The Future U.S. Healthcare System

, by Altman, Stuart H.; Reinhardt, Uwe E.; Shields, Alexandra E.

Write a Review

Note: Supplemental materials are not guaranteed with Rental or Used book purchases.

ISBN: 9781567930672 | 1567930670
Cover: Paperback
Copyright: 10/1/1997

Rent

(Recommended)

$11.01

Term

Due

Price

Semester

Dec 12

$11.59

Quarter

Aug 13

$11.01

Short Term

Jul 12

$10.43

*This item is part of an exclusive publisher rental program and requires an additional convenience fee. This fee will be reflected in the shopping cart.
Buy New

In Stock Usually Ships in 24 Hours

$14.84

Supplemental Materials

Foreword

xiii

(4)

Steven A. Schroeder

Acknowledgments

xvii

1. Healthcare for the Poor and Uninsured: An Uncertain Future

(24)

Stuart H. Altman

Uwe E. Reinhardt

Alexandra Shields

Introduction

(1)

The Number of Uninsured in the United States: What Is the Magnitude of the Problem?

(3)

The Implications of Being Without Health Insurance

(2)

Why Has the Problem Persisted?

(5)

Increasingly Less Healthcare Available for the Uninsured

(3)

Concrete Proposals for Change

(1)

Incremental Reforms at the National and State Levels

(3)

Looking to the Future

(7)

Part I The Problem of the Uninsured--It's Real and Getting Worse

(74)

2. Uninsured in America: The Causes and Consequences

(20)

Diane Rowland

Judith Feder

Patricia Seliger Keenan

Introduction

(1)

Who Are the Uninsured?

(4)

What Is Happening to Health Insurance Coverage?

(6)

What Are the Consequences of Lack of Insurance?

(5)

Conclusion

(4)

3. All Uninsured Are Not the Same

(22)

Katherine Swartz

Characteristics of the Uninsured at a Specific Point in Time

(6)

Dynamics of Being Without Health Insurance

(2)

Policy Choices

(10)

Conclusion

(3)

4. The Changing Role of Medicaid

(20)

John F. Holahan

Medicaid Growth Explosion, 1988-92

(6)

Slowdown in Medicaid Expenditure Growth, 1992-95

(4)

Medicaid Spending in the Near Future

(3)

Implications

(4)

Acknowledgments

(3)

5. The Medically Uninsured--Will They Always Be With Us?

(12)

Steven A. Schroeder

Why We Tolerate Having So Many Uninsured

(4)

What Lies Ahead?

(7)

Part II Traditional Safety Net Providers: Showing Signs of Strain

(90)

6. The Challenges Facing Health Centers in a Changing Healthcare System

(24)

Daniel R. Hawkins

Sara Rosenbaum

Introduction

(1)

Background and Overview

100

(6)

Trends Affecting Health Centers

106

(8)

Conclusion

114

(9)

7. The Future of Safety-Net Hospitals

123

(28)

Larry S. Gage

Characteristics of Safety-Net Health Systems

125

(3)

Safety-Net Hospitals Provide a Large Volume of Inpatient and Outpatient Care

128

(6)

Safety-Net Hospitals Provide Disproportionate Levels of Medicaid, Medicare, and Uncompensated Care

134

(2)

Safety-Net Hospitals Rely Disproportionately on Medicare, Medicaid, and Local Subsidies to Cross-Subsidize Uncompensated Care

136

(3)

The Impact of Managed Care

139

(2)

Options for Protecting Safety-Net Health Systems

141

(1)

The Need to Reform DSH

142

(1)

The Need for Managed Care Safeguards

143

(1)

The Need for a Level Playing Field for Safety-Net Health Systems

144

(3)

Conclusion

147

(1)

Acknowledgments

148

(3)

8. The Role of Academic Health Centers and Teaching Hospitals in Providing Care for the Poor

151

(16)

James Reuter

Darrell J. Gaskin

Academic Health Centers and Care to the Poor

152

(3)

Academic Health Centers and the New Medical Market

155

(5)

The Impact of the Market on AHCs' Missions

160

(2)

Looking to the Future

162

(5)

9. The Hidden U.S. Healthcare Safety Net: Will It Survive?

167

(22)

Stuart H. Altman

Stuart Guterman

Financing the American Hospital

167

(5)

The Funding That Supports the Safety-Net Hospital

172

(4)

The Critical Role of Private Patient Revenues

176

(2)

Distribution of Uncompensated Care Burden across Hospitals

178

(3)

The Effect of Increasing Financial Pressure on the Distribution of Uncompensated Care

181

(2)

A Worst-Case Scenario

183

(1)

Conclusions

184

(5)

Part III Changes in Hospital Ownership and Care for the Uninsured

189

(44)

10. The Impact of Hospital Conversions on the Healthcare Safety Net

189

(18)

David Schactman

Stuart H. Altman

Introduction

189

(1)

The Provision of Charity Care and Community Benefits

190

(10)

The Provision of Health Services

200

(1)

The Price of Health Services

201

(2)

Conclusion

203

(4)

11. Hospital Ownership Form and Care of the Uninsured

207

(16)

Bradford H. Gray

The Significance of Ownership Form

208

(3)

Ownership Form and Care of the Poor

211

(2)

Uncompensated Care and Tax Exemptions

213

(3)

Conclusion

216

(7)

12. The Role of Investor-Owned and Not-for-Profit Organizations in Providing Healthcare to the Poor and Uninsured: A Perspective

223

(10)

Thomas A. Scully

Introduction

223

(1)

The Changing Healthcare Market

224

(1)

Why the Concern?

225

(1)

Is the Concern Justified?

226

(4)

Conclusion

230

(3)

Part IV The Search for Solutions I: The Road Is Paved with Incremental Reforms at the Federal and State Levels

233

(76)

13. Less Is More: After the Clinton Plan, Let's Think Small

233

(14)

Henry J. Aaron

Introduction

233

(2)

Lessons from the Past

235

(3)

Looking Forward

238

(1)

A Brief Sketch of U.S. Healthcare Financing

239

(5)

Postscript

244

(1)

Acknowledgments

244

(3)

14. Incremental Health Insurance Coverage: Building on the Current System

247

(18)

Karen Davis

Cathy Schoen

Increased Risks for the Uninsured

247

(2)

Prioritizing Coverage

249

(2)

Low-and Modest-Income Families

251

(2)

Building on Existing Administrative Mechanisms

253

(2)

Expanding Medicaid

255

(2)

Making Medicare Available to Older Adults

257

(2)

Financing Options

259

(1)

Trust Fund

260

(1)

Summary

260

(5)

15. Incremental Reform: The Health Insurance Portability and Accountability Act of 1996

265

(8)

Gail R. Wilensky

Incremental Reform: The Way Change Occurs

265

(1)

The Uninsured: A Heterogeneous Group

266

(1)

Implications for Incremental Reform

267

(1)

The Health Insurance Portability and Accountability Act as an Example of Incremental Reform

268

(1)

The Remaining Problems

269

(4)

16. Can We Count on the States to Cover the Poor and Uninsured?

273

(12)

Trish Riley

Introduction

273

(1)

Comprehensive Reforms and Access Initiatives

273

(7)

The Challenge of Financing Incremental Reform

280

(3)

Conclusion

283

(2)

17. The State Health Agenda: Austerity, Efficiency, and Monitoring the Emerging Market

285

(24)

Raymond C. Scheppach

Introduction

285

(1)

The Recent Past

286

(1)

The Federal Framework

287

(5)

Obstacles to Comprehensive State Healthcare Reform

292

(2)

State Challenges

294

(3)

State Fiscal and Regulatory Climates

297

(1)

Increased Access--State Action

297

(3)

The New State Health Agenda

300

(3)

Conclusion

303

(1)

Acknowledgments

304

(5)

Part V The Search for Solutions II: Considerations for Comprehensive Reforms

309

(96)

18. Where Will Americans Obtain Their Health Insurance? The Job Link Revisited

309

(16)

Alain C. Enthoven

Consumer Choice Health Plan

309

(1)

Critique of Employment-Based Health Insurance

310

(8)

Employers Do a Better Job than Government Monopolies

318

(1)

A Program to Extend the Benefits of Employment-Based Coverage to Nearly All Americans

319

(6)

19. Employer-Based Health Insurance: R.I.P.

325

(28)

Uwe E. Reinhardt

Introduction

325

(3)

Pricing Kindness out of a Nation's Soul

328

(4)

Government as a Cost Driver in Healthcare

332

(5)

Employer-Based Health Insurance: Merits and Shortcomings

337

(11)

Alternatives to Employment-Based Health Insurance

348

(5)

20. Trading Cost, Quality, and Coverage of the Uninsured: What Will We Demand and What Will We Supply?

353

(22)

Mark V. Pauly

Introduction

353

(1)

What Competitive Markets Will and Will Not Do

354

(1)

How Healthcare Used to Be: Myth and Reality

354

(3)

An Invidious Distinction

357

(5)

How Far Will It Go and How Long Can It Go On?

362

(3)

Limits on Equity

365

(1)

What to Do in Theory

365

(2)

So Who Pays?

367

(2)

How to Pay

369

(1)

What to Do?

370

(2)

What Will It Take?

372

(3)

21. Seeking More Efficient Healthcare Subsidies

375

(12)

Robert B. Helms

Do Not Increase Taxes or Budget Deficits

378

(2)

Give Consumers a Stronger Role in Seeking Cost-Effective Medical Care

380

(1)

Public Subsidies Should Be Explicit

381

(2)

Minimize the "Woodwork Effect"

383

(1)

Conclusion

383

(4)

22. The Case for Universal Health Insurance Coverage

387

(18)

Thomas Rice

Utilitarianism versus Alternative Philosophies

388

(10)

Implications for Universal Coverage

398

(4)

Acknowledgments

402

(3)

Index

405

(14)

About the Authors

419

(5)

About the Editors

424

Please wait while the item is added to your bag...

FREE SHIPPING

Rent More, Save More! Use code: BBRENTAL

5% off 1 book, 7% off 2 books, 10% off 3+ books

The Future U.S. Healthcare System

Table of Contents

Supplemental Materials

FREE SHIPPING

Rent More, Save More! Use code: BBRENTAL

5% off 1 book, 7% off 2 books, 10% off 3+ books

The Future U.S. Healthcare System

Table of Contents

Supplemental Materials

Digital License