Introduction to Health Care Services: Foundations and Challenges

Introduction to Health Care Services: Foundations and Challenges offers new insights into the most important sectors of the United States' health care industry and the many challenges the future holds. Designed to provide a comprehensive and up-to-date understanding of the system, this textbook covers the many facets of health care delivery and details the interaction of health, environments, organizations, populations, and the health professions. Written by authors with decades of experience teaching and working in health care administration and management, the book examines the current state and changing face of health care delivery in the United States. Each chapter includes learning objectives and discussion questions that help guide and engage deeper consideration of the issues at hand, providing a comprehensive approach for students. Cases studies demonstrating innovations in the delivery of health care services are also presented.

Health care administration requires a thorough understanding of the multiple systems that define and shape the delivery of health care in the United States. At the same time, it is important for students to gain an appreciation of the dilemma confronting policy makers, providers, and patients in the struggle to balance cost, quality, and access. Introduction to Health Care Services: Foundations and Challenges is an in-depth examination of the major health care issues and policy changes that have had an impact on the U.S. health care delivery system.

• Includes information on U.S. health care delivery, from care to cost, and the forces of change
• Focuses on major industry players, including providers, insurers, and facilities
• Highlights challenges facing health care delivery in the future, including physician shortages, quality care, and the chronic disease epidemic

The U.S. health care system is undergoing major reform, and the effects will ripple across every sector of the industry. Introduction to Health Care Services: Foundations and Challenges gives students a complete introduction to understanding the issues and ramifications.

BERNARD J. HEALEY, PHD, is professor of health care administration at King's College in Wilkes Barre, Pennsylvania. Dr. Healey has four books and over 100 articles about leadership in health care, public health, health policy, and health care partnerships.

TINA MARIE EVANS, PHD, ATC, is associate professor and department head of applied health studies at Pennsylvania College of Technology. She is an active researcher, publishing and presenting on various allied health topics on the local, regional, national, and international levels.

Figures, Tables, and Exhibits xiii

Introduction xvii

Acknowledgments xix

About the Authors xxi

About the Contributors xxiii

Part One: Overview of Health Care Service Delivery 1

Chapter 1 An Overview of Health Care Delivery in the United States 3
Bernard J. Healey

Health Care Costs 4

Health Care Access 15

Health Levels and Outcomes 17

Health Care Quality 24

Summary 26

Discussion Questions 27

Chapter 2 The Forces of Change in Health Care  31
Bernard J. Healey

Consequences of Forty Years of Health Care Cost Escalation 32

Health Care Reform 38

Summary 49

Discussion Questions 51

Part Two: The Major Players in Health Care Services 55

Chapter 3 Providers of Health Care Services 57
Tina Marie Evans

Primary Care Physicians and Primary Care Assistants 57

Specialty Care Providers 59

Dentists, Dental Hygienists, and Dental Assistants 61

Mental Health Care Providers 62

Nurses 66

Radiologic and Imaging Professionals 67

Allied Health Rehabilitation Professionals 70

Collaboration in Health Care 73

Employment Trends in the Health Care Sector 74

Summary 77

Discussion Questions 78

Chapter 4 Hospitals 81
Denice Yanchik

History of Hospitals 81

Management of Hospitals 85

Quality and Safety in Hospitals 93

Magnet Recognition Program 96

Challenges and the Future 99

Summary 100

Discussion Questions 101

Chapter 5 Ambulatory Care Services 105
Tina Marie Evans

History of Ambulatory Care Services 107

Reasons for the Expansion of Ambulatory Care 110

Hospital-Based Ambulatory Care 112

Non-Hospital-Based Ambulatory Care 114

Primary Care Management 120

Home Health Care Services 121

Hospice Services 124

Quality Assurance in Ambulatory Care 126

Summary 127

Discussion Questions 128

Chapter 6 Health Insurance and Payment for Health Care Services 131
Jeffrey R. Helton and Bernard J. Healey

Basics of U.S. Health Insurance 134

History of Health Insurance 135

How Health Insurance Markets Work 138

Health Insurance Providers 139

Reimbursement for Health Care Providers 145

Why Health Insurance Is Such a Huge Problem in the United States 148

Creative Destruction of Health Insurance 149

Summary 152

Discussion Questions 153

Chapter 7 Managed Care 155
Bernard J. Healey

Concepts of Managed Health Care 157

History of Managed Health Care 158

Types of Managed Care Plans 161

Managed Care Utilization Control 163

Managed Care Quality Issues 166

Managed Care and Prevention of Disease 168

Comparative Effectiveness Research 169

Future of Managed Health Care 172

Summary 174

Discussion Questions 176

Chapter 8 Long-Term Care 179
Tina Marie Evans

The Aging of Americans 180

History of Long-Term Care 184

Organization of Long-Term Care 186

Payment for Long-Term Care Services 193

Chronic Diseases and Their Complications 198

Challenges for Long-Term Care in the Future 202

Summary 205

Discussion Questions 205

Chapter 9 Mental Health Care 209
Tina Marie Evans

History of Mental Health 210

The Role of Stress 216

Types of Mental Illnesses 218

Mental Health Care Providers 226

Mental Health Parity 229

Summary 233

Discussion Questions 234

Chapter 10 Public Health Services 237
Bernard J. Healey

History of Public Health 240

Structure of Public Health Departments 242

Determinants of Health 244

Core Functions of Public Health 247

Epidemiology and Public Health 248

Population-Based Health 250

Public Health Leadership 255

Future of Public Health 258

Summary 260

Discussion Questions 261

Part Three: Challenges in Health Care Delivery 265

Chapter 11 The Pursuit of Quality Care 267
Tina Marie Evans

Origins of the Quality Movement 268

IOM Report on Medical Errors 274

IOM Report on the Quality Chasm  278

Quality Improvement Strategies 286

Medical Errors 292

Health Care–Associated Infections 293

Summary 296

Discussion Questions 297

Chapter 12 The Chronic Disease Epidemic 299
Bernard J. Healey

Chronic Diseases and Their Complications 301

Costs of Chronic Diseases 307

Chronic Disease Prevention and Behavioral Changes 310

Applying Business and Other Models to Chronic Disease Prevention 311

Summary 318

Discussion Questions 319

Chapter 13 Leadership Solutions to Health Care Problems 323
Bernard J. Healey

Health Care Reform Beyond the ACA 325

Reengineering the Health Care Sector 326

Understanding Power in the Health Care Sector 327

Changing the Health Care Environment 328

How Leaders Can Meet These Challenges 337

Summary 340

Discussion Questions 341

Chapter 14 Integrating Clinical Services and CommunityPrevention: The Community-Centered Health Home Model  345
Larry Cohen, Leslie Mikkelsen, Jeremy Cantor, Rea Pa˜nares, Janani Srikantharajah, and Erica Valdovinos

History of Clinical Services and Community Prevention Integration 346

Elements of the Community-Centered Health Home 354

Capacities Needed for Effective Implementation 365

Overarching Systems Change Recommendations 367

Summary 371

Discussion Questions 372

Chapter 15 A Look into the Future 375
Bernard J. Healey

Major Challenges Facing Health Care Delivery 376

Areas of Future Concern 385

How to Meet These Challenges 389

Summary 396

Discussion Questions 397

Case Study 1 Innovation in Physician Leadership Education 401
Francis G. Belardi

Case Study 2 Using Marketing Tools to Increase Early Referrals of Children with Developmental and Behavioral Disorders 405
Jeff Kile and Bernard J. Healey

Case Study 3 Fall Reduction at Geisinger Wyoming Valley Medical Center: ‘‘Above All, Do No Harm’’ 409
Daniel J. Amorino

Case Study 4 The VA Reinvents Itself 419
Joseph J. Marrone

Index 427

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