Services 310

Complementary and Alternative Medicine 330

Utilization of Outpatient Services 332

Primary Care in Other Countries 334

Summary 339

Test Your Understanding 340

References 341

Chapter 8 Inpatient Facilities and Services 349

Introduction 350

Hospital Transformation in the United States 350

The Expansion Phase: Late 1800s to Mid-1980s 354

The Downsizing Phase: Mid-1980s Onward 356

Some Key Utilization Measures and Operational Concepts 357

Hospital Demand, Employment, Expenditures, and Profitability 363

Types of Hospitals 366

Expectations for Nonprofit Hospitals 376

Some Management Concepts 377

Licensure, Certification, and Accreditation 380

Magnet Recognition Program 381

Ethical and Legal Issues in Patient Care 382

Summary 384

Test Your Understanding 386

References 388

Chapter 9 Managed Care and Integrated Organizations 393

Introduction 394

What Is Managed Care? 395

Evolution of Managed Care 397

Historical Growth of Managed Care 399

Efficiencies and Inefficiencies in Managed Care 402

Cost Control Methods in Managed Care 402

Types of Managed Care Organizations 408

Trends in Managed Care 413

Impact on Cost, Access, and Quality 415

Historical Managed Care Backlash and the Aftermath 417

Organizational Integration 418

Basic Forms of Integration 422

Highly Integrated Health Care Systems 423

Summary 426

Test Your Understanding 426

References 428

Chapter 10 Long-Term Care 433

Introduction 434

Age, Functional Deficits, and Long-Term Care 434

The Nature of Long-Term Care 436

Long-Term Care Services 440

Users of Long-Term Care 445

Level of CareContinuum 446

Home- and Community-Based Services 447

Institutional Long-Term Care Continuum 454

Specialized Care Facilities 457

Continuing Care Retirement Communities 458

Institutional Trends, Utilization, and Expenditures 459

Insurance for Long-Term Care 460

Summary 461

Test Your Understanding 462

References 463

Chapter 11 Health Services for Special Populations 467

Introduction 468

Framework to Study Vulnerable Populations 468

Racial/Ethnic Minorities 469

The Uninsured 483

Children 484

Women 487

Rural Health 490

Migrant Workers 493

The Homeless 494

Mental Health 497

The Chronically III 501

HIV/AIDS 502

Addressing Disparities Across Subpopulations 509

Racism in Health Care 511

The Effects of COVID-19 512

Summary 513

Test Your Understanding 513

References 514

Part IV System Outcomes 523

Chapter 12 Cost, Access, and Quality 525

Introduction 526

Cost of Health Care 526

Reasons for Cost Escalation 534

Cost Containment: Regulatory Approaches 540

Cost Containment: Competitive Approaches 546

Cost Containment Under Health Reform 548

Access to Care 548

The Affordable Care Act and Access to Care 556

Quality of Care 558

Quality Assessment and Assurance 561

Public Reporting of Quality 565

The Affordable Care Act and Quality of Care 568

Summary 570

Test Your Understanding 571

References 572

Chapter 13 Health Policy 581

Introduction 582

What Is Health Policy? 582

Principal Features of U.S. Health Policy 585

The Development of Legislative Health Policy 594

Critical Policy Issues 598

Role of Research in Policy Development 604

Future Considerations in Domestic Health Policy 604

International Health Policy 609

Summary 613

Test Your Understanding 613

References 613

Part V System Outlook 619

Chapter 14 The Future of Health Services Delivery 621

Introduction 622

Forces of Future Change 622

Health Care Reform in Transition 628

Innovations in the Health Care Delivery Infrastructure 631

Future Workforce Challenges 635

The Future of Long-Term Care 638

Global Threats and International Cooperation 639

New Frontiers in Clinical Technology 642

The Future of Evidence-Based Health Care 644

Summary 645

Test Your Understanding 646

References 646

Glossary 651

Index 677

Editorial Reviews

Provides a detailed overview of health care delivery in the US, using a systems approach that clarifies the complexities of health care organization and finance while explaining how various components fit together in actual operation. Coverage includes conceptual basis and historical origins, structures of care, costs, and quality. Learning features include objectives, summaries, key terms, and review questions. This second edition offers new lead articles for each chapter to spark student interest, and incorporates new laws and current health data. Also new is a list of Web sites. Shi teaches in the School of Public Health and Hygiene, Johns Hopkins University. Singh teaches in the School of Public and Environmental Affairs at Indiana University-South Bend. Annotation c. Book News, Inc., Portland, OR (booknews.com)

Booknews

Reviewer: Esperanza Magat-Domingo, MSN (Rush University Medical Center)
Description: The U.S. healthcare delivery system is unique in the world. It is complex, dynamic, governed by an imperfect market, and made up of an amalgam of its functional components and subsystems. It is a product of many reforms and policies influenced by conditions of austerity brought about by the rigid dichotomy of the U.S. political system. This book highlights that healthcare for all is a universal theoretical concept.
Purpose: Updated data figures, trends, research findings, exhibits, graphs, and summaries make this edition come alive. The authors are successful in providing exhaustive and current information on the complexities of healthcare delivery and finance using a systems approach. Knowledge of the historical antecedents of healthcare delivery, how it evolves and how it works, the legacy and outcomes of the Affordable Care Act, and the continued quest to reform will allow the audience to maintain a strategic position in the macrosystem of healthcare and in the world.
Audience: The audience is students in graduate and undergraduate courses, instructors, policymakers, healthcare managers, practitioners, and others in this country and overseas. They are provided with up-to-date information about our how this dynamic healthcare delivery system works and evolves and the continuous quest for reform. While the book may be overwhelming to beginners, the accompanying ebook provides a comprehensive summary, interactive tools, and assessments to help readers fully understand the content. The authors are both professors and recognized experts in health policy and management and business and economics.
Features: The book recounts the foundation and evolution of healthcare delivery and the resources and processes that make it work. It highlights the salient outcomes of the current Affordable Care Act and provides insights into future reforms by the current administration. Using a systems approach, it is able deliver a wealth of information on how the components of healthcare delivery work interdependently and fit together to improve access, cost, and quality on the personal and population level.
Assessment: This book is indispensable for anyone who can influence policy in healthcare delivery to maintain a strategic position to achieve cost effectiveness, access, and quality, and tackle contemporary trends in healthcare in the U.S. and abroad. This edition reflects updated data and the most recent trends in the U.S. healthcare delivery system.

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