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, PowerPoints, and a test bank

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 PROFESSIONalS 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