Health Care in the United States

Tables and Figures x Preface to the Second Edition xii The Author xv Acknowledgments xvi About the Companion Website xvii Part 1 The System and Its Tasks 1 Understanding Health Care 3 Health Care as a National Concern 3 Health Care Objectives and Goals 6 Essential Challenges in Health Care 7 Public Trust and Professional Ethics 10 Three Perspectives on Management and Policy 11 2 The U.S. Health Care System: Features, Development, and Controversies 16 The U.S. Health Care System’s Magnitude 16 Uniqueness of the System 16 American Values and Health Care 25 Controversies in U.S. Health Care 29 3 Major Health Problems in Modern Society 35 Conceptions of Health and Disease 35 The Causes of Disease 41 Epidemiology: The Science of the Denominator 46 Health, Illness, and Demand for Services 54 Future Threats to Human Health 57 4 Human Behavior, Health, and Health Care 62 The Behavioral Dimension 62 The Concept of the Sick Role 62 Health Risk Behavior 63 Use of Health Services 71 Adverse Patient Behavior 75 Health Literacy and Cultural Competence 77 Complementary and Alternative Medicine 80 Consumer Preferences and Health Care Marketing 81 Part 2 Means of Delivery 5 Health Care Organizations 89 The Importance of Organizations in Health Care 89 Health Service Industry Sectors 90 Ambulatory Care Organizations 93 The Hospital 98 The Managed Care Organization 108 Other Health Care Organizations 109 Organizational Management in Health Care 113 6 The Health Care Labor Force 118 Health Care Labor Force Issues 118 The Concept of Professionalism 119 History, Background, and Challenges in Three Key Fields 121 Clinicians as Managers 129 The Health Care Labor Force: Facts and Figures 130 Labor Force Dynamics in the Health Professions 133 Professional Oversight and Discipline 138 7 Health Care Expenditures, Financing, and Insurance 143 Funding Sources and Expenditures 143 Health Care Costs: A Global Issue 146 Cost Accelerators in the United States 148 The Health Insurance Landscape 151 Additional Insurance Concepts and Terminology 161 Medicare Specifics and Issues 162 Affordable Care Act Coverage Expansion 164 Uninsurance: The Continuing Problem 165 Continuing Issues 167 8 Biomedical Research and Program Evaluation 172 The Importance of Research 172 Principles of Experimental Design 172 Modern Research Designs 174 Outcome Measures 179 Program Evaluation 180 Cost-Effectiveness and Cost-Benefit Analysis 182 The Social and Economic Context of Research 183 Science Gone Wrong: Error, Distortion, and Fraud 187 Part 3 Paths Forward 9 Innovations and Outcomes 195 Importance and Background 195 Innovation Assessment: Measurement and Methods 198 Selective Contracting 201 Cost Sharing 202 Managed Care 204 Diagnosis Related Groups 206 The Affordable Care Act (ACA) 207 Other Innovations 210 Total Effects and Unanticipated Consequences 212 10 Disease Prevention and Health Promotion 217 The Importance of Prevention 217 Preventable Morbidity and Mortality 218 Prevention Dimensions 220 Prevention in Practice 221 Evidence-Based Prevention 224 Health Promotion 225 Challenges to Prevention 229 Does Prevention Save Money? 236 The Future: Prevention and U.S. Health Care 238 11 Government, Policy, and Politics in Health Care 243 Government and Health Care in the United States 243 The Need for Government Participation 244 How Government Shapes Health Care 246 Politics: The Driver of Policy 254 Political Money 258 Effective Health Care Politics: Case Studies in Legislation 259 The Case Against Government in Health Care 265 12 Looking into the Future 269 Challenges to Reform 269 Non-U.S. Health Care Systems 272 A System to Emulate? A Closer Look at Canada 276 Future Reform in the United States 279 Glossary 284 Abbreviations 290 Index 291