Healthcare Delivery in the U.S.A.: An Introduction

Description

With the same clarity that made the previous edition a bestseller, Healthcare Delivery in the U.S.A.: An Introduction, Second Edition provides readers with the understanding required to navigate the healthcare provider field. Brilliantly simple, yet comprehensive, this updated edition explains how recent health care reform will impact hospitals and health systems. It includes updated case studies and describes the new organizational structures being driven by current market conditions. Focusing on healthcare management, the book addresses the range of topics critical to understanding the U.S. healthcare system, including the quality of care movement, recent finance reform, and the recent increase in merger and acquisition activity. Dr. Schulte walks readers through the history of the development of U.S. healthcare delivery. She describes the various venues of care delivery as well as the different elements of the financing system. Offering a glimpse into the global market and medical tourism, the text includes coverage of legal and regulatory issues, workforce, and the drivers and barriers that are shaping healthcare delivery around the world. Painting a clear and up-to-date picture, this quick-and-easy read provides you with the understanding of the terminology, structures, roles, relationships, and nuances needed to interact effectively and efficiently with anyone in the healthcare provider field. Cover Half Title Title Copyright Contents List of Figures and Tables Acknowledgments About the Author Introduction 1 History: U.S.A. Healthcare Delivery System 1.1 Introduction 1.2 1700 to 1850: The Early Days 1.3 1850 to the Late Nineteenth Century: Shift from Care to Cure 1.4 1900 to the Mid-twentieth Century: Era of Standardization 1.5 Mid- to Late Twentieth Century: Advances in Science and Expansion of Insurance 1.6 Early Twenty-First Century: Improved Access and a Pandemic 1.7 Summary References 2 Health Status: The Health of the Population 2.1 Introduction 2.2 Health Status and Its Measures 2.2.1 Mortality 2.2.2 Life Expectancy 2.2.3 Infant Mortality 2.2.4 Morbidity 2.3 Health Determinants 2.4 Summary References 3 Components of the Healthcare Delivery System 3.1 Introduction 3.2 The Providers in Healthcare Delivery 3.2.1 Hospitals 3.2.2 Levels of Care 3.2.2.1 Primary Care 3.2.2.2 Secondary Care 3.2.2.3 Tertiary Care 3.2.2.4 Quaternary Care 3.2.3 Other Categorizations of Healthcare Service Levels 3.2.3.1 Ambulatory Care 3.2.3.2 Public Health Service 3.2.3.3 Sub-acute Care 3.2.3.4 Long-Term Care 3.2.3.5 Home Healthcare 3.2.3.6 Hospice Care 3.2.3.7 Respite and Day Care 3.2.3.8 Rehabilitation 3.2.3.9 Emergency Services 3.2.3.10 Mental Health and Substance Abuse 3.3 Summary References 4 Structure of Healthcare Delivery 4.1 Introduction 4.2 Hospital Classifications 4.2.1 Ownership 4.2.1.1 Private Healthcare Organizations 4.2.1.2 Government/Public Hospitals and Clinics 4.2.2 Tax Status: Taxed or Tax-Exempt 4.2.2.1 Tax-Exempt, Not-for-Profit Healthcare Providers 4.2.2.2 Taxed, For-Profit Healthcare Providers 4.2.3 Geography 4.3 Types of Hospitals 4.3.1 General Acute Care Hospitals 4.3.2 Academic Medical Centers and Teaching Hospitals 4.3.3 Specialty Hospitals 4.3.4 Mental Health Hospitals 4.4 Hospital Operations 4.4.1 The Structure of the Hospital-Physician Relationship 4.4.2 Integrated Delivery Networks (IDNs) 4.5 Summary References 5 Doctors 5.1 Introduction 5.2 Physician Workforce 5.3 Physician Education 5.3.1 Medical School 5.3.2 Typical Course of Study in Medical School 5.3.2.1 Preclinical Curriculum 5.3.2.2 Clinical Phase of Medical Education 5.3.3 Medical Licensing 5.3.4 Preparation of the Specialist 5.4 International Medical Graduates 5.5 Financial Support of Medical Education 5.6 The Physician–Hospital Relationship 5.7 Malpractice 5.8 Summary References 6 The Healthcare Workforce 6.1 Introduction 6.2 Nursing 6.2.1 Registered Nurses 6.2.2 Advanced Practice Registered Nurses 6.2.3 Licensed Practical Nurses 6.2.4 Nursing Supply 6.3 Physician Assistants 6.4 Pharmacists 6.5 Medical Technologists 6.6 Radiology Technologists 6.7 Physical, Occupational, and Speech Therapists 6.7.1 Physical Therapists 6.7.2 Speech and Language Pathologists 6.7.3 Occupational Therapists 6.8 Other Allied Health Professionals and Researchers 6.9 Supporting Professionals 6.10 Administrative Management Professionals 6.11 Nursing Facility Administration 6.12 Summary References 7 The Legal and Regulatory Environment 7.1 Introduction 7.1.1 The Government as Regulator 7.2 The Legislature: Healthcare Statutes 7.2.1 Hill–Burton 7.2.2 Medicare and Medicaid (Titles XVIII and XIX of the Social Security Amendments) 7.2.3 Certificate of Need 7.2.4 The Health Maintenance Organization Act 7.2.5 Prospective Payment 7.2.6 Emergency Medical Treatment and Active Labor Act 7.2.7 Stark Law: The Physician Self-Referral Act (Stark I-1989 and Stark II-1993) 7.2.8 HIPAA 7.2.9 Patient Protection and Affordable Care Act 7.3 Malpractice 7.4 Summary References 8 Financing Healthcare 8.1 Introduction 8.2 National Health Expenditures 8.3 Medicare 8.3.1 Medicare Cost Control Initiatives 8.3.2 The Sustainability of Medicare 8.4 Medicaid 8.4.1 Federal/State Medicaid Matching Funding 8.4.2 Waivers 8.4.3 Medicaid Managed Care 8.5 Children’s Health Insurance Program 8.6 Other Governmentally Financed Healthcare Programs 8.6.1 Military Healthcare Programs 8.6.2 Indian Health Service 8.7 The Private Sector in Healthcare Financing 8.7.1 Employer Health Insurance Plans 8.8 Managed Care Organizations (MCOs) 8.9 Fee-for-Service 8.10 PPACA 8.11 Healthcare Reform Options 8.12 Summary References 9 Quality 9.1 Introduction 9.2 Defining Quality in Healthcare 9.3 The Healthcare Quality Problem 9.4 Challenge of Quality and Safety in Healthcare Delivery 9.5 Standardization/Accreditation 9.5.1 The Joint Commission 9.5.2 DNV Healthcare, Inc. 9.5.3 The National Committee for Quality Assurance 9.6 Quality Improvement Initiatives 9.6.1 National Quality Organizations and Agencies 9.6.1.1 The National Quality Forum 9.6.1.2 Centers for Medicare and Medicaid Services 9.6.1.3 Institute for Healthcare Improvement 9.7 Evidence-Based Medicine 9.8 Never Events 9.9 The Patient-Centered Medical Home 9.10 Tools for Quality Improvement 9.10.1 Dashboards 9.10.2 Measures and Benchmarks 9.11 Summary References 10 Public Health 10.1 Introduction 10.2 Role of Public Health 10.3 A Brief History of the Public Health Service 10.4 The U.S. Public Health Service Today 10.5 Healthy People 2030 10.6 2019 Novel Coronavirus Pandemic (COVID-19) 10.7 Summary References 11 Medical Science and Information Technology 11.1 Introduction 11.2 The Science of Medicine 11.2.1 Pharmaceuticals 11.2.1.1 Clinical Trials Research 11.2.1.2 Challenges for the Pharmaceutical Sector 11.2.2 Biomedical Research 11.2.3 Genomics 11.3 Information Technology 11.3.1 Introduction 11.3.2 The EHR and Healthcare Quality Improvement 11.3.3 Components of the EHR 11.3.4 Health Information Exchange 11.3.5 The Personal Health Record 11.3.6 Types of Information Systems in Healthcare 11.3.7 Health IT Standards 11.3.8 Digital Health 11.4 Summary References Index