Cover image for Health care USA : understanding its organization and delivery
Health care USA : understanding its organization and delivery
Sultz, Harry A.
Personal Author:
Second edition.
Publication Information:
Gaithersburg, Md. : Aspen Publishers, 1999.
Physical Description:
xxi, 439 pages : illustrations ; 24 cm
Overview of health care: a population perspective -- Benchmark developments in U.S. health care -- Hospitals: origin, organization, and operation -- Hospitals: reengineered for the future -- Ambulatory care -- Medical education and the changing practice of medicine -- Health care personnel -- Financing health care -- Managed care -- Long-term care -- Mental health services / Susan V. McLeer, MD -- Public health and the role of government in health care -- Research: how health care advances -- The future of health care.
Added Author:
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RA395.A3 S897 1999 Adult Non-Fiction Central Closed Stacks

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Health Care USA: Understanding Its Organization and Delivery, Second E dition reflects recent major legislative changes that have occurred in Medicare, Medicaid and public health. The growing concern about menta l health services will be covered by taking a close look at emerging b ehavioral health managed care organizations. The new edition will also reflect the increased penetration of managed care across the country and its effect on not only the health care industry, but also on consu mers. Current benchmarks in all areas of health care will be thoroughl y updated.

Reviews 1

Choice Review

This thorough, broad-ranging presentation of the complexities of the US health system's organizational shape gives current data on each of the various aspects of this country's health care industry. Topics include an introductory overview of the system with benchmark developments in US health care, hospitals, ambulatory care, medical education, health personnel, finance, long-term care, mental health, public health, and the role of government. In each case the authors present both historical data and an analysis of current trends. Good use of charts and graphs. Useful appendix containing abbreviations. All levels. J. E. Allen; University of North Carolina at Chapel Hill

Table of Contents

Susan V. McLeer, MD
Forewordp. xi
Acknowledgmentsp. xiii
Introductionp. xv
Chapter 1 Overview of Health Care: A Population Perspectivep. 1
Problems of Health Carep. 2
Understanding Health Carep. 3
Why Patients and Providers Behave the Way They Dop. 4
Indexes of Health and Diseasep. 5
Natural Histories of Disease and the Levels of Preventionp. 6
Major Stakeholders in the U.S. Health Care Industryp. 9
Long-Term Carep. 15
Development of Managed Carep. 17
Rural Health Networksp. 19
Priorities of Health Carep. 20
Social Choices of Health Carep. 23
The Aging Populationp. 23
Access to Health Carep. 26
Quality of Carep. 28
Conflicts of Interestp. 28
Health Care's Ethical Dilemmasp. 29
Chapter 2 Benchmark Developments in U.S. Health Carep. 31
The Great Depression and the Birth of Blue Crossp. 33
The Dominant Influence of Governmentp. 34
Health Maintenance Organizationsp. 38
The Reagan Administrationp. 39
Biomedical Advances: Evolution of High-Technology Medicinep. 40
Roles of Medical Education and Specializationp. 42
Influence of Interest Groupsp. 44
Public Health Focus on Preventionp. 49
Economic Influences: Rising Costsp. 50
The Uninsured and Problems of Access to Medical Carep. 50
The Aging of Americap. 51
Values and Assumptions That Guide Prioritiesp. 52
Oregon Death with Dignity Actp. 54
Provisions of the Oregon Death with Dignity Actp. 55
The Internet and Health Carep. 55
The Basic Issuesp. 56
Chapter 3 Hospitals: Origin, Organization, and Performancep. 60
Historical Perspectivep. 60
Sources That Shaped the Hospital Industryp. 63
Growth and Decline in Numbers of Hospitalsp. 65
Types of Hospitalsp. 65
Financial Condition of Hospitalsp. 67
Academic Health Centers, Medical Education, and Specializationp. 68
The Balanced Budget Act and Academic Medical Centersp. 69
The Hospital System of the Department of Veterans Affairsp. 69
Structure and Organization of Hospitalsp. 70
Types and Roles of Patientsp. 77
Rights and Responsibilities of Hospitalized Patientsp. 78
Important Decisions, Informed Consent, and Second Opinionsp. 81
Diagnosis-Related Group Hospital Reimbursement Systemp. 83
Discharge Planningp. 84
Subacute Carep. 85
Market-Driven Reforms Affecting Hospitalsp. 86
Integrated Health Systemsp. 91
Market Responses to Managed Carep. 95
The Quality of Hospital Carep. 97
Variations in Medical Carep. 99
Hazards of Hospitalizationp. 100
Current Research Efforts in Quality Improvementp. 102
Responsibility of Governing Boards for Quality of Carep. 103
Incremental Quality Improvementp. 105
Forces of Reform: Cost, Quality, and Accessp. 106
Chapter 4 Ambulatory Carep. 110
Overview and Trendsp. 110
Private Medical Office Practicep. 113
Other Ambulatory Care Practitionersp. 116
Ambulatory Care Services of Hospitals: History and Trendsp. 116
Hospital Emergency Servicesp. 121
Free-Standing Servicesp. 123
Community Health Centersp. 129
Public Health Servicesp. 131
Voluntary Agenciesp. 133
Conclusionp. 134
Chapter 5 Medical Education and the Changing Practice of Medicinep. 137
The Flexner Report and Medical School Reformsp. 139
Academic Medical Centersp. 140
Graduate Medical Education Consortiap. 143
Delineation and Growth of Medical Specialtiesp. 145
Specialty Boards and Residency Performancep. 146
Funding of Graduate Medical Educationp. 149
Physician Surplus and U.S. Medical Schoolsp. 149
The Generalist/Specialist Imbalancep. 151
Primary Care Physicians--Gatekeepers of the Systemp. 152
Preventive Medicinep. 153
Changing Physician/Hospital Relationshipsp. 154
Cost Containment and the Restructuring of Medical Practicep. 155
Hold Harmless Clausesp. 157
Clinical Practice Guidelinesp. 157
Physician Report Cardsp. 159
Growing Concern about Ethical Issuesp. 160
Physicians and the Internetp. 161
Provider Network Contractingp. 162
The Future of Medical Practicep. 163
Chapter 6 Health Care Personnelp. 169
Health Professionsp. 170
Health Care Personnel and Health Care Reformsp. 171
Credentialing and Regulating Health Professionalsp. 171
Health Care Occupationsp. 173
Alternative Therapistsp. 194
Factors That Influence Demand for Health Personnelp. 197
Health Care Work Force Issuesp. 200
Conclusionp. 200
Chapter 7 Financing Health Carep. 207
Health Care Expenditures in Perspectivep. 207
New Diagnostic and Treatment Technologyp. 209
The Aging of Americap. 210
The Growth of Specialized Medicinep. 212
The Uninsured and Underinsuredp. 212
A Labor-Intensive Industryp. 214
Economic Incentives That Fuel Rising Costsp. 214
Components of Health Care Expendituresp. 214
Sources of Health Care Paymentp. 215
Evolution of Health Insurance: Third-Party Paymentp. 217
Self-Funded Insurance Programsp. 221
Government as a Source of Paymentp. 222
The Future: Continuing Changep. 250
Chapter 8 Managed Carep. 257
Historical Perspectivep. 257
Managed Care Fundamentalsp. 260
HMO Act of 1973p. 262
The Evolution of Managed Carep. 264
Emerging Developments in Managed Carep. 268
Medicare and Medicaid Managed Carep. 270
Managed Care Organizations and Qualityp. 272
The Future of Managed Carep. 275
Chapter 9 Long-Term Carep. 279
Long-Term Care and the Continuum of Carep. 279
Development of Long-Term Care Servicesp. 281
Modes of Long-Term Care Service Deliveryp. 284
Innovations in Long-Term Carep. 305
Long-Term Care Insurancep. 308
The Future of Long-Term Carep. 309
Chapter 10 Mental Health Servicesp. 316
Historical Perspectivep. 316
Recipients of Mental Health Servicesp. 320
Special Populationsp. 326
The Organization and Financing of Mental Health Servicesp. 328
Health Insurance Coverage and Managed Behavioral Health Carep. 331
Barriers to Accessing Servicesp. 338
Priorities for Mental Health Servicesp. 339
Need for Further Researchp. 341
Chapter 11 Public Health and the Role of Government in Health Carep. 348
Historical Perspectivep. 348
Decline in Influence of the Public Health Servicep. 358
Responsibilities of the Public Health Sectorp. 359
Relationships of Public Health and Private Medicinep. 362
Resource Priorities Favor Curative Medicinep. 364
Health Care Reform and the Public Health/Medicine Relationshipp. 365
Hospital-Sponsored Public Health Activitiesp. 366
Public Health Services of Voluntary Agenciesp. 367
Changing Roles of Government in Public Healthp. 368
Public Health in an Era of Privatization and Managed Carep. 369
Federal Support To Address Emerging Health Issuesp. 371
Future Role of Government in Promoting the Public's Healthp. 372
Chapter 12 Research: How Health Care Advancesp. 376
The Focus of Different Types of Researchp. 377
Research in Health and Diseasep. 377
Epidemiologyp. 378
Health Services Researchp. 380
Agency for Healthcare Research and Quality (Formerly the Agency for Health Care Policy and Research)p. 380
Health Services Research and Health Policyp. 383
Quality Improvementp. 384
Outcomes Researchp. 390
Patient Satisfactionp. 391
Research Ethicsp. 392
Future Challengesp. 393
Chapter 13 The Future of Health Carep. 398
The Paradox of U.S. Health Carep. 399
Organizations and Facilitiesp. 400
Corporate Growth in Health Carep. 402
Corporate Alliancesp. 404
Future of Managed Carep. 405
Growth of Home, Outpatient, and Ambulatory Carep. 407
Technologyp. 408
Personnelp. 409
Physiciansp. 410
Academic Health Centersp. 413
Health Professionsp. 414
Nursesp. 416
Nurse Practitionersp. 417
Physician Assistantsp. 417
Future Role of the Federal Governmentp. 417
Conclusionp. 419
Appendix A Abbreviations and Acronymsp. 428
Appendix B Web Sitesp. 439
Indexp. 442
About the Authorsp. 461