Table of Contents
Preface ix
New in the Fourth Edition xi
Acknowledgments xiii
List of Exhibits xv
List of Tables xvii
List of Figures xix
Chapter 1 Major Characteristics of U.S. Health Care Delivery 1
Introduction 1
Subsystems of U.S. Health Care Delivery 3
Characteristics of the U-S. Health Care System 9
Health Care Systems of Other Developed Countries 19
Systems Framework 23
Conclusion 25
Chapter 2 Foundations of U.S. Health Care Delivery 29
Introduction 29
What Is Health? 30
Determinants of Health 33
Cultural Beliefs and Values 36
Distribution of Health Care 37
Strategies to Improve Health 41
Conclusion 48
Chapter 3 Historical Overview of U.S. Health Care Delivery 53
Introduction 53
Medical Services in Preindustrial America 55
Medical Training 56
Medical Services in Postindustrial America 59
History of Health Insurance 64
Medical Services in the Corporate Era 72
Era of Health Care Reform 74
U.S. Health Care Today 76
Conclusion 77
Chapter 4 Health Care Providers and Professionals 81
Introduction 81
Physicians 83
Dentists 91
Pharmacists 92
Other Doctoral-Level Health Professionals 93
Nurses 95
Nonphysician Practitioners 97
Allied Health Professionals 99
Public Health Professionals 101
Health Services Administrators 102
Conclusion 103
Chapter 5 Technology and Its Effects 107
Introduction 107
What Is Medical Technology? 109
Health Information Technology 110
Diffusion and Utilization of Medical Technology 114
The Governments Role in Technology Diffusion 117
Impact of Medical Technology 122
Assessment of Medical Technology 127
Benefits of Technology Assessment 129
Conclusion 130
Chapter 6 Financing and Reimbursement Methods 135
Introduction 135
Effects of Health Care Financing and Insurance 137
Insurance: Its Nature and Purpose 139
Private Insurance 141
The Affordable Care Act and Private Insurance 145
Public Insurance 147
The Affordable Care Act and Public Insurance 155
Reimbursement Methods 156
The Affordable Care Act and Payment Reform 160
National Health Expenditures 161
Conclusion 163
Chapter 7 Outpatient Services and Primary Care 167
Introduction 167
What Is Outpatient Care? 168
Scope of Outpatient Services 168
Outpatient Care Settings and Methods of Delivery 171
Primary Care 176
Effectiveness of Primary Care 181
The Medical-Home Strategy 185
Assessment of Community Health Centers 185
Conclusion 187
Chapter 8 Hospitals 193
Introduction 193
Evolution of the Hospital in the United States 194
Expansion and Downsizing of Hospitals in the United States 196
Access and Utilization Measures 200
Hospital Employment 202
Types of Hospitals 202
The Affordable Care Act and Hospitals 210
Licensure, Certification, and Accreditation 210
Hospital Organization 211
Ethics and Public Trust 212
Conclusion 215
Chapter 9 Managed Care and Integrated Systems 219
Introduction 219
What h Managed Care? 220
Evolution of Managed Care 222
Growth and Transformation of Managed Care 225
Utilization Control Methods in Managed Care 227
Types of Managed Care Plans 229
Impact on Cost, Access, and Quality 234
Integrated Systems 236
Types of Integration 238
Managed Care and Organizational Integration Under the Affordable Care Act 241
Conclusion 241
Chapter 10 Long-Term Care Services 245
Introduction 245
What Is LTC? 247
Community-Based Long-Term Care Services 253
Institutional Long-Term Care 257
Licensing and Certification of Nursing Homes 261
Other Long-Term Care Services 263
The Affordable Care Act and Long-Term Care 264
Nursing Home Industry and Expenditures 264
Conclusion 266
Chapter 11 Populations with Special Health Needs 269
Introduction 269
Framework to Study Vulnerable Populations 270
Predisposing Characteristics 271
Enabling Characteristics 279
Eliminating Socioeconomic Disparities 281
Need Characteristics 283
Conclusion 286
Chapter 12 Cost, Access, and Quality 291
Introduction 291
Cost of Health Care 292
The High Cost of U.S. Health Care 293
Reasons for High Health Care Costs 296
Cost Containment 298
Unequal in Access 301
Average in Quality 306
Quality Strategies and Initiatives 310
Developments in Process Improvement 311
Conclusion 312
Chapter 13 Health Policy 317
Introduction 317
What Is Health Policy9 318
Principal Features of U.S. Health Policy 320
Development of Legislative Health Policy 329
Critical Policy Issues 331
International Health Policy: Comparisons 337
Conclusion 338
Chapter 14 The Future of Health Services Delivery 341
Introduction 341
Forces of Future Change 342
Challenges of Coverage, Access, and Cost 346
The Future of Health Care Reform 348
Future Models of Care Delivery 352
Future Workforce Challenges 354
Global Challenges 355
New Frontiers in Clinical Technology 356
Care Delivery of the Future 358
Conclusion 358
Appendix 363
Glossary 367
Index 379
