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.
Table of Contents
History of the U.S. Healthcare Delivery System
1750 to 1850—The Early Days
1850 to the Late Nineteenth Century—Shift from Care to Cure
1900 to the Mid-Twentieth Century—Era of Standardization
Mid-Twentieth Century to Twenty-First Century
Start of the Twenty-First Century
Health Status: The Health of the Population
Components of the Healthcare Delivery System
Who Are the Players in Healthcare Delivery?
Healthcare Providers: Inpatient or Outpatient?
Scope and Size of Hospitals
Levels of Care
Other Categorizations of Healthcare Service Levels
Respite and Day Care
Mental Health and Substance Abuse
Structure of Healthcare Delivery
Private Healthcare Entities
Community and Voluntary Providers of Care
Government/Public Hospitals and Clinics
Tax Status: Taxed or Tax-Exempt
Types of Hospitals
General Acute Care Hospitals
Academic Medical Centers and Teaching Hospitals
Mental Health Hospitals
The Structure of the Hospital-Physician Relationship
Integrated Delivery Networks
Doctors in the Healthcare Delivery Structure
How Are Doctors Trained?
Number of Medical Schools and Their Enrollments
Typical Course of Study in Medical School
Preclinical Curriculum/Basic Sciences
Graduate Medical Education: Becoming a Specialist
International Medical Graduates
Financial Support of Medical Education
How Doctors Work with Hospitals
The Physician’s Source(s) of Income
Workforce: Nurses and Others
Registered Nursing Education
Advanced Practice Nurses
Clinical Nurse Specialists
Licensed Practical Nurses
Other Allied Health Professionals
Physical, Occupational, and Speech Therapists
Other Allied Health Professionals
Shortage of Clinical Personnel in the United States
Administrative Management Professionals
Nursing Facility Administration
The Legal and Regulatory Environment
The Government as Regulator
The Legislature: Healthcare Statutes
Medicare and Medicaid (Titles XVIII and XIX of the Social Security Amendments)
Certificate of Need (1973)
Prospective Payment (1982)
HMO Act (1973)
Emergency Medical Treatment and Active Labor Act (1986)
Stark Law—The Physician Self-Referral Act (Stark I—1989 and Stark II—1993)
How Much Does Healthcare Cost in the United States?
Federal/State Matching Funding
Medicaid Managed Care
State Children’s Health Insurance Program
The Impact of PPACA on Medicaid and SCHIP
Other Governmentally Financed Healthcare Programs
Indian Health Services
The Private Sector in Healthcare Financing
Managed Care Organizations
Fee for Service
PPACA: Health Reform
What Is the Problem with Healthcare Quality?
The Challenge of Quality and Safety in Healthcare Delivery
The Joint Commission
The National Committee for Quality Assurance
Quality Improvement Initiatives
National Organizations and Agencies on Quality
The National Quality Forum
Centers for Medicare and Medicaid Services
Quality Improvement Organizations
Premier Hospital Quality Incentive Demonstration
"Hospital Compare" Public Reporting of Performance Measures
The Leapfrog Group
The IHI and Pursuing Perfection
The Medical Home
Tools for Quality Improvement
Role of Public Health
History of Public Health Service
Public Health at the Federal Level
Office of Public Health and Science
The Office of the Surgeon General
U.S. Public Health Service Today
Technology: Medical and Information Technologies
Clinical Trials Research
Basic Scientific Research
Why the HER?
EMR or EHR: Which Is It?
Components of the EHR
Health Information Exchange (HIE)
The Personal Health Record
Types of Information Systems in Healthcare
Challenges to IT Adoption
Margaret F. Schulte, DBA, FACHE, CPHIMS, works independently, serving several organizations in various capacities. She is an instructor in Northwestern University’s Masters in Medical Informatics, adjunct faculty in the Masters in Health Administration at Penn State, editor of Frontiers of Health Services Management for the American College of Healthcare Executives, editor of Go-Live Smart Strategies from Davies Award-Winning EHR Implementations, and consultant to the Health Information and Management Systems Society for its Meaningful Use OneSource website. She previously served as vice president of education for the Healthcare Information and Management Systems Society (HIMSS), where she was responsible for the professional education programs of this membership association of IT professionals. In this role, she led the development of conference education for the society’s annual conference, which is attended by over 25,000 professionals, and she was responsible for global healthcare IT conferences in Europe and Asia and for other HIMSS education offerings in online and seminar formats.
Dr. Schulte held positions as vice president of research and development for the publishing division of the American Hospital Association and as director of education with the Healthcare Financial Management Association. She served on the faculty of the graduate program in Healthcare Policy and Management at Mercer University in Atlanta, Georgia, where she also served as adjunct faculty to the Mercer University School of Medicine. Previously, she held various management and executive positions in hospitals and in the governmental sector.
Dr. Schulte recently served as a commissioner with the Council for Accreditation of Healthcare Management Education (CAHME) and is on the advisory board of Main Stay Therapeutic Riding Program. She holds a doctorate in business administration from Nova Southeastern University, Fort Lauderdale, Florida, and a master’s in business administration from Xavier University, Cincinnati, Ohio. Dr. Schulte is a fellow in the American College of Healthcare Executives (FACHE) and holds the CPHIMS designation.
Praise for the Bestselling First Edition:
This brief but remarkable book is balanced in its consideration of the history and scope of health care in the US today … The volume comes too late to be a factor in the 2009 congressional debate over health care reform. Although Schulte (Grand Valley State Univ.) avoids legislative recommendations, this work should have been required reading for every member of Congress and all lobbyists seeking to impose their own, more limited agendas before Congress took up the challenge … Everyone should read this book.
—D.R. Shanklin, University of Chicago, CHOICE, Vol. 47, No. 09, May 2010
Margaret Schulte provides a concise introduction to the history, issues, terminology and structure of a very complex and often unwieldy industry – healthcare. This book would be helpful for those early in their careers or transitioning in from other industries to help improve quality and processes. I certainly wish I had this guide when I was starting in healthcare.
—Mark Graban, Shingo Prize-winning author of Lean Hospitals
Because traditional approaches to health reform aren’t working, the business of medical care obviously needs new thinking from skilled professionals who can approach it from fresh perspectives. Many creative problem solvers from other industries would surely relish the opportunity to bring their insights to health care, but first they need to understand the industry and to speak its special language. Dr. Margaret Schulte has written the perfect book to bridge the gap. Healthcare Delivery in the U.S.A. is the resource that outsiders need to join the conversation and start teaching the medical sector lessons it must learn from other industries. The more non-health professionals who read this book, the sooner we’ll see efficiency and effectiveness in medical care.
—Jeff Bauer, Ph.D., Management Consulting Partner and Director of the Futures Practice, Affiliated Computer Services Healthcare Solutions, Author of Paradox and Imperatives in Health Care
I wish a book like this had been available when I entered health care. In easy-to-understand terms, Dr. Schulte lays out the components of the healthcare system so those of us who enter can be oriented to the terms and to the various entities we will be encountering. As the level of complexity of the healthcare system continues to increase, books such as this can help us deconstruct the system into understandable components. As we know, in order to improve, we must first understand. Dr. Schulte helps us understand.
—Dean Bliss, Lean Improvement Specialist, Iowa Health System
Selling technology solutions to hospitals is challenging because it requires knowing what’s important to different people – patients, doctors, and employees – without any margin for error. Dr. Schulte’s book is 'Healthcare 101' for any sales professional striving to understand the healthcare industry. It couldn’t be more timely with the new economic stimulus package which includes $20 billion for healthcare IT.
—Linda Ewing, Regional Sales Director, Amcom Software