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Delivering Health Care in America : A Systems Approach

ISBN: 9780763724931 | 0763724939
Edition: 2nd
Format: Paperback
Publisher: Jones & Bartlett Pub
Pub. Date: 1/1/2001

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SummaryTable of Contents
Johns Hopkins Univ. Baltimore, MD. Overview of the U.S. health services system, including history, structure, services offered, impact on costs and quality, and future direction. Each chapter begins with a reprinted article, includes a lengthy discussion, and ends with terminology and review questions. Previous edition: c1998. Softcover.
Forewordxi
Prefacexiii
Acknowledgmentsxv
A Distinctive System of Health Care Delivery
1(32)
... MOREAPHA Makes Its Voice Heard on Federal Issues
1(2)
Introduction
3(1)
An Overview of the Scope and Size of the System
4(1)
A Broad Description of the System
4(3)
The Mechanism for Health Services Delivery
7(2)
Transition from Traditional Approaches to Managed Care
9(1)
Primary Characteristics of the U.S. Health Care System
10(9)
Trends and Directions
19(1)
Significance for Health Care Managers
20(2)
Health Care Systems of Other Countries
22(4)
The Systems Framework
26(3)
Summary
29(1)
Test Your Understanding
29(1)
Review Questions
30(3)
PART I SYSTEM FOUNDATIONS
33(78)
Beliefs, Values, and Health
35(42)
Healthy People 2010
35(3)
Introduction
38(1)
Significance for Managers and Policy Makers
38(1)
Basic Concepts
39(8)
Determinants of Health
47(4)
Cultural Beliefs and Values
51(2)
A Social Model of Health
53(1)
Equitable Distribution of Health Care
53(4)
Justice in the U.S. Health Delivery System
57(2)
Limitations of Market Justice
59(1)
Integration of Individual and Community Health
60(4)
Measures of Health Status
64(5)
Measures of Health Services Utilization
69(1)
Summary
70(1)
Test Your Understanding
71(1)
Review Questions
71(6)
The Evolution of Health Services in the United States
77(34)
A Bloody Evolution: Human Error in Medicine Is as Old as the Practice Itself
77(2)
Introduction
79(1)
Medical Services in Preindustrial America
80(4)
Medical Services in Postindustrial America
84(18)
Recent Evolutions and the 21st Century
102(4)
Summary
106(1)
Test Your Understanding
107(1)
Review Questions
107(4)
PART II SYSTEM RESOURCES
111(116)
Health Services Professionals
113(38)
COGME Reports to the DHHS Secretary and Congress
113(2)
Introduction
115(2)
Physicians
117(15)
Dentists
132(1)
Pharmacists
133(1)
Other Doctoral-Level Health Professionals
134(1)
Nurses
135(2)
Nonphysician Practitioners
137(3)
Allied Health Professionals
140(2)
Health Services Administrators
142(1)
Summary
143(1)
Test Your Understanding
144(1)
Review Questions
144(7)
List of Professional Organizations
149(2)
Medical Technology
151(31)
Seeing the Body Electric, in 3-D
151(3)
Introduction
154(1)
What Is Medical Technology?
155(1)
Information Technology
155(2)
The Diffusion and Utilization of Medical Technology
157(4)
Managed Care and Technology Diffusion
161(1)
The Government's Role in Technology Diffusion
162(2)
The Impact of Medical Technology
164(7)
The Assessment of Medical Technology
171(3)
The Role of the Private Sector in Technology Assessment
174(1)
Implications for Policy and Management
174(2)
Some Critical Issues
176(1)
Summary
177(1)
Test Your Understanding
178(1)
Review Questions
178(4)
Health Services Financing
182(45)
Budget Act Putting Squeeze on Medicare: Cost Cutting Curbs Some Benefits
182(3)
Introduction
185(1)
The Role and Scope of Health Services Financing
185(2)
Financing and Cost Control
187(1)
The Insurance Function
188(5)
Public Financing
193(9)
Miscellaneous Private and Public Programs
202(1)
The Payment Function
203(6)
National Health Care Expenditures
209(5)
Problems and Issues in Financing
214(5)
Trends and Directions
219(2)
Summary
221(1)
Test Your Understanding
222(1)
Review Questions
223(4)
PART III SYSTEM PROCESSES
227(240)
Outpatient and Primary Care Services
229(41)
Match Continues Move toward Primary Care
229(2)
Introduction
231(1)
What Is Outpatient Care?
232(1)
The Scope of Outpatient Services
233(1)
Primary Care
234(4)
Community-Oriented Primary Care
238(1)
Primary Care Providers
239(1)
Growth in Outpatient Services
240(1)
Reasons for the Growth in Outpatient Services
241(3)
Types of Outpatient Care Settings and Methods of Delivery
244(18)
Utilization of Outpatient Services
262(2)
Summary
264(2)
Test Your Understanding
266(1)
Review Questions
266(4)
Inpatient Facilities and Services
270(42)
A Two-Front Battle: Hospitals Fight Error Reporting as They Seek Higher Payments
270(3)
Introduction
273(1)
Transformation of the Hospital in the United States
273(4)
Expansion of Hospitals in the United States
277(2)
Hospital Downsizing in Recent Years
279(2)
Some Key Utilization Measures and Operational Concepts
281(5)
Hospital Employment
286(1)
Types of Hospitals
287(10)
What Makes a Hospital Non-Profit?
297(2)
Some Management Concepts
299(2)
Licensure, Certification, and Accreditation
301(1)
Ethical and Legal Issues in Patient Care
302(2)
Hospitals and Public Trust
304(1)
The Future Outlook for Hospitals
305(1)
Summary
306(1)
Test Your Understanding
307(1)
Review Questions
308(4)
Managed Care and Integrated Organizations
312(50)
A Surprisingly Popular U.S. Export: Managed Care
312(3)
Introduction
315(3)
The Evolution of Managed Care
318(2)
What Is Managed Care?
320(4)
Reasons for the Growth of Managed Care
324(1)
Cost Control in Managed Care
325(5)
Types of Managed Care Organizations
330(7)
Trends in Managed Care
337(4)
Impact on Cost, Access, and Quality
341(2)
Managed Care Backlash
343(3)
Consolidation, Expansion, Diversification, and Integration
346(2)
Integrated Delivery Systems
348(1)
Types of Integration
348(5)
Issues Related to Integration
353(2)
Managed Competition
355(1)
Summary
356(1)
Test Your Understanding
357(1)
Review Questions
357(5)
Long-Term Care
362(50)
What Is PACE?
362(3)
Introduction
365(1)
What Is Long-Term Care?
366(4)
The Nature of Long-Term Care
370(7)
The Clients of Long-Term Care
377(3)
Types of Community-Based Long-Term Care Services
380(8)
Institutional Long-Term Care
388(6)
Specialized Facilities
394(2)
Institutional Demographics of Long-Term Care Facilities
396(3)
Sources of Financing Nursing Home Care
399(3)
Future Financing of Long-Term Care
402(2)
Prospective Payment System for SNFs
404(1)
Requirements of Participation
405(1)
Summary
406(1)
Test Your Understanding
407(1)
Review Questions
408(4)
Health Services for Special Populations
412(55)
Mental Health: A Report of the Surgeon General
412(4)
Introduction
416(1)
Racial Minorities
416(13)
The Uninsured
429(1)
Children
430(3)
Women
433(3)
Rural Health
436(3)
The Homeless
439(3)
Mental Health
442(5)
The Chronically III and Disabled
447(2)
HIV/AIDS
449(12)
Summary
461(1)
Test Your Understanding
461(1)
Review Questions
462(5)
PART IV SYSTEM OUTCOMES
467(78)
Cost, Access, and Quality
469(48)
A Vision for Creating a New Model To Reach 100% Access and Zero Health Disparities
469(5)
Introduction
474(1)
Cost of Health Care
474(5)
Reasons for Cost Escalation
479(7)
Cost Containment---Regulatory Approaches
486(5)
Cost Containment---Competitive Approaches
491(2)
Access to Care
493(8)
Quality of Care
501(1)
Dimensions of Quality
502(2)
Quality Assurance
504(2)
Quality Assessment
506(5)
Quality Report Cards
511(1)
Summary
511(1)
Test Your Understanding
512(1)
Review Questions
513(4)
Health Policy
517(28)
Health Policy Is One of the Defining Issues in the Race for the White House
517(3)
Introduction
520(1)
What Is Health Policy?
520(2)
The Principle Features of U.S. Health Policy
522(8)
The Development of Legislative Health Policy
530(3)
Critical Policy Issues
533(6)
The Future of Health Policy
539(3)
Summary
542(1)
Test Your Understanding
543(1)
Review Questions
543(2)
PART V SYSTEM OUTLOOK
545(35)
The Future of Health Services Delivery
547(33)
Health Industry Confronting Changes: 700 Executives in Town Discuss Challenges Ahead
547(3)
Introduction
550(1)
Toward a True Health Care System
551(5)
Workforce Composition
556(2)
Financing of Care
558(6)
Managed Care
564(4)
Long-Term Care
568(1)
Caring for the Uninsured
569(1)
Technology
570(1)
Outcome, Measurement, Monitoring, and Assessment
571(3)
Enhanced Focus on Customer Service
574(1)
Work Organization
575(1)
Conclusion
576(1)
Summary
576(1)
Test Your Understanding
577(1)
Review Questions
578(2)
Appendix A---Glossary580(21)
Appendix B---Selected Web Sites601(3)
Index604

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