Analyzing Form, Function, and Financing of the U.S. Health Care System: 1st Edition (Hardback) book cover

Analyzing Form, Function, and Financing of the U.S. Health Care System

1st Edition

By Paula Stamps Duston

CRC Press

474 pages | 30 B/W Illus.

Purchasing Options:$ = USD
Hardback: 9781482236538
pub: 2015-12-24
SAVE ~$19.59
$97.95
$78.36
x
eBook (VitalSource) : 9780429256325
pub: 2015-12-24
from $48.98


FREE Standard Shipping!

Description

Analyzing Form, Function, and Financing of the U.S. Health Care System tells the story of the U.S. health care system by using a narrative approach identifying function rather than the more common data-driven focus on structure. It presents policy decisions we have made about our health care system and analyzes some of their consequences to better understand the choices we have. To facilitate this, the book is divided into four major sections.

Section I is mostly "about" the health care system. It describes several theoretical models that provide a foundation for the structure of the U.S. health care system. Section II provides a description of the form, or organization, of the U.S. health care delivery system. It presents a comprehensive overview of the entire health care delivery system, including identifying all levels of care.

Section III focuses on financing, beginning with a description of the economic and political values that determine how we finance our system. It describes health insurance, from the perspective of both the consumer and the provider, and discusses how money moves through the system. It concludes with a discussion and analysis of cost and cost control efforts.

Section IV describes some of the more important efforts in health care reform, including several targeted programs that are a significant part of the U.S. health care system, such as Medicare and Medicaid. It also describes other targeted programs within the U.S. health care system and explores how other countries with economies similar to that of the United States organize and finance their health care systems.

Table of Contents

INTRODUCTION: SETTING THE CONTEXT

Definitions of Health and Illness

Health and Illness: Language Issues

Modification of the Biomedical Model: Epidemiological Model

Stress as Cause of Illness

Models of Health Not Illness

From Language to Behavior: Access

Health Belief Model Helps Explain Utilization

Health Care System or Medical Care System?

Acknowledgments

Public Health: Defining Determinants of Health

What Are Determinants of Health?

Why Do Health Determinants Matter?

Healthy People Initiative

Acknowledgments

Health Status Indicators

Measuring Death: Mortality Rates

Measuring Diseases: Morbidity Rates

Life Expectancy Rates

Other Measures of Health Indicators

What to Do with This Information?

Acknowledgments

Role of Culture in the Organization of Health Care Delivery Systems

Role of Culture in Defining Health and Illness

Impact of Culture on Organized Health Care Systems

Alternative or Complementary Medical Systems and Practices

Culturally Based CAM Medical Practices

Nonculturally Based CAM Healing Practices

What Really Works?

Acknowledgments

Political and Philosophical Values That Influence the U.S. Health Care System

The Private Market and the Role of Government

Cultural Belief in Science and Technology—Sometimes

When Political Values Restrict Health Care Services

Acknowledgments

FUNCTIONAL DESCRIPTION OF THE U.S. HEALTH AND MEDICAL CARE SYSTEM

Do We Have a System? A Functional Analysis

Describing the Health Care System: The Numbers

Functional Description: Levels of Care

Resource Implications of Levels of Care: Issues of Balance

Acknowledgments

People Who Make the Medical Care System Go: The Workforce

Physicians: The Story of Professionalization and the Development of the Biomedical Model

Mid-Level Independent Clinicians

The Nursing Profession

Other Independent Clinical Providers

Clinical Providers with Varying Levels of Practice Independence

Policy Issues

Acknowledgments

Hospitals

History

Classification of Hospitals

Organization and Management of Hospitals

Licensure, Accreditation, and Regulation

Hospital Finance and Controlling Costs

Summary and Policy Issues

Acknowledgments

Ambulatory Care: Functions, Structures, and Services

Settings for Ambulatory Care Services

What Is Primary Care?

Managed Care Concepts

Summary and Policy Issues

Acknowledgments

Other Components of the Medical Care System

Mental Health Care System

Long-Term Care System

Dental and Vision Care Systems

Summary

Acknowledgments

POLITICAL AND ECONOMIC VALUES AND HEALTH CARE FINANCING

Health Economics 101: Do Health Care Goods/Services Follow Standard Economic Rules?

Very Simple Health Economics Guidelines

Are Health Care Goods and Services Examples of Public Goods?

An Important Economic Concept: Elasticity

Market Justice versus Social Justice: Where to Go Next?

Acknowledgments

From Economics to Health Policy and Regulation

What Is Health Policy?

Who Creates and Implements Health Policy?

How Can We Tell If a Policy Works?

Examples of Policies and Links to Models of Allocation

Summary

Acknowledgments

Health Care Financing: Health Insurance

What Is Health Insurance and Why Do We Have It?

Consumer Responsibilities: What Do We Pay for and What Does Health Insurance Pay for?

History of the Health Insurance Industry in the United States

Types of Health Insurance

What about the Uninsured?

What Difference Does Health Insurance Make?

Summary

Acknowledgments

Health Insurance: Two Conceptual Models

Model I: Conventional Indemnity Health Insurance

Model II: How to Control Increasing Costs—HMO Insurance Model

From Conceptual Model to Early Implementation

From HMOs to Managed Care Plans

Summary

Acknowledgments

The Payment Function: Money Moving through the System

The Payment Function in Medicare

Payment Function: Medicaid

Payment Function: Private Insurance

Consequences of the Payment Function in the U.S. Health Care System

Another Way to Look at the Payment Function

Summary

Acknowledgments

Why Does Medical Care Cost So Much and What Can We Do about It?

What Is Cost in the Health Care System?

How Much Do We Spend and on What?

Demand: Role of "Us" in High Health Care Costs

Supply Factors: Influence Felt throughout the Health Care System

Costs as a Result of the Financing System

Costs Arising from the Medical Treatment Process

Cost Control: Approaches and Targets

What Is the Real Problem?

Acknowledgments

HEALTH CARE REFORM IN THE UNITED STATES: TARGETED PROGRAMS AND CONSEQUENCES

Health Care Reform: Past as Prologue to Present

The Foundation

Too Close for Comfort

Health Insurance Becomes an Employment Benefit

Health Care as Part of a Social Services Network

HMOs: The Beginning of Managed Care

Clinton and the Free Market

The ACA Builds on the Past

Where Are We at Today?

Acknowledgments

Taking Care of the Elderly: Medicare

The Target Group: Changes over Time

Medicare: A Four-Part Program

So, How Good Is Medicare?

Challenges Facing Medicare: Suggested Policy Changes

Summary

Acknowledgments

Taking Care of the Poor: Medicaid

Who Is Poor: Definitions of Eligibility

Financing and Administration of Medicaid: Federal and State

Who Is Covered under Medicaid?

What Does the Medicaid Program Cover?

State Modifications of Financing and Coverage

Does Medicaid Do What It Was Designed to Do?

Another Way to Think about This

Acknowledgments

Taking Care of Almost Everybody Else

Programs Focusing on Low-Income Children

Poor, Frail, Elderly: The Program of All-Inclusive Care for the Elderly

A Public Health Approach: CHCs

Too Sick to Be Insured: The State Approach

Workers’ Compensation Programs

Indian Health Services

Military and Veterans Health Services Systems

Does the Targeted Program Approach Work?

Acknowledgments

A Persistent Problem: Racial and Ethnic Disparities in Health Outcomes

What Are Health Disparities?

How Health Disparities Are Investigated

What Can Be Done about Health Disparities?

Where Are We Today?

Acknowledgments

Alternative Models for Health Care Systems: International Perspectives

What Countries Should We Examine?

Overall Description of Health Care System and Demographic Features

Financing and Cost Sharing

Resources

Indicators of Utilization and Financial Access

Selected Health Status Indicators

What Can We Learn from These Health Systems?

Summary and Final Thoughts

Acknowledgments

References

About the Author

Dr. Paula Stamps Duston earned her PhD degree from the School of Public Health at the University of Oklahoma. She currently is teaching in the Commonwealth Honors College at the University of Massachusetts and serves as the graduate program director for public health in the university’s School of Public Health and Health Sciences. She is best known for her research in developing validated scales to measure the level of satisfaction of direct care providers, including both nurses and physicians. Her nurse satisfaction instrument, the Index of Work Satisfaction (IWS), is the most widely used in the field and is recommended by the American Nursing Association and JCAHCO for use as a quality indicator.

Subject Categories

BISAC Subject Codes/Headings:
BUS041000
BUSINESS & ECONOMICS / Management
BUS070080
BUSINESS & ECONOMICS / Industries / Service Industries
MED002000
MEDICAL / Administration