Delivering Health Care In America / Edition 4

Delivering Health Care In America / Edition 4

by Leiyu Shi, Douglas A. Singh

ISBN-10: 076374512X

ISBN-13: 9780763745127

Pub. Date: 09/05/2007

Publisher: Jones & Bartlett Learning

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

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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

New Fifth Edition Now Available

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Product Details

Jones & Bartlett Learning
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Table of Contents

Preface ix

List of Exhibits xiii

List of Figures xv

List of Tables xix

List of Abbreviations/Acronyms xxi

Chapter 1 A Distinctive System of Health Care Delivery 1

Introduction 2

An Overview of the Scope and Size of the System 2

A Broad Description of the System 4

Basic Components of a Health Services Delivery System 5

Uninsured Americans 7

Transition from Traditional Insurance to Managed Care 8

Primary Characteristics of the US Health Care System 8

Trends and Directions 17

Significance for Health Care Practitioners and Policymakers 18

Significance for Health Care Managers 18

Health Care Systems of Other Countries 20

The Systems Framework 28

Summary 30

Test Your Understanding 31

Review Questions 31

Part I System Foundations

Chapter 2 Beliefs, Values, and Health 39

Introduction 40

Significance for Managers and Policymakers 40

Basic Concepts of Health 41

Risk Factors and Disease 43

Health Promotion and Disease Prevention 46

Public Health 48

Bioterrorism and Disaster Preparedness 50

Determinants of Health 51

Cultural Beliefs and Values 55

Equitable Distribution of Health Care 57

Justice in the US Health Delivery System 61

Integration of Individual and Community Health 63

Measures of Health Status 67

Summary 73

Test Your Understanding 74

Review Questions 75

Chapter 3 The Evolution of Health Services in the United States 81

Introduction 82

Medical Services in Preindustrial America 83

Medical Services in Postindustrial America 88

Medical Care in the Corporate Era 107

Has the Era of Socialized Medicine Arrived? 110

Summary 111

Test Your Understanding 113

Review Questions 113

Part II System Resources

Chapter 4 Health Services Professionals 121

Introduction 122

Physicians 124

Issues in Medical Practice, Training, and Supply 130

International Medical Graduates 136

Dentists 137

Pharmacists 138

Other Doctoral-Level Health Professionals 139

Nurses 140

Nonphysician Practitioners 142

Allied Health Professionals 145

Health Services Administrators 148

Summary 149

Test Your Understanding 150

Review Questions 150

Appendix 4-A List of Professional Associations 151

Chapter 5 Medical Technology 159

Introduction 160

What Is Medical Technology? 161

Information Technology and Informatics 161

Innovation, Diffusion, and Utilization of Medical Technology 167

Managed Care and Technology Diffusion 172

The Government's Role in Technology Diffusion 173

The Impact of Medical Technology 177

The Assessment of Medical Technology 182

Current and Future Directions in Health Technology Assessment 186

Summary 189

Test Your Understanding 190

Review Questions 190

Chapter 6 Health Services Financing 199

Introduction 200

The Role and Scope of Health Services Financing 200

Financing and Cost Control 201

The Insurance Function 203

Private Financing 206

Public Financing 210

Miscellaneous Private and Public Programs 225

The Payment Function 226

National Health Care Expenditures 232

Trends, Problems, and Issues in Insurance and Financing 234

Summary 238

Test Your Understanding 239

Review Questions 240

Part III System Processes

Chapter 7 Outpatient and Primary Care Services 247

Introduction 248

What Is Outpatient Care? 248

The Scope of Outpatient Services 249

Primary Care 251

Models of Patient-Centered Primary Care 255

Primary Care Providers 256

Growth in Outpatient Services 257

Reasons for the Growth in Outpatient Services 258

Types of Outpatient Care Settings and Methods of Delivery 260

Complementary and Alternative Medicine 276

Utilization of Outpatient Services 279

Summary 282

Test Your Understanding 282

Review Questions 283

Chapter 8 Inpatient Facilities and Services 289

Introduction 290

Hospital Transformation in the United States 290

The Expansion Phase: Late 1800s to Mid-1980s 295

The Downsizing Phase: Mid-1980s Onward 296

Some Key Utilization Measures and Operational Concepts 299

Hospital Employment 304

Types of Hospitals 304

Expectations from Nonprofit Hospitals 316

Some Management Concepts 318

Licensure, Certification, and Accreditation 320

The Magnet Recognition Program® 321

Ethical and Legal Issues in Patient Care 322

Summary 324

Test Your Understanding 326

Review Questions 326

Chapter 9 Managed Care and Integrated Organizations 333

Introduction 334

What Is Managed Care? 335

Evolution of Managed Care 337

Growth of Managed Care 340

Efficiencies and Inefficiencies in Managed Care 342

Cost Control Methods in Managed Care 343

Types of Managed Care Organizations 348

Trends in Managed Care 355

Impact on Cost, Access, and Quality 357

Managed Care Backlash, Regulation, and the Aftermath 359

Consolidation, Expansion, Diversification, and Integration 361

Integrated Delivery Systems 362

Accountable Care Organizations 362

Types of Integration 363

Pros and Cons of Integration 367

Summary 368

Test Your Understanding 369

Review Questions 370

Chapter 10 Long-Term Care 377

Introduction 378

The Nature of Long-Term Care 381

Long-Term Care Services 384

The Clients of Long-Term Care 388

Level of Care Continuum 391

Types of Community-Based Long-Term Care Services 392

Institutional Long-Term Care Continuum 399

Specialized Facilities 402

Nursing Home Industry and Patient Demographics 404

Summary 412

Test Your Understanding 412

Review Questions 413

Chapter 11 Health Services for Special Populations 419

Introduction 420

Framework to Study Vulnerable Populations 420

Racial/Ethnic Minorities 422

The Uninsured 34

Children 435

Women 437

Rural Health 440

The Homeless 443

Mental Health 445

The Chronically Ill and Disabled 448


Summary 460

Test Your Understanding 461

Review Questions 461

Part IV System Outcomes

Chapter 12 Cost, Access, and Quality 471

Introduction 472

Cost of Health Care 472

Reasons for Cost Escalation 479

Cost Containment-Regulatory Approaches 485

Cost Containment-Competitive Approaches 491

Access to Care 493

Quality of Care 499

Dimensions of Quality 501

Quality Assurance 503

Quality Assessment 505

Public Reporting of Quality 510

Summary 511

Test Your Understanding 512

Review Questions 512

Chapter 13 Health Policy 519

Introduction 520

What Is Health Policy? 520

Principal Features of US Health Policy 523

The Development of Legislative Health Policy 530

Policy Implementation 533

Critical Policy Issues 534

Summary 538

Test Your Understanding 539

Review Questions 539

Part V System Outlook

Chapter 14 The Future of Health Services Delivery 543

Introduction 544

Forces of Change 544

Precedents of Health Reform 546

The Future of Health Reform 549

Delivery Infrastructure of the Future 553

Future Workforce Challenges 556

The Future of Long-Term Care 558

Global Threats and International Cooperation 560

New Frontiers in Clinical Technology 561

Evidence-Based Health Care and Beyond 564

Summary 565

Test Your Understanding 566

Review Questions 566

Glossary 571

Index 595

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