Health Care USA: Understanding Its Organization and Delivery / Edition 8

by Harry A. Sultz, Kristina M. Young

Overview

Health Care USA: Understanding Its Organization and Delivery, Second Edition reflects recent major legislative changes that have occurred in Medicare, Medicaid and public health. The growing concern about mental health services will be covered by taking a close look at emerging behavioral health managed care organizations. The new edition will also reflect the increased penetration of managed care across the country and its effect on not only the health care industry, but also on consumers. Current benchmarks in all areas of health care will be thoroughly updated. Also, an Instructor's Manual is available to support this book.

Product Details

ISBN-13:	9781284065480
Publisher:	Jones & Bartlett Learning
Publication date:	08/26/2014
Pages:	586
Product dimensions:	6.00(w) x 8.90(h) x 1.40(d)

About the Author

Professor Emeritus, Social and Preventative Medicine, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Dean Emeritus, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, New York


Instructor, School of Public Health and Health Professions, State University of New York at Buffalo, Instructor, Canisius College, President, Kristina M. Young & Associates, Inc., Buffalo, New York

Table of Contents

	Foreword	xi
	Acknowledgments	xiii
	Introduction	xv
Chapter 1	Overview of Health Care: A Population Perspective	1
	Problems of Health Care	2
	Understanding Health Care	3
	Why Patients and Providers Behave the Way They Do	4
	Indexes of Health and Disease	5
	Natural Histories of Disease and the Levels of Prevention	6
	Major Stakeholders in the U.S. Health Care Industry	9
	Long-Term Care	15
	Development of Managed Care	17
	Rural Health Networks	19
	Priorities of Health Care	20
	Social Choices of Health Care	23
	The Aging Population	23
	Access to Health Care	26
	Quality of Care	28
	Conflicts of Interest	28
	Health Care's Ethical Dilemmas	29
Chapter 2	Benchmark Developments in U.S. Health Care	31
	The Great Depression and the Birth of Blue Cross	33
	The Dominant Influence of Government	34
	Health Maintenance Organizations	38
	The Reagan Administration	39
	Biomedical Advances: Evolution of High-Technology Medicine	40
	Roles of Medical Education and Specialization	42
	Influence of Interest Groups	44
	Public Health Focus on Prevention	49
	Economic Influences: Rising Costs	50
	The Uninsured and Problems of Access to Medical Care	50
	The Aging of America	51
	Values and Assumptions That Guide Priorities	52
	Oregon Death with Dignity Act	54
	Provisions of the Oregon Death with Dignity Act	55
	The Internet and Health Care	55
	The Basic Issues	56
Chapter 3	Hospitals: Origin, Organization, and Performance	60
	Historical Perspective	60
	Sources That Shaped the Hospital Industry	63
	Growth and Decline in Numbers of Hospitals	65
	Types of Hospitals	65
	Financial Condition of Hospitals	67
	Academic Health Centers, Medical Education, and Specialization	68
	The Balanced Budget Act and Academic Medical Centers	69
	The Hospital System of the Department of Veterans Affairs	69
	Structure and Organization of Hospitals	70
	Types and Roles of Patients	77
	Rights and Responsibilities of Hospitalized Patients	78
	Important Decisions, Informed Consent, and Second Opinions	81
	Diagnosis-Related Group Hospital Reimbursement System	83
	Discharge Planning	84
	Subacute Care	85
	Market-Driven Reforms Affecting Hospitals	86
	Integrated Health Systems	91
	Market Responses to Managed Care	95
	The Quality of Hospital Care	97
	Variations in Medical Care	99
	Hazards of Hospitalization	100
	Current Research Efforts in Quality Improvement	102
	Responsibility of Governing Boards for Quality of Care	103
	Incremental Quality Improvement	105
	Forces of Reform: Cost, Quality, and Access	106
Chapter 4	Ambulatory Care	110
	Overview and Trends	110
	Private Medical Office Practice	113
	Other Ambulatory Care Practitioners	116
	Ambulatory Care Services of Hospitals: History and Trends	116
	Hospital Emergency Services	121
	Free-Standing Services	123
	Community Health Centers	129
	Public Health Services	131
	Voluntary Agencies	133
	Conclusion	134
Chapter 5	Medical Education and the Changing Practice of Medicine	137
	The Flexner Report and Medical School Reforms	139
	Academic Medical Centers	140
	Graduate Medical Education Consortia	143
	Delineation and Growth of Medical Specialties	145
	Specialty Boards and Residency Performance	146
	Funding of Graduate Medical Education	149
	Physician Surplus and U.S. Medical Schools	149
	The Generalist/Specialist Imbalance	151
	Primary Care Physicians--Gatekeepers of the System	152
	Preventive Medicine	153
	Changing Physician/Hospital Relationships	154
	Cost Containment and the Restructuring of Medical Practice	155
	Hold Harmless Clauses	157
	Clinical Practice Guidelines	157
	Physician Report Cards	159
	Growing Concern about Ethical Issues	160
	Physicians and the Internet	161
	Provider Network Contracting	162
	The Future of Medical Practice	163
Chapter 6	Health Care Personnel	169
	Health Professions	170
	Health Care Personnel and Health Care Reforms	171
	Credentialing and Regulating Health Professionals	171
	Health Care Occupations	173
	Alternative Therapists	194
	Factors That Influence Demand for Health Personnel	197
	Health Care Work Force Issues	200
	Conclusion	200
Chapter 7	Financing Health Care	207
	Health Care Expenditures in Perspective	207
	New Diagnostic and Treatment Technology	209
	The Aging of America	210
	The Growth of Specialized Medicine	212
	The Uninsured and Underinsured	212
	A Labor-Intensive Industry	214
	Economic Incentives That Fuel Rising Costs	214
	Components of Health Care Expenditures	214
	Sources of Health Care Payment	215
	Evolution of Health Insurance: Third-Party Payment	217
	Self-Funded Insurance Programs	221
	Government as a Source of Payment	222
	The Future: Continuing Change	250
Chapter 8	Managed Care	257
	Historical Perspective	257
	Managed Care Fundamentals	260
	HMO Act of 1973	262
	The Evolution of Managed Care	264
	Emerging Developments in Managed Care	268
	Medicare and Medicaid Managed Care	270
	Managed Care Organizations and Quality	272
	The Future of Managed Care	275
Chapter 9	Long-Term Care	279
	Long-Term Care and the Continuum of Care	279
	Development of Long-Term Care Services	281
	Modes of Long-Term Care Service Delivery	284
	Innovations in Long-Term Care	305
	Long-Term Care Insurance	308
	The Future of Long-Term Care	309
Chapter 10	Mental Health Services	316
	Historical Perspective	316
	Recipients of Mental Health Services	320
	Special Populations	326
	The Organization and Financing of Mental Health Services	328
	Health Insurance Coverage and Managed Behavioral Health Care	331
	Barriers to Accessing Services	338
	Priorities for Mental Health Services	339
	Need for Further Research	341
Chapter 11	Public Health and the Role of Government in Health Care	348
	Historical Perspective	348
	Decline in Influence of the Public Health Service	358
	Responsibilities of the Public Health Sector	359
	Relationships of Public Health and Private Medicine	362
	Resource Priorities Favor Curative Medicine	364
	Health Care Reform and the Public Health/Medicine Relationship	365
	Hospital-Sponsored Public Health Activities	366
	Public Health Services of Voluntary Agencies	367
	Changing Roles of Government in Public Health	368
	Public Health in an Era of Privatization and Managed Care	369
	Federal Support To Address Emerging Health Issues	371
	Future Role of Government in Promoting the Public's Health	372
Chapter 12	Research: How Health Care Advances	376
	The Focus of Different Types of Research	377
	Research in Health and Disease	377
	Epidemiology	378
	Health Services Research	380
	Agency for Healthcare Research and Quality (Formerly the Agency for Health Care Policy and Research)	380
	Health Services Research and Health Policy	383
	Quality Improvement	384
	Outcomes Research	390
	Patient Satisfaction	391
	Research Ethics	392
	Future Challenges	393
Chapter 13	The Future of Health Care	398
	The Paradox of U.S. Health Care	399
	Organizations and Facilities	400
	Corporate Growth in Health Care	402
	Corporate Alliances	404
	Future of Managed Care	405
	Growth of Home, Outpatient, and Ambulatory Care	407
	Technology	408
	Personnel	409
	Physicians	410
	Academic Health Centers	413
	Health Professions	414
	Nurses	416
	Nurse Practitioners	417
	Physician Assistants	417
	Future Role of the Federal Government	417
	Conclusion	419
Appendix A	Abbreviations and Acronyms	428
Appendix B	Web Sites	439
	Index	442
	About the Authors	461

Editorial Reviews

3 Stars from Doody

This is a relatively brief (320 page) introductory textbook on the U.S. healthcare system written for students in the health professions. The purpose is to provide a text for introductory courses on the U.S. healthcare system for students entering the health professions, including public health, medicine, nursing, dentistry, pharmacy, and allied health. As such, the audience is students in the health professions. To facilitate its use as a teaching text, the authors have organized this book in a succession of chapters intended to stand alone as reviews of specific subjects, or when read sequentially, to build a comprehensive understanding of the U.S. healthcare system. Therefore, this book begins with two general chapters followed by a series of topics organized around different structural features of the delivery system (e.g., hospitals, ambulatory care, medical education, etc.). The book also includes chapters on general topics, such as healthcare personnel, finance, and healthcare research, and concludes with a brief reflection on the future of U.S. healthcare. There is a helpful list of abbreviations at the end, which can assist students grappling with the alphabet soup of the U.S. healthcare system. The authors' effort to organize this text in chapters that stand alone and provide incremental information poses a challenge to the book as a coherent whole. As a result, key topics (the aging U.S. population, Medicare, managed care) receive brief and overlapping discussion in several chapters, rather than focused, thorough treatment. Other important developments such as physician assistants, nurse practitioners, the NIH, and the biotechnology industry receive limited attention.References for some chapters are quite limited and often do not include key source material for students who may wish to explore the topic further.

Eugene C. Rich

This is a general text on the organization and delivery of healthcare services. This second edition is updated with significant developments. The purpose is to provide a broad and general overview of the healthcare system. This book is intended for use as text for introductory courses on the organization and delivery of healthcare services. Thus it is primarily intended for students pursuing education as clinicians, administrators, policy makers, or other allied health professions within the healthcare system. The chapters are self-explanatory and can stand alone; however, when combined with the other chapters, they build a comprehensive picture of the U.S. healthcare system. The authors provide a brief discussion of the development and current status of our healthcare system, present the specific healthcare players and policies, and end with a chapter concerning the future of the healthcare system. Specific subjects include the different organizational structures, healthcare personnel, and policies that are integral in the delivery of healthcare services. An appendix of acronyms will be very useful to the reader. This book covers the essential topics for understanding the U.S. healthcare system. Though admittedly lacking in detail, the breadth of the text provides the beginning student with an understanding of the more vital components of our delivery system. An easily read text allows one to begin to understand an ever-increasingly complex healthcare system. However, because of the book's intent, many important topics only receive minimal attention that serves to detract from the text's comprehensiveness.

James D. Bramble

This text for introductory courses on the organization of health at schools and colleges that prepare health professionals is designed to provide the reader with an understanding of the total health care system. Writing from a population perspective, the authors cover such topics as hospital reengineering, ambulatory and long-term care, medical education, health care personnel, finance and managed care, and mental health service. Annotation c. by Book News, Inc., Portland, Or.

Booknews

Reviewer: James D. Bramble, PhD (Creighton University)
Description: This is an update of a general book on the organization and delivery of healthcare services.
Purpose: The purpose is to provide a clear understanding and overview of the healthcare system and the complicated and complex issues that it confronts. This is a useful book for courses on the organization and delivery of healthcare services.
Audience: Intended for students of healthcare and related professions, healthcare practitioners can also benefit from the broad understanding of the U.S. healthcare system addressed in this book.
Features: The chapters together provide a broad overview of the social and political forces that help shape the complex structures and processes of the U.S. healthcare system. Each chapter begins with a brief description of its contents and is able to stand alone for the reader wishing to study specific topics. In addition to an appendix of acronyms, the authors included a list of web site address of U.S. government and other related healthcare sites for the reader.
Assessment: Updates to this edition provide relevant recent studies and statistics that further the discussion started in the previous edition. The breadth of the book seems more than adequate to familiarize the reader with the U.S. healthcare system. By the authors' own admission, however, readers from allied health professions (i.e., physical therapy) may be disappointed with the lack of specifics regarding their area of specialty. Nonetheless, allied healthcare providers need a greater understanding of the issues affecting the healthcare delivery system in which they work. With easy to read and well organized chapters accompanied by appropriate figures and tables, this book accomplishes its goal of providing a basic broad understanding of the American healthcare system.

Doody's Review Service