Paperback(6th ed.)
-
PICK UP IN STORECheck Availability at Nearby Stores
Available within 2 business hours
Related collections and offers
Overview
Product Details
| ISBN-13: | 9781284235104 |
|---|---|
| Publisher: | Jones & Bartlett Learning |
| Publication date: | 08/01/2022 |
| Edition description: | 6th ed. |
| Pages: | 390 |
| Product dimensions: | 7.07(w) x 8.95(h) x 0.50(d) |
About the Author
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 x
Acknowledgments xiii
List of Exhibits xiv
List of Tables xv
List of Figures xvi
Chapter 1 Major Characteristics of U.S. Health Care Delivery 1
Introduction 1
Subsystems of U.S. Health Care Delivery 2
Managed Care 3
Military Medical Care 4
Subsystems for Special Populations 5
Integrated Systems 6
Long-Term Care Delivery 8
Public Health System 9
Patient Advocacy Organizations 9
Health Care Reform 10
Public Health Under Covid-19 11
Health Care During the Covid-19 Pandemic 12
Health Care Reform Under the Biden Administration 13
Characteristics of The U.S. Health Care System 13
No Central Governing Agency; Little Integration and Coordination 14
Technology Driven and Focused on Acute Care 14
High in Cost, Unequal in Access, and Average in Outcome 14
Imperfect Market Conditions 16
Government as Subsidiary to the Private Sector 17
Fusion of Market Justice and Social Justice 17
Multiple Players and Balance of Power 18
Quest for Integration and Accountability 18
Access to Health Care Services Selectively Based on Insurance Coverage 18
Legal Risks Influence Practice Behaviors 19
Health Care Systems of Other Developed Countries 19
Canada 19
Germany 21
United Kingdom 22
Systems Framework 24
System Foundations 24
System Resources 24
System Processes 25
System Outcomes 25
System Outlook 25
Conclusion 25
References 25
Chapter 2 Foundations of U.S. Health Care Delivery 31
Introduction 31
What Is Health? 31
Illness and Disease 33
Infectious Disease 34
Acute and Chronic Conditions 36
Quality of Life 36
Determinants of Health 36
Environment 37
Behavior and Lifestyle 37
Heredity 37
Medical Care 37
Cultural Beliefs and Values 38
Distribution of Health Care 38
Market Justice 38
Social Justice 40
Justice in the U.S. Health Care System 40
Strategies to Improve Health 41
Healthy People Initiatives 41
UN Sustainable Development Goals 44
Public Health 46
Focus on Determinants 46
Social Determinants of Health Approach to Health Care Delivery 50
Conclusion 51
References 51
Chapter 3 Historical Overview of U.S. Health Care Delivery 57
Introduction 57
Medical Services in Preindustrial America 58
Medical Training 58
Medical Practice 59
Medical Institutions 60
Medical Services in Postindustrial America 61
Medical Profession 61
The American Medical Association 63
Educational Reform 63
Development of Hospitals 64
Reform of Mental Health Care 64
History of Health Insurance 64
Worker's Compensation 64
Emergence and Rise of Private Health Insurance 65
First Hospital Plan and the Birth of Blue Cross 65
First Physician Plan and the Birth of Blue Shield 65
Employment-Based Health Insurance 66
Failure of National Health Insurance in the United States 66
Creation of Medicare and Medicaid 67
Medical Services in the Corporate Era 70
Corporatization of Health Care Delivery 70
Information Revolution 70
Globalization 71
Era of Health Care Reform 71
Butting Heads Against Religious Liberty 72
Repeal of the Individual Mandate 72
Ongoing Litigation 72
Health Care Reform in Flux 73
Conclusion 73
References 74
Chapter 4 Health Care Providers and Professionals 75
Introduction 75
Physicians 77
Similarities and Differences Between MDs and DOs 78
Generalises and Specialists 78
Hospitalists 78
Differences Between Primary and Specialty Care 79
Work Settings and Practice Patterns 79
Imbalance and Maldistribution of Physicians 79
Health Care Providers During the Covid-19 Pandemic 82
Health Care and Value-Based Pay 83
Dentists 84
Pharmacists 85
Other Doctoral-Level Health Professionals 85
Nurses 86
Advanced-Practice Nurses 87
Nonphysician Practitioners 87
Value of NPP Services 88
Allied Health Professionals 89
Technicians and Assistants 89
Technologists and Therapists 89
Public Health Professionals 90
Community Health Workers 90
Community-Oriented Primary Care 92
Health Services Administrators 93
Patient-Centered Care 93
Multidisciplinary Teams 94
Precision Medicine 95
Conclusion 96
References 96
Chapter 5 Technology and Its Effects 101
Introduction 101
What Is Medical Technology? 102
Health Information Technology 102
Major Categories 103
Electronic Health Records 104
The Internet, E-Health, and E-Therapy 105
Telemedicine and Remote Monitoring 106
Diffusion and Utilization of Medical Technology 107
Cultural Beliefs and Values 108
Medical Training and Practice 108
Insurance Coverage 108
Competition Among Providers 109
The Government's Role in Technology Diffusion 109
Regulation of Drugs, Devices, and Biologies 109
Research on Technology 112
Impact of Medical Technology 113
Impact on Quality of Care 113
Impact on Quality of Life 114
Impact on Health Care Costs 114
Impact on Access 115
Impact on the Structure and Processes of Health Care Delivery 115
Impact on Global Medical Practice 115
Impact on Bioethics 116
Assessment of Medical Technology 116
Efficacy 116
Safety 117
Cost-Effectiveness 117
Benefits of Technology Assessment 117
Delivering Value 118
Cost Containment 118
Standardized Practice Protocols 118
Conclusion 118
References 119
Chapter 6 Financing and Reimbursement Methods 123
Introduction 123
Effects of Health Care Financing and Insurance 124
Insurance: Its Nature and Purpose 125
Basic Insurance Concepts 125
Cost Sharing 126
Private Insurance 127
Group Insurance 128
Self-Insurance 128
Direct-Purchase Private Insurance 128
Managed Care Plans 128
High-Deductible Health Plans 129
Private Insurance Under the ACA and Beyond 130
Public Insurance 131
Medicare 131
Medicaid 134
Children's Health Insurance Program 134
Issues with Medicaid 135
Reimbursement Methods 135
Fee for Service 136
Bundled Payments 136
Resource-Based Relative Value Scale 136
Payments for Quality and Cost Savings 136
Reimbursement Under Managed Care 137
From Retrospective to Prospective Reimbursement 137
National Health Expenditures 140
Conclusion 141
References 142
Chapter 7 Outpatient Services and Primary Care 145
Introduction 145
What Is Outpatient Care? 145
Scope of Outpatient Services 145
Reimbursement 147
Technological Factors 147
Utilization Control Factors 147
Social Factors 147
Outpatient Care Settings and Methods of Delivery 148
Private Practice 148
Hospital Outpatient Clinics 148
Freestanding Facilities 148
Mobile Facilities for Medical, Diagnostic, and Screening Services 149
Telephone or Internet Triage 149
Home Care 149
Hospice Care 149
Outpatient Long-Term Care Services 150
Public Health Services 150
Community Health Centers 150
Free Clinics 150
Alternative Medicine Clinics 150
Primary Care 151
What Is Primary Care? 151
WHO Definition 151
IOM Definition 152
Domains of Primary Care 152
Community-Oriented Primary Care 153
Primary Care Around the World 154
Effectiveness of Primary Care 155
Hospitalizations and Use of Emergency Care 155
Cost of Care 156
Morbidity 156
Mortality 157
Mental Health 157
The Medical Home Strategy 157
Primary Care Assessment Tools 158
Primary Care in Integrated Care Delivery 159
Primary Care and Geriatric Care Integration 160
Use of Information Technology in Primary Care 161
Assessment of Community Health Centers 162
CHCs' Quality of Care 162
CHCs' Access to Care 163
CHCs' Cost-Effectiveness 164
CHCs and the Affordable Care Act 164
Primary Care in Pandemics 164
Conclusion 165
References 166
Chapter 8 Hospitals 171
Introduction 171
Evolution of the Hospital in the United States 171
Stage 1 172
Stage 2 172
Stage 3 172
Stage 4 172
Stage 5 173
Stage 6 173
Expansion and Downsizing of Hospitals in the United States 173
Effects of Covid-19 on U.S. Hospitals 175
Access and Utilization Measures 176
Measures of Access 176
Measures of Utilization 176
Utilization of Hospital Capacity 177
Hospital Employment 177
Types of Hospitals 177
Community Hospitals 178
Public Hospitals 178
Private Nonprofit Hospitals 179
Private For-Profit Hospitals 180
General Hospitals 181
Specialty Hospitals 181
Psychiatric Hospitals 181
Rehabilitation Hospitals 181
Children's Hospitals 182
Rural Hospitals 182
Teaching Hospitals 182
Osteopathic Hospitals 183
Licensure, Certification, and Accreditation 183
Hospital Quality and Safety 184
Hospital Organization 184
Ethics and Public Trust 185
Ethical Challenges 185
Addressing Ethical Issues 185
Public Trust 186
Conclusion 186
References 187
Chapter 9 Managed Care and Integrated Systems 189
Introduction 189
What Is Managed Care? 190
Accreditation and Quality Indicators 190
Evolution of Managed Care 191
Growth and Transformation of Managed Care 192
Private Insurance Enrollment 193
Medicare Enrollment 193
Medicaid Enrollment 194
Managed Care Backlash 194
Transformation of Managed Care 194
Utilization Control Methods in Managed Care 195
Gatekeeping 195
Utilization Review 195
Types of Managed Care Plans 196
HMO Plans 196
PPO Plans 198
Point-of-Service Plans 199
Impact on Cost, Access, and Quality 199
Influence on Cost Containment 199
Impact on Access 199
Influence on Quality of Care 200
Organizational Integration 200
Effects of Integration 201
Types of Integration 201
Integration Based on Major Participants 201
Integration Based on Type of Ownership or Affiliation 202
Integration Based on Service Consolidation 203
Highly Integrated Systems 203
Integrated Delivery Systems 203
Accountable Care Organizations 204
Oregon's Coordinated Care Organizations 204
Conclusion 205
References 205
Chapter 10 Long-Term Care Services 209
Introduction 209
Aging and Long-Term Care 210
What Is Long-Term Care? 211
A Variety of Health Care Services 212
Individualized Services 212
Coordination of Services 213
Maximum Possible Functional Independence 213
Extended Period of Time 213
Holistic Approach 213
Quality of Life 214
Community-Based Long-Term Care Services 214
Home Health Care 215
Adult Day Care 215
Adult Foster Care 216
Senior Centers 216
Home-Delivered and Congregate Meals 216
Homemaker and Handyman Services 216
Emergency Response Systems 217
Case Management 217
Institutional Long-Term Care 217
Retirement Facilities 217
Personal Care Facilities 218
Assisted Living Facilities 218
Skilled Nursing Facilities 219
Subacute Care Facilities 219
Specialized Care Facilities 219
Licensing and Certification of Nursing Homes 220
Licensing 220
Certification 220
Other Long-Term Care Services 221
Respite Care 221
Restorative Care 221
Hospice Care 221
The Affordable Care Act and Long-Term Care 222
Nursing Home Industry and Expenditures 222
Conclusion 223
References 224
Chapter 11 Populations with Special Health Needs 227
Introduction 227
Framework to Study Vulnerable Populations 227
Predisposing Characteristics 228
Racial/Ethnic Minorities 229
Women and Children 231
Geographic Distribution: Rural Health 233
Enabling Characteristics 234
The Uninsured 234
Homelessness 235
Need Characteristics 235
Mental Health 236
Chronic Illness/Disability 237
HIV/AIDS 238
Vulnerable Populations Under Covid-19 239
Eliminating Disparities 240
Conclusion 243
References 243
Chapter 12 Cost, Access, and Quality 249
Introduction 249
Cost of Health Care 249
The High Cost of U.S. Health Care 250
Reasons for High Health Care Costs 252
Third-Party Payment 252
Growth of Technology 253
Increase in the Elderly Population 253
Medical Model of Health Care Delivery 253
Multipayer System and Administrative Costs 253
Defensive Medicine 253
Waste and Abuse 254
Practice Variations 254
Cost Containment 254
Health Planning 254
Price Controls 254
Peer Review 255
Competitive Approaches 255
Value-Based Payment 256
Chronic Disease Prevention, Management, and Cost Control 256
Prospects of Cost Containment 256
Unequal Access to Health Care 257
Data on Access 257
Access Disparities 259
Access Initiatives 260
Health Care Quality 261
Structure 262
Process 263
Outcome 263
Quality Strategies and Initiatives 263
Developments in Process Improvement 267
Clinical Practice Guidelines 267
Cost-Efficiency 267
Critical Pathways 267
Risk Management 267
Learning Health System 268
Patient Safety 268
Baldrige Framework for Health Care 271
Conclusion 272
References 273
Chapter 13 Health Policy 279
Introduction 279
What Is Health Policy? 279
Different Forms of Health Policies 279
Regulatory Tools 280
Allocative Tools 280
Principal Features of U.S. Health Policy 281
Government as Subsidiary to the Private Sector 281
Fragmented, Incremental, and Piecemeal Reform 282
Pluralistic and Interest Group Politics 283
Decentralized Role of the States 285
Impact of Presidential Leadership 286
Research and Policy Development 287
Development of Legislative Health Policy 287
Policy Cycle 287
Legislative Process 288
Critical Policy Issues 289
Access to Care 289
Providers 289
Public Financing 289
Access and the Elderly 290
Access and Minorities 290
Access in Rural Areas 290
Access and Low-Income Populations 290
Smoking and Tobacco Use 290
Cost Containment 291
Quality of Care 292
Mental Health 293
One Health 295
U.S. National Health Reform 295
Health Reform Around the World 298
Conclusion 299
References 300
Chapter 14 The Future of Health Services Delivery 303
Introduction 303
Forces of Future Change 303
Social, Demographic, and Cultural Trends 303
Economic Forces 304
Political Will, Ideologies, and Legal Rulings 305
Reliable and Timely Information 305
Technological Innovation 305
Global Health Issues 306
Ecological Events 306
Cost, Coverage, and Access Dilemmas 307
The Future of Health Care Reform 308
Broader Economic Contexts for Reform 310
Future Models of Care Delivery 310
Value-Based Health Care 311
Risk-Bearing for Population Health 311
Community Outreach 311
Patient Advocacy 311
Virtual Care 312
Technology-Driven Home Visits 312
Step-Down Providers 312
Future Workforce Challenges 312
Global Challenges 314
New Frontiers in Clinical Research and Technology 314
Conclusion 316
References 316
Glossary 319
Index 331