Delivering health care in America : a systems approach / Leiyu Shi, Douglas A. Singh.

Format:

Book

Author/Creator:

Shi, Leiyu.

Contributor:

Singh, Douglas A., 1946-

Language:

English

Subjects (All):

Medical care--United States.

Medical care.

United States.

Medical policy--United States.

Medical policy.

Delivery of Health Care.

Health Policy.

Medical Subjects:

Delivery of Health Care.

United States.

Health Policy.

Physical Description:

xv, 634 pages : illustrations ; 26 cm

Edition:

Second edition.

Place of Publication:

Gaithersburg, MD : Aspen Publishers, 2001.

Summary:

Delivering Health Care in America, Second Edition provides readers with a comprehensive understanding of the basic structures and operations of one of the largest sectors of the U.S. economy. With the most current data, legislation and overall system changes reflected, the second edition covers the conceptual basis for the system; its historical origins; the structures of ambulatory care, inpatient care, and other important services structures; the translation of these structures into health services themselves; and the manifestations of their impact on costs and quality. The text includes learning objectives, review questions and key terminology.

Contents:

Chapter 1 A Distinctive System of Health Care Delivery 1

APHA Makes Its Voice Heard on Federal Issues 1

An Overview of the Scope and Size of the System 4

A Broad Description of the System 4

The Mechanism for Health Services Delivery 7

Transition from Traditional Approaches to Managed Care 9

Primary Characteristics of the U.S. Health Care System 10

Trends and Directions 19

Significance for Health Care Managers 20

Health Care Systems of Other Countries 22

The Systems Framework 26

Part I System Foundations 33

Chapter 2 Beliefs, Values, and Health 35

Healthy People 2010 35

Significance for Managers and Policy Makers 38

Determinants of Health 47

Cultural Beliefs and Values 51

A Social Model of Health 53

Equitable Distribution of Health Care 53

Justice in the U.S. Health Delivery System 57

Limitations of Market Justice 59

Integration of Individual and Community Health 60

Measures of Health Status 64

Measures of Health Services Utilization 69

Chapter 3 The Evolution of Health Services in the United States 77

A Bloody Evolution: Human Error in Medicine Is as Old as the Practice Itself 77

Medical Services in Preindustrial America 80

Medical Services in Postindustrial America 84

Recent Evolutions and the 21st Century 102

Part II System Resources 111

Chapter 4 Health Services Professionals 113

COGME Reports to the DHHS Secretary and Congress 113

Physicians 117

Dentists 132

Pharmacists 133

Other Doctoral-Level Health Professionals 134

Nurses 135

Nonphysician Practitioners 137

Allied Health Professionals 140

Health Services Administrators 142

Chapter 5 Medical Technology 151

Seeing the Body Electric, in 3-D 151

What Is Medical Technology? 155

Information Technology 155

The Diffusion and Utilization of Medical Technology 157

Managed Care and Technology Diffusion 161

The Government's Role in Technology Diffusion 162

The Impact of Medical Technology 164

The Assessment of Medical Technology 171

The Role of the Private Sector in Technology Assessment 174

Implications for Policy and Management 174

Some Critical Issues 176

Chapter 6 Health Services Financing 182

Budget Act Putting Squeeze on Medicare: Cost Cutting Curbs Some Benefits 182

The Role and Scope of Health Services Financing 185

Financing and Cost Control 187

The Insurance Function 188

Public Financing 193

Miscellaneous Private and Public Programs 202

The Payment Function 203

National Health Care Expenditures 209

Problems and Issues in Financing 214

Trends and Directions 219

Part III System Processes 227

Chapter 7 Outpatient and Primary Care Services 229

Match Continues Move toward Primary Care 229

What Is Outpatient Care? 232

The Scope of Outpatient Services 233

Primary Care 234

Community-Oriented Primary Care 238

Primary Care Providers 239

Growth in Outpatient Services 240

Reasons for the Growth in Outpatient Services 241

Types of Outpatient Care Settings and Methods of Delivery 244

Utilization of Outpatient Services 262

Chapter 8 Inpatient Facilities and Services 270

A Two-Front Battle: Hospitals Fight Error Reporting as They Seek Higher Payments 270

Transformation of the Hospital in the United States 273

Expansion of Hospitals in the United States 277

Hospital Downsizing in Recent Years 279

Some Key Utilization Measures and Operational Concepts 281

Hospital Employment 286

Types of Hospitals 287

What Makes a Hospital Non-Profit? 297

Some Management Concepts 299

Licensure, Certification, and Accreditation 301

Ethical and Legal Issues in Patient Care 302

Hospitals and Public Trust 304

The Future Outlook for Hospitals 305

Chapter 9 Managed Care and Integrated Organizations 312

A Surprisingly Popular U.S. Export: Managed Care 312

The Evolution of Managed Care 318

What Is Managed Care? 320

Reasons for the Growth of Managed Care 324

Cost Control in Managed Care 325

Types of Managed Care Organizations 330

Trends in Managed Care 337

Impact on Cost, Access, and Quality 341

Managed Care Backlash 343

Consolidation, Expansion, Diversification, and Integration 346

Integrated Delivery Systems 348

Types of Integration 348

Issues Related to Integration 353

Managed Competition 355

Chapter 10 Long-Term Care 362

What Is PACE? 362

What Is Long-Term Care? 366

The Nature of Long-Term Care 370

The Clients of Long-Term Care 377

Types of Community-Based Long-Term Care Services 380

Institutional Long-Term Care 388

Specialized Facilities 394

Institutional Demographics of Long-Term Care Facilities 396

Sources of Financing Nursing Home Care 399

Future Financing of Long-Term Care 402

Prospective Payment System for SNFs 404

Requirements of Participation 405

Chapter 11 Health Services for Special Populations 412

Mental Health: A Report of the Surgeon General 412

Racial Minorities 416

The Uninsured 429

Children 430

Women 433

Rural Health 436

The Homeless 439

Mental Health 442

The Chronically Ill and Disabled 447

HIV/AIDS 449

Part IV System Outcomes 467

Chapter 12 Cost, Access, and Quality 469

A Vision for Creating a New Model To Reach 100% Access and Zero Health Disparities 469

Cost of Health Care 474

Reasons for Cost Escalation 479

Cost Containment

Regulatory Approaches 486

Competitive Approaches 491

Access to Care 493

Quality of Care 501

Dimensions of Quality 502

Quality Assurance 504

Quality Assessment 506

Quality Report Cards 511

Chapter 13 Health Policy 517

Health Policy Is One of the Defining Issues in the Race for the White House 517

What Is Health Policy? 520

The Principle Features of U.S. Health Policy 522

The Development of Legislative Health Policy 530

Critical Policy Issues 533

The Future of Health Policy 539

Part V System Outlook 545

Chapter 14 The Future of Health Services Delivery 547

Health Industry Confronting Changes: 700 Executives in Town Discuss Challenges Ahead 547

Toward a True Health Care System 551

Workforce Composition 556

Financing of Care 558

Managed Care 564

Long-Term Care 568

Caring for the Uninsured 569

Technology 570

Outcome, Measurement, Monitoring, and Assessment 571

Enhanced Focus on Customer Service 574

Work Organization 575.

Notes:

Includes bibliographical references and index.

ISBN:

0834217643

OCLC:

44128124