Introduction to the US Healthcare System
The Structure of Management and Financing of the U.S. Health Care System
Samenvatting
You can get there
Where do you want to go? You might already be working in a health care or business setting. You may be looking to expand your skills. Or, you might be setting out on a new career path.
Wherever you want to go, Introduction to U.S. Health Care will help you get there. Easy–to–read, practical, and up–to–date, this text not only helps you learn fundamental concepts of the American health care system; it also helps you master the core competencies and skills you need to succeed in the classroom and beyond. The book′s brief, modular format and variety of built–in learning resources enable you to learn at your own pace and focus your studies.
With this book, you will be able to:
∗ Understand the role of governing boards and the challenges they face.
∗ Compare and contrast the primary–care and specialty–care models.
∗ Explore recent health care reforms that affect the primary–care model.
∗ Examine how we pay for health care.
∗ Learn about the many different roles played by the health care workforce.
∗ Discover how medical miracles are financed.
∗ Trace the evolution of hospitals throughout the nation′s history and through their current state.
∗ Assess the reasons behind the growing reliance on ambulatory care.
∗ Understand who needs long–term care, why, and what the choices are.
∗ Explore the challenges of providing health services for society′s most vulnerable groups.
∗ Identify obstacles in caring for the uninsured.
∗ Examine the types of managed care organizations, such as HMOs, PPOs, and POS plans.
∗ Explore current and future challenges for the health care industry.
∗ Understand the impact of new and emerging laws, regulations, and initiatives.
Wiley Pathways helps you achieve your goals
When it comes to learning about health care, not everyone is on the same path. But everyone wants to succeed. The new Wiley Pathways series in Health Care Management helps you achieve your goals with its brief, inviting format, clear language, and focus on core competencies and skills.
The books in this series––Introduction to U.S. Health Care, Health Care Economics, Health Care Management, and Health Care Law and Ethics––offer a coordinated curriculum for learning health care management. Learn more at www.wiley.com/go/pathways.
Specificaties
Inhoudsopgave
<p>1 The U.S. Health Care System 1</p>
<p>Introduction 2</p>
<p>1.1 Gauging the Size of the Health Care Industry 2</p>
<p>Self–Check 4</p>
<p>1.2 Balancing Public and Private Health: Health Care Organizations 4</p>
<p>Self–Check 8</p>
<p>1.3 Identifying Health Systems 9</p>
<p>Self–Check 11</p>
<p>1.4 Classifying Health Care Industry Sectors 11</p>
<p>Self–Check 14</p>
<p>1.5 Defining Health and Disease 15</p>
<p>Self–Check 18</p>
<p>1.6 Accessing Health Services in the United States 19</p>
<p>Self–Check 23</p>
<p>Summary 23</p>
<p>Key Terms 23</p>
<p>Summary Questions 25</p>
<p>Review Questions 27</p>
<p>Applying This Chapter 28</p>
<p>You Try It. 29</p>
<p>2 Boards and Governance 30</p>
<p>Introduction 31</p>
<p>2.1 Understanding the Role of Governing Boards 31</p>
<p>Self–Check 35</p>
<p>2.2 Board Composition, Structure, and Infrastructure 35</p>
<p>Self–Check 38</p>
<p>2.3 Challenges Facing Boards 39</p>
<p>Self–Check 41</p>
<p>Summary 41</p>
<p>Key Terms 41</p>
<p>Summary Questions 44</p>
<p>Review Questions 44</p>
<p>Applying This Chapter 45</p>
<p>You Try It. 46</p>
<p>Part II: Health Care Organization and Financing 47</p>
<p>3 Health Care Provision 47</p>
<p>Introduction 48</p>
<p>3.1 Health Provision at a Glance: Specialty–Care versus Primary–Care 48</p>
<p>Self–Check 50</p>
<p>3.2 Primary Care Reforms in the United States 50</p>
<p>Self–Check 52</p>
<p>3.3 Performance of the Primary Care Model in the United States 52</p>
<p>Self–Check 55</p>
<p>3.4 Primary Care Innovations 55</p>
<p>Self–Check 57</p>
<p>3.5 Identifying the PCP 57</p>
<p>Self–Check 60</p>
<p>3.6 PCPs and the Populations They Serve 60</p>
<p>Self–Check 63</p>
<p>Summary 63</p>
<p>Key Terms 64</p>
<p>Summary Questions 66</p>
<p>Review Questions 68</p>
<p>Applying This Chapter 72</p>
<p>You Try It.73</p>
<p>4 Financing the U.S. Health Care System 74</p>
<p>Introduction 75</p>
<p>4.1 Changing Economic Dynamics 75</p>
<p>Self–Check 80</p>
<p>4.2 Flow of Funds through the System 80</p>
<p>Self–Check 84</p>
<p>4.3 Examining Who Has Health Insurance 84</p>
<p>Self–Check 87</p>
<p>4.4 Categorizing Health Insurance Plans 87</p>
<p>Self–Check 91</p>
<p>4.5 Private Insurance Coverage: Voluntary Health Insurance (VHI) 92</p>
<p>Self–Check 94</p>
<p>4.6 Government Insurance Programs: Medicare and Medicaid 94</p>
<p>Self–Check 98</p>
<p>4.7 Health Maintenance Organizations (HMOs) 99</p>
<p>Self–Check 101</p>
<p>Summary 101</p>
<p>Key Terms 102</p>
<p>Summary Questions 104</p>
<p>Review Questions 107</p>
<p>Applying This Chapter 108</p>
<p>You Try It 109</p>
<p>Part III: Health Care Resources 110</p>
<p>5 The Health Care Workforce 110</p>
<p>Introduction 111</p>
<p>5.1 Sizing Up the Workforce 111</p>
<p>Self–Check 114</p>
<p>5.2 Understanding the Role of the Physician 114</p>
<p>Self–Check 118</p>
<p>5.3 Training Doctors 118</p>
<p>Self–Check 121</p>
<p>5.4 Nurses 121</p>
<p>Self–Check 125</p>
<p>5.5 Other Independent Health Professionals 125</p>
<p>Self–Check 129</p>
<p>5.6 Working in Concert with Physicians 129</p>
<p>Self–Check 131</p>
<p>Summary 131</p>
<p>Key Terms 132</p>
<p>Summary Questions 135</p>
<p>Review Questions 137</p>
<p>Applying This Chapter 139</p>
<p>You Try It 140</p>
<p>6 Research and Technology 141</p>
<p>Introduction 142</p>
<p>6.1 Understanding Medical Research 142</p>
<p>Self–Check 149</p>
<p>6.2 Research Facilities 149</p>
<p>Self–Check 153</p>
<p>6.3 Funding Research: Knowing Where the Money Comes From 153</p>
<p>Self–Check 155</p>
<p>6.4 Assessment and Challenges of Continuing Medical Advancement 155</p>
<p>Self–Check 157</p>
<p>Summary 158</p>
<p>Key Terms 158</p>
<p>Summary Questions 159</p>
<p>Review Questions 161</p>
<p>Applying This Chapter 162</p>
<p>You Try It 164</p>
<p>Part IV: The Health Care Delivery System 165</p>
<p>7 Hospitals in the U.S. 165</p>
<p>Introduction 166</p>
<p>7.1 The Evolution of Hospitals in the U.S 166</p>
<p>7.1.1 Forming Hospitals: the Refuge Stage 166</p>
<p>Self–Check 170</p>
<p>7.2 Components and Cost of American Hospitals 170</p>
<p>Self–Check 172</p>
<p>7.3 Classifying Hospitals 173</p>
<p>Self–Check 176</p>
<p>7.4 Care and Competition in the Twenty–First Century 177</p>
<p>Self–Check 179</p>
<p>Summary 179</p>
<p>Key Terms 180</p>
<p>Summary Questions 182</p>
<p>Review Questions 183</p>
<p>Applying This Chapter 184</p>
<p>You Try It 185</p>
<p>8 Ambulatory Care 186</p>
<p>Introduction 187</p>
<p>8.1 Understanding Ambulatory Care 187</p>
<p>Self–Check 191</p>
<p>8.2 Ambulatory Care Settings and Providers 191</p>
<p>Self–Check 197</p>
<p>8.3 Home Health and Visiting Nurse Agencies. 197</p>
<p>Self–Check 199</p>
<p>Summary 199</p>
<p>Key Terms 200</p>
<p>Summary Questions 201</p>
<p>Review Questions 202</p>
<p>Applying This Chapter 204</p>
<p>You Try It 205</p>
<p>9 Long–Term Care 206</p>
<p>Introduction 207</p>
<p>9.1 Understanding Long–Term Care 207</p>
<p>Self–Check 209</p>
<p>9.2 Personal Care Facilities 209</p>
<p>Self–Check 214</p>
<p>9.3 Community–Based and Home Health Care 214</p>
<p>Self–Check 218</p>
<p>9.4 Rehabilitation Centers 218</p>
<p>Self–Check 219</p>
<p>9.5 Hospice Care 219</p>
<p>Self–Check 222</p>
<p>Summary 222</p>
<p>Key Terms 222</p>
<p>Summary Questions 225</p>
<p>Review Questions 226</p>
<p>Applying This Chapter 227</p>
<p>You Try It 229</p>
<p>10 Caring For Special Populations 230</p>
<p>Introduction 231</p>
<p>10.1 Caring For Mentally Ill Patients 231</p>
<p>Self–Check 239</p>
<p>10.2 Homeless Patients 239</p>
<p>Self–Check 241</p>
<p>10.3 Veterans 241</p>
<p>Self–Check 243</p>
<p>10.4 Immigrants 243</p>
<p>Self–Check 245</p>
<p>10.5 Caring For Other Special Populations 245</p>
<p>Self–Check 246</p>
<p>Summary 247</p>
<p>Key Terms 247</p>
<p>Summary Questions 249</p>
<p>Review Questions 251</p>
<p>Applying This Chapter 251</p>
<p>You Try It 253</p>
<p>11 Caring For Uninsured Patients 254</p>
<p>Introduction 255</p>
<p>11.1 Identifying Uninsured Patients 255</p>
<p>Self–Check 257</p>
<p>11.2 Accessing Health Care When Uninsured 257</p>
<p>Self–Check 260</p>
<p>11.3 Challenges in Providing Health Care to Uninsured Patients 260</p>
<p>Self–Check 263</p>
<p>11.4 Legal Issues and Uninsured Patients 263</p>
<p>Self–Check 264</p>
<p>Summary 264</p>
<p>Key Terms 264</p>
<p>Summary Questions 266</p>
<p>Review Questions 267</p>
<p>Applying This Chapter 267</p>
<p>You Try It 268</p>
<p>12 Managed Care 269</p>
<p>Introduction 270</p>
<p>12.1 Understanding Managed Care 270</p>
<p>Self–Check 272</p>
<p>12.2 Types of Managed Care Organizations 273</p>
<p>Self–Check 276</p>
<p>12.3 Assessing the Performance of Managed Care 276</p>
<p>Self–Check 278</p>
<p>Summary 279</p>
<p>Key Terms 279</p>
<p>Summary Questions 281</p>
<p>Review Questions 282</p>
<p>Applying This Chapter 284</p>
<p>You Try It 285</p>
<p>Part V: Challenges Of US Health Care 286</p>
<p>13 Promoting Health And Preventing Disease 286</p>
<p>Introduction 287</p>
<p>13.1 Growing Complexity of the U.S. Health Care System 287</p>
<p>Self–Check 290</p>
<p>13.2 Financing Health Care 290</p>
<p>Self–Check 294</p>
<p>13.3 Aging Population 294</p>
<p>Self–Check 296</p>
<p>13.4 Challenges for Primary Care 296</p>
<p>Self–Check 302</p>
<p>13.5 Examining The Underserved: Rural and Inner–City Areas 302</p>
<p>Self–Check 305</p>
<p>13.6 Fixing the Problem of the Underserved 305</p>
<p>Self–Check 308</p>
<p>13.7 Other Challenges 309</p>
<p>Self–Check 311</p>
<p>Summary 311</p>
<p>Key Terms 311</p>
<p>Summary Questions 313</p>
<p>Review Questions 315</p>
<p>Applying This Chapter 316</p>
<p>You Try It 318</p>
<p>14 Public Health Policy 319</p>
<p>Introduction 320</p>
<p>14.1 Public Health Services 320</p>
<p>Self–Check 328</p>
<p>14.2 Federal and State Health Laws 328</p>
<p>Self–Check 330</p>
<p>14.3 Assessing U.S. Health Policy 330</p>
<p>Self–Check 331</p>
<p>14.4 Comparing U.S. Health Care to Health Care in Other Countries 332</p>
<p>Self–Check 334</p>
<p>Summary 334</p>
<p>Key Terms 335</p>
<p>Summary Questions 336</p>
<p>Review Questions 337</p>
<p>Applying This Chapter 338</p>
<p>You Try It 340</p>
<p>Endnotes 341</p>
<p>Glossary 343</p>
<p>Index 359</p>