Delivering Health Care in America : A Systems Approach

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ISBN: 9780763724931 | 0763724939
Cover: Paperback
Copyright: 1/1/2001

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Johns Hopkins Univ. Baltimore, MD. Overview of the U.S. health services system, including history, structure, services offered, impact on costs and quality, and future direction. Each chapter begins with a reprinted article, includes a lengthy discussion, and ends with terminology and review questions. Previous edition: c1998. Softcover.

Foreword

Preface

xiii

Acknowledgments

A Distinctive System of Health Care Delivery

(32)

APHA Makes Its Voice Heard on Federal Issues

(2)

Introduction

(1)

An Overview of the Scope and Size of the System

(1)

A Broad Description of the System

(3)

The Mechanism for Health Services Delivery

(2)

Transition from Traditional Approaches to Managed Care

(1)

Primary Characteristics of the U.S. Health Care System

(9)

Trends and Directions

(1)

Significance for Health Care Managers

(2)

Health Care Systems of Other Countries

(4)

The Systems Framework

(3)

Summary

(1)

Test Your Understanding

(1)

Review Questions

(3)

PART I SYSTEM FOUNDATIONS

(78)

Beliefs, Values, and Health

(42)

Healthy People 2010

(3)

Introduction

(1)

Significance for Managers and Policy Makers

(1)

Basic Concepts

(8)

Determinants of Health

(4)

Cultural Beliefs and Values

(2)

A Social Model of Health

(1)

Equitable Distribution of Health Care

(4)

Justice in the U.S. Health Delivery System

(2)

Limitations of Market Justice

(1)

Integration of Individual and Community Health

(4)

Measures of Health Status

(5)

Measures of Health Services Utilization

(1)

Summary

(1)

Test Your Understanding

(1)

Review Questions

(6)

The Evolution of Health Services in the United States

(34)

A Bloody Evolution: Human Error in Medicine Is as Old as the Practice Itself

(2)

Introduction

(1)

Medical Services in Preindustrial America

(4)

Medical Services in Postindustrial America

(18)

Recent Evolutions and the 21st Century

102

(4)

Summary

106

(1)

Test Your Understanding

107

(1)

Review Questions

107

(4)

PART II SYSTEM RESOURCES

111

(116)

Health Services Professionals

113

(38)

COGME Reports to the DHHS Secretary and Congress

113

(2)

Introduction

115

(2)

Physicians

117

(15)

Dentists

132

(1)

Pharmacists

133

(1)

Other Doctoral-Level Health Professionals

134

(1)

Nurses

135

(2)

Nonphysician Practitioners

137

(3)

Allied Health Professionals

140

(2)

Health Services Administrators

142

(1)

Summary

143

(1)

Test Your Understanding

144

(1)

Review Questions

144

(7)

List of Professional Organizations

149

(2)

Medical Technology

151

(31)

Seeing the Body Electric, in 3-D

151

(3)

Introduction

154

(1)

What Is Medical Technology?

155

(1)

Information Technology

155

(2)

The Diffusion and Utilization of Medical Technology

157

(4)

Managed Care and Technology Diffusion

161

(1)

The Government's Role in Technology Diffusion

162

(2)

The Impact of Medical Technology

164

(7)

The Assessment of Medical Technology

171

(3)

The Role of the Private Sector in Technology Assessment

174

(1)

Implications for Policy and Management

174

(2)

Some Critical Issues

176

(1)

Summary

177

(1)

Test Your Understanding

178

(1)

Review Questions

178

(4)

Health Services Financing

182

(45)

Budget Act Putting Squeeze on Medicare: Cost Cutting Curbs Some Benefits

182

(3)

Introduction

185

(1)

The Role and Scope of Health Services Financing

185

(2)

Financing and Cost Control

187

(1)

The Insurance Function

188

(5)

Public Financing

193

(9)

Miscellaneous Private and Public Programs

202

(1)

The Payment Function

203

(6)

National Health Care Expenditures

209

(5)

Problems and Issues in Financing

214

(5)

Trends and Directions

219

(2)

Summary

221

(1)

Test Your Understanding

222

(1)

Review Questions

223

(4)

PART III SYSTEM PROCESSES

227

(240)

Outpatient and Primary Care Services

229

(41)

Match Continues Move toward Primary Care

229

(2)

Introduction

231

(1)

What Is Outpatient Care?

232

(1)

The Scope of Outpatient Services

233

(1)

Primary Care

234

(4)

Community-Oriented Primary Care

238

(1)

Primary Care Providers

239

(1)

Growth in Outpatient Services

240

(1)

Reasons for the Growth in Outpatient Services

241

(3)

Types of Outpatient Care Settings and Methods of Delivery

244

(18)

Utilization of Outpatient Services

262

(2)

Summary

264

(2)

Test Your Understanding

266

(1)

Review Questions

266

(4)

Inpatient Facilities and Services

270

(42)

A Two-Front Battle: Hospitals Fight Error Reporting as They Seek Higher Payments

270

(3)

Introduction

273

(1)

Transformation of the Hospital in the United States

273

(4)

Expansion of Hospitals in the United States

277

(2)

Hospital Downsizing in Recent Years

279

(2)

Some Key Utilization Measures and Operational Concepts

281

(5)

Hospital Employment

286

(1)

Types of Hospitals

287

(10)

What Makes a Hospital Non-Profit?

297

(2)

Some Management Concepts

299

(2)

Licensure, Certification, and Accreditation

301

(1)

Ethical and Legal Issues in Patient Care

302

(2)

Hospitals and Public Trust

304

(1)

The Future Outlook for Hospitals

305

(1)

Summary

306

(1)

Test Your Understanding

307

(1)

Review Questions

308

(4)

Managed Care and Integrated Organizations

312

(50)

A Surprisingly Popular U.S. Export: Managed Care

312

(3)

Introduction

315

(3)

The Evolution of Managed Care

318

(2)

What Is Managed Care?

320

(4)

Reasons for the Growth of Managed Care

324

(1)

Cost Control in Managed Care

325

(5)

Types of Managed Care Organizations

330

(7)

Trends in Managed Care

337

(4)

Impact on Cost, Access, and Quality

341

(2)

Managed Care Backlash

343

(3)

Consolidation, Expansion, Diversification, and Integration

346

(2)

Integrated Delivery Systems

348

(1)

Types of Integration

348

(5)

Issues Related to Integration

353

(2)

Managed Competition

355

(1)

Summary

356

(1)

Test Your Understanding

357

(1)

Review Questions

357

(5)

Long-Term Care

362

(50)

What Is PACE?

362

(3)

Introduction

365

(1)

What Is Long-Term Care?

366

(4)

The Nature of Long-Term Care

370

(7)

The Clients of Long-Term Care

377

(3)

Types of Community-Based Long-Term Care Services

380

(8)

Institutional Long-Term Care

388

(6)

Specialized Facilities

394

(2)

Institutional Demographics of Long-Term Care Facilities

396

(3)

Sources of Financing Nursing Home Care

399

(3)

Future Financing of Long-Term Care

402

(2)

Prospective Payment System for SNFs

404

(1)

Requirements of Participation

405

(1)

Summary

406

(1)

Test Your Understanding

407

(1)

Review Questions

408

(4)

Health Services for Special Populations

412

(55)

Mental Health: A Report of the Surgeon General

412

(4)

Introduction

416

(1)

Racial Minorities

416

(13)

The Uninsured

429

(1)

Children

430

(3)

Women

433

(3)

Rural Health

436

(3)

The Homeless

439

(3)

Mental Health

442

(5)

The Chronically III and Disabled

447

(2)

HIV/AIDS

449

(12)

Summary

461

(1)

Test Your Understanding

461

(1)

Review Questions

462

(5)

PART IV SYSTEM OUTCOMES

467

(78)

Cost, Access, and Quality

469

(48)

A Vision for Creating a New Model To Reach 100% Access and Zero Health Disparities

469

(5)

Introduction

474

(1)

Cost of Health Care

474

(5)

Reasons for Cost Escalation

479

(7)

Cost Containment---Regulatory Approaches

486

(5)

Cost Containment---Competitive Approaches

491

(2)

Access to Care

493

(8)

Quality of Care

501

(1)

Dimensions of Quality

502

(2)

Quality Assurance

504

(2)

Quality Assessment

506

(5)

Quality Report Cards

511

(1)

Summary

511

(1)

Test Your Understanding

512

(1)

Review Questions

513

(4)

Health Policy

517

(28)

Health Policy Is One of the Defining Issues in the Race for the White House

517

(3)

Introduction

520

(1)

What Is Health Policy?

520

(2)

The Principle Features of U.S. Health Policy

522

(8)

The Development of Legislative Health Policy

530

(3)

Critical Policy Issues

533

(6)

The Future of Health Policy

539

(3)

Summary

542

(1)

Test Your Understanding

543

(1)

Review Questions

543

(2)

PART V SYSTEM OUTLOOK

545

(35)

The Future of Health Services Delivery

547

(33)

Health Industry Confronting Changes: 700 Executives in Town Discuss Challenges Ahead

547

(3)

Introduction

550

(1)

Toward a True Health Care System

551

(5)

Workforce Composition

556

(2)

Financing of Care

558

(6)

Managed Care

564

(4)

Long-Term Care

568

(1)

Caring for the Uninsured

569

(1)

Technology

570

(1)

Outcome, Measurement, Monitoring, and Assessment

571

(3)

Enhanced Focus on Customer Service

574

(1)

Work Organization

575

(1)

Conclusion

576

(1)

Summary

576

(1)

Test Your Understanding

577

(1)

Review Questions

578

(2)

Appendix A---Glossary

580

(21)

Appendix B---Selected Web Sites

601

(3)

Index

604

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Delivering Health Care in America : A Systems Approach

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