Understanding Healthcare Economics: Managing Your Career in an Evolving Healthcare System

Overview

Healthcare economics is a topic of increasing importance due to the substantial changes that are expected to radically alter the way Americans obtain and finance healthcare. Understanding Healthcare Economics: Managing Your Career in an Evolving Healthcare System provides an evidence-based framework to help practitioners comprehend the changes already underway in our nation’s healthcare system. It presents important economic facts and explains the economic concepts needed to understand the implications of these ...

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Overview

Healthcare economics is a topic of increasing importance due to the substantial changes that are expected to radically alter the way Americans obtain and finance healthcare. Understanding Healthcare Economics: Managing Your Career in an Evolving Healthcare System provides an evidence-based framework to help practitioners comprehend the changes already underway in our nation’s healthcare system. It presents important economic facts and explains the economic concepts needed to understand the implications of these facts. It also summarizes the results of recent empirical studies on access, cost, and quality problems in today’s healthcare system.

Explaining what the term healthcare crisis means, the book evaluates key reforms designed to ameliorate the crisis. It examines emerging trends in the healthcare delivery system to provide a clear understanding of the implications of recently implemented policy solutions. It also illustrates how public- and private-sector initiatives are working to reduce cost increases by fundamentally altering the systems for delivery of care through managed care organizations, accountable care organizations, and patient-centered medical homes.

The text identifies the pressures for change and examines six emerging strategies that can help boost efficiencies in the healthcare system. It addresses the macro-economic problems, such as the impact of changing demographics, as well as the micro-economic problems, such as lifestyle choices on healthcare costs.

Demystifying the terminology, facts, and types of changes that are currently underway, the book provides you with the understanding of healthcare economics you will need to identify viable strategies for adapting to the changes on the horizon.

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Product Details

  • ISBN-13: 9781482203974
  • Publisher: Taylor & Francis
  • Publication date: 10/29/2013
  • Pages: 255
  • Product dimensions: 6.90 (w) x 10.00 (h) x 0.80 (d)

Meet the Author

William T. O’Donohue, PhD, received a doctorate in psychology from the State University of New York at Stony Brook and a master’s degree in philosophy from Indiana University. He is a licensed clinical psychologist in Nevada. He is a full professor of clinical psychology at the University of Nevada, Reno, and has directed the Victims of Crime Treatment Center, which provides free treatment to sexual assault victims at the university, for 17 years. Since 1996, he has received over $1,500,000 in federal grant monies from sources including the National Institute of Mental Health and the National Institute of Justice. He has published over 60 books, and more than 200 articles and book chapters.

Teresa Serratt, RN, PhD, is an assistant professor at the Orvis School of Nursing at the University of Nevada, Reno. She received her doctorate in nursing from the University of California, San Francisco, with a specialty in health policy. She currently teaches courses in healthcare leadership and management, healthcare analysis, and healthcare economics. Her primary research focus is health policy, nursing workforce, and organizational analysis of economic and quality issues of acute care hospitals.

As a registered nurse for over 20 years, she has spent the majority of her career at the bedside providing care to critically ill adult patients. She has also held hospital education and administrative positions. In these various roles, she has experienced firsthand some of the failures of our healthcare system and feels it is imperative that healthcare professionals understand the healthcare reform issues and join the debate.

Jeanne Wendel, PhD
, earned a doctorate in economics from Southern Methodist University. She is an economics professor at the University of Nevada, Reno, where she teaches classes in health economics and the economics of government regulation. She completed the first Intermountain Advanced Training Program in Clinical Practice Improvement, served on a hospital design team, which implemented a hospital-wide quality improvement program, and supported quality improvement teams for two and a half years. She also served as the initial coordinator for the Nevada health information technology work group.

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Table of Contents

PRESSURES FOR CHANGE

Access
Introduction
Background: Information Available to Lawmakers during the PPACA Debate
Proposed Strategies for Increasing Access: Impacts on the Incidence of Uninsurance (Pre-PPACA Estimates)
Public and Private Insurance Trends
Who Was Uninsured Prior to PPACA?
Insurance Markets: Three Critical Access Issues
How Do Insurance Markets Work?
Basic Insurance Concepts
Three Critical Issues
Issue 1: Some Employers Do Not Offer Health Insurance
Issue 2: Some Individuals Are Uninsured, Even Though They Are Eligible for Public Insurance or ESI Because They Do Not Take Up the Insurance Offer
Issue 3: Restrictive Insurance Company Practices Make It Impossible for Some Individuals to Purchase Insurance
Solution Options: What Do We Learn from Examining the Three Critical Issues?
Conclusion: Equitable Access to Healthcare Is an Important Social Goal, but Health Insurance Is Just a Tool to Achieve a Larger Goal—Health
Endnotes

Cost
Introduction
Background Information: What Does It Mean to Say, "The System Is Not Sustainable"?
Diagnosing the Problem: What Is Fueling the Cost Increases?
Technology
Since Technological Advancement Is the Root Cause of the Unsustainable Cost Increases, Maybe We Should Reduce Our Investment in Research
Do the New Treatments Produce Good Value for the Dollar?
Can We Assess Whether $1.9 Million Is Too Much (or Too Little) to Spend in Order to Save a Life?
Solution Options: How Can We Make the System More Sustainable?
Option 1: We Could Continue to Spend More on Healthcare Every Year, and Accommodate This by Spending Less on Other Goods
Option 2: We Could Restrain the Quantities of Healthcare Services That Are Utilized Annually in the United States
We Could Ration by Price
We Could Ration by Wait Time
We Could Ration by Setting Priorities
Option 3: We Could Make Our Healthcare System More Efficient
Conclusion: Given the Challenges Posed by Strategies to Ration or Prioritize, We Should Pay Serious Attention to Strategies for Increasing the Efficiency of Our Healthcare System
Two of the Numerous Suggestions That Sound Good, but Have Limited Potential for Solving the Problem
Modify Tax or Patent Policies to Reduce Pharmaceutical Profits
Facilitate Importation of Prescription Drugs from Lower-Price Non-U.S. Sources
General Conclusions

Quality
Introduction
Background Information: Three Types of Evidence Indicate That Quality Is Not Consistently High
International Comparisons Indicate That Other Countries Are Doing More with Less
What Can We Conclude about This Evidence?
Diagnosing the Root Cause of the Quality Problem
Evidence Documents the Occurrence of Preventable Medical Errors
Evidence Documents Variations in Regional Treatment Patterns
What Is Influencing Physician Decisions?
Does Higher Utilization Reduce Mortality?
Are the Regional Differences Large Enough to Be Important?
Solution Options: How Can We Make Our Healthcare System More Systematic?
Applying Total Quality Management Principles to Healthcare
Brief History
Implement Systematic Protocols: Clinical Pathways and Guidelines
Clinical Pathways
Clinical Guidelines
Implications of Not Enough Science
Conclusion: Some Strategies for Strengthening Quality Are Clear; However, the Concept of Healthcare Quality Is Multidimensional
Conclusion to Section I
Endnote

STRATEGIES TO INCREASE EFFICIENCY
Introduction
Do Healthcare Markets Operate Efficiently?
Two Key Market Failures in Healthcare
The Principal-Agent Problem: Healthcare Providers and Auto Mechanics
Insurance Reduces the Incentive for Patients to Shop Wisely
How Should Government Address These Market Failures?

Align Incentives via Payment System Design
Introduction
Strategies to Control Cost: Rate Design Replaced Certificate of Need Programs
What Is the "Right" Price?
Rate Design: Setting the Level of Payments
Rate Design: Designing the Structure of Payments
Efficiency Incentives: Diagnostic-Related Groups (DRGs)
Current Issues: Two Facets of Medicare Payment Policy
Bundled Payment: Eliminate Silos
Selective Contracting
Measuring Quality: Pay-for-Performance and Consumer Information
Conclusion

Managed Care Organizations, Accountable Care Organizations, and Patient-Centered Medical Homes
Introduction
Background: Managed Care Organizations
Managed Care: Historical Trends
Managed Care: The Backlash
Current Issues: Lessons Learned
Lesson 1. Defining Consumer Protection Is Complex
Lesson 2. Shifting to Managed Care or ACOs Focuses On A Definition of Quality That Is New for Many Patients
Lesson 3. Growth of Managed Care Organizations Raised Two Types of Market Power Issues
Lesson 4. Managed Care Organizations Also Raised Questions About Physician Risk Taking and Solvency Regulation
Lesson 5. Mental Health Parity Mandate May Constitute A Special Case
Lesson 6. Physician Rating Systems Raise Concerns
Conclusion: Experiences with Managed Care Organizations Provide Significant Lessons Learned, as Providers Begin Forming ACOs and PCMHs
Endnotes

Wellness, Prevention, Disease Management
Introduction
Background: PPACA Focuses Increased Attention on Prevention and Wellness
Current Issues
After We Identify Individuals Who Are Most Likely to Benefit from Prevention Programs, Can We Design Programs to Successfully Induce Them to Participate?
Conclusion

New Types of Providers
Introduction
Background
Current Issues
New Types of Providers
Retail Clinics
Single Specialty Hospitals
New Roles for Patients

HIT = EMR + HIE
Introduction
Background: Simultaneous Public- and Private-Sector Initiatives
Federal Initiatives
Private Sector Initiatives
Concerns
Provider Privacy
Patient Privacy
Conclusion
Conclusion to Section II

References
Index

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