Healthcare Delivery in the U.S.A.: An Introduction, Second Edition, 2nd Edition (Paperback) book cover

Healthcare Delivery in the U.S.A.

An Introduction, Second Edition, 2nd Edition

By Margaret F. Schulte

Productivity Press

239 pages | 30 B/W Illus.

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pub: 2012-12-13
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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.


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

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


Health Status




Health Determinants




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

Ambulatory Care

Subacute Care

Long-Term Care

Home Healthcare

Hospice Care

Respite and Day Care


Emergency Services

Mental Health and Substance Abuse




Structure of Healthcare Delivery


Hospital Classifications


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

Specialty Hospitals

Mental Health Hospitals

Hospital Operations

The Structure of the Hospital-Physician Relationship

Integrated Delivery Networks




Doctors in the Healthcare Delivery Structure


Physician Workforce

How Are Doctors Trained?

Number of Medical Schools and Their Enrollments

Typical Course of Study in Medical School

Preclinical Curriculum/Basic Sciences

Clinical Phase


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


Physician Supply




Workforce: Nurses and Others



Nursing Shortage

Registered Nurses

Registered Nursing Education

RN Licensing

Advanced Practice Nurses

Nurse Practitioners

Clinical Nurse Specialists

Licensed Practical Nurses

Physician Assistants


Other Allied Health Professionals

Radiology Technologists

Physical, Occupational, and Speech Therapists

Other Allied Health Professionals

Supporting 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)

HIPAA (1986)




Financing Healthcare


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

The VA

Indian Health Services

The Private Sector in Healthcare Financing

Employer Plans

Managed Care Organizations

Fee for Service

PPACA: Health Reform





Defining Quality

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

Never Events

The Leapfrog Group

The IHI and Pursuing Perfection

Payer Initiatives

Evidence-Based Medicine

The Medical Home

Tools for Quality Improvement





Public Health


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


Medical Technology


Clinical Trials Research

Preclinical Research

Basic Scientific Research


Information Technology


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



About the Author

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 Managementfor 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.

Subject Categories

BISAC Subject Codes/Headings:
BUSINESS & ECONOMICS / Quality Control
BUSINESS & ECONOMICS / Industries / Service Industries
MEDICAL / Administration