Praise for the Seventh Edition:
There are many books on the U.S. healthcare system, but few have the longevity of this one. It is easy to read and straightforward in its approach to difficult subjects such as the rise of the Tea Party and how that movement has impacted healthcare. This update is certainly needed as the landscape has changed dramatically since the previous edition was published.
Doody’s Medical Reviews
The eighth edition of this best-selling text, valued for its concise and balanced introduction to the U.S. health care system, is entirely updated to reflect alterations to health care services, delivery, and financing resulting from the Affordable Care Act (ACA). The text describes how our health care system currently functions, the key forces that led to its structure, and the influences likely to shape the industry during the next 5 to 10 years. With an emphasis on policy development, the authors underscore the fluidity of the system and examine the debates and conflicts that have shaped health care changes and influenced American values and belief systems. Other new areas of focus include an assessment of who uses health care and in what way, health care trends, and a forecast for the health care system of the future.
The text elucidates the basic building blocks of the health care system, including its components, organization, services, and financing. It describes the ongoing evolution of the system since the passage of the ACA, development of accountable care organizations (ACOs), and uneven acceptance of Medicaid expansion by states. Organized to facilitate understanding of concepts at work, the text provides health care students with a clear road map of the field in which they will practice, so they can position themselves to navigate the upcoming changes.
New to the Eighth Edition:
- Entirely updated to address changes in health care services, delivery, and financing resulting from the ACA
- Describes influences that will shape the industry in years to come
- Emphasizes policy development
- Assesses current consumers of health care and how they use it
- Examines the debates and conflicts that have structured health care change
- Monitors health care trends
- Discusses the continuing evolution of our system since the ACA
- Explores the development of ACOs
- Reinforces information with illustrative tables and figures
Key Features:
- Remains the most concise and balanced introduction to the U.S. health care system
- Ideal for use in undergraduate courses, in graduate survey courses, and in courses introducing the subject to medical students
- Includes review questions at the conclusion of each chapter
- Provides a full suite of ancillary materials for the educator, including an Instructor’s Manual, Power Points, and a test bank
Table of Content
Abbreviations
Preface
Acknowledgments
I U.S. Health Care System: Present State
1 Introduction
HEALTH AND HEALTH CARE
What Is Health?
Determinants of Health
Health Care as a Determinant of Health
The Population Served
U.S. HEALTH CARE SYSTEM
Components of the U.S. Health Care System
Organization of the U.S. Health Care System
Types of Health Services Provided
Health Care System Performance
FUTURE OF THE U.S. HEALTH CARE SYSTEM
NOTES
REFERENCES
2 The Settings for Health Care Delivery
HOSPITALS
Historical Background
Present-Day Hospitals
Health Conditions of Hospitalized Patients
Hospital Structure
LONG-TERM CARE
AMBULATORY CARE
Ambulatory Care Utilization
Hospital Outpatient Departments
Hospital Emergency Services
Hospital Ambulatory Services Outside the Walls of the Hospital
Public Health Agency Clinics
Neighborhood and Community Health Centers
Industrial Health Service Units
School Health Clinics
Home Care and Hospice
SUMMARY
NOTES
REFERENCES
3 The People Who Provide Health Care
PHYSICIANS
Historical Background
Licensure
Private Medical Practice
Patterns of Practice
Medical Specialization
Medical Education
Graduate Medical Education
Physician Supply
Physician Workforce Projections
Physician Supply Model
NURSES
Historical Background
Definition of Nursing
Categories of Nurses and Nursing Education
From Nursing Shortage to Nursing Oversupply, and Back Again
Nurses in Expanded Roles
PHYSICIAN ASSISTANTS
OTHER HEALTH CARE PROFESSIONal S AND OCCUPATIONS
PRIMARY CARE AND ITS PROVIDERS
Functions
Historical Background
Primary Care Workforce
Primary Care and the Health Care Delivery System
SUMMARY
NOTES
REFERENCES
4 Government and the Health Care System
THE CONSTITUTIONAL BASIS OF GOVERNMENTAL AUTHORITY IN HEALTH CARE
THE HEALTH CARE FUNCTIONS OF GOVERNMENT
The Legislative Branch
The Judiciary
The Executive Branch
Provision of Personal Health Services
Provision of Community Health Services
Health Services Financing
THE FEDERAL GOVERNMENT AND THE PROVISION OF HEALTH SERVICES
Department of Health and Human Services
Other Federal Departments
STATE GOVERNMENT’s ROLE IN HEALTH SERVICES
Health Statistics
Licensing
LOCAL GOVERNMENT’s ROLE IN HEALTH SERVICES
Public Health Contributions
SUMMARY
NOTE
REFERENCES
5 Financing the Health Care System
HOW MUCH IS SPENT?
WHERE THE MONEY COMES FROM WITHIN THE SYSTEM
Private Health Insurance
Out-of-Pocket Expenditures
Government Spending on Health Care
Other Government Programs
WHERE THE MONEY GOES
HOW THE MONEY IS PAID: PROVIDERS, PAYERS, AND PAYMENTS
Provider Payment Approaches
Risk Transfer and Good Intentions
Third-Party Payers
SUMMARY
NOTES
REFERENCES
6 Health Care System Performance
QUALITY OF HEALTH CARE
Population Health Outcomes
Clinical Outcomes
Clinical Effectiveness
Patient Safety
A Health Care Quality-Improvement Example With Update
Organizations With Major Influence on Health Care Quality
EQUITY OF HEALTH CARE
Equity and the Quality of Health Care
Equity and Access to Health Care
EFFICIENCY OF HEALTH CARE
A NATIONAL SCORECARD
DATA AND INFORMATION TECHNOLOGY
Office of the National Coordinator for Health Information Technology
A Health Information Example: National Healthcare Safety Network
SUMMARY
NOTE
REFERENCES
II U.S. Health Care System in Transition: How We Got Here and Where We Are Going
7 Debates and Conflicts That Have Structured Health Care Change
WHAT KIND OF CHANGE?
Health Care: Private or Public Enterprise?
Logic Behind Regulatory Complexity
Past and Future of the U.S. Mixed System
SUMMARY
NOTE
REFERENCES
APPENDIX A: LIST OF CRITICAL REPORTS ON THE U.S. HEALTH CARE DELIVERY SYSTEM, 1927–2006
APPENDIX B: TIMELINE OF EVENTS IN DEVELOPMENT OF THE U.S. HEALTH CARE SYSTEM, 1763–2015
8 History of Change From 1990 to the Present: Piecemeal Reform
ACCESS TO HEALTH CARE
Employer-Based Health Insurance
Expansion to Nonemployer Groups
Other “Fixes” for Problems of Access
EFFICIENCY AND QUALITY OF HEALTH CARE
Group Medical Practice
From Prepaid Group Practice to Health Maintenance Organizations
HMOs Entering the 1990s and Into the 21st Century
Managed Care
Integrated Delivery Systems
For-Profit Versus Not-for-Profit
REFERENCES
9 History of Change From 1900 Through the Present: Comprehensive Reform
NATIONAL HEALTH INSURANCE AS THE SOLUTION
World Historical Background
History of NHI in the United States
NHI by Contract, or the Personal Health Care System
CONTEMPORARY APPROACHES TO COMPREHENSIVE HEALTH CARE REFORM
The Clinton Health Plan
THE OBAMA HEALTH PLAN
Major Features of the Obama Health Plan
Obama Health Plan From the Consumer Perspective
Supreme Court Challenges to the Obama Health Plan in 2012 and 2015
NOTES
REFERENCES
10 Trends in the U.S. Health Care System
THE OBAMA HEALTH PLAN
Future of the Obama Health Plan
OTHER TRENDS
Consolidation Within the Health Care System
Big Data and Health Information
Prevention and Mental Health
Cost of Prescription Drugs Comes Under Scrutiny
Impact of New Technology
Hospital Versus Ambulatory Care
Complementary Medicine
A PRIVATE SYSTEM?
REFERENCES
Index
About the author
Benjamin Z. Goldsteen, MBA, has 20 years of experience as an innovator in health care and life sciences organizations. While working at one of the largest consulting firms in the world, he led multiple strategy and performance-improvement engagements for health care clients across the United States from assessment through implementation. He is highly knowledgeable about all aspects of health care delivery and the policies that impact the health care system. He currently serves as Chief Analytics Officer of a division dedicated to driving transformation across the largest municipal health care system in the United States.
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