3rd Edition
Healthcare Delivery in the U.S.A. An Introduction
With the same clarity that made the previous editions bestsellers, Healthcare Delivery in the U.S.A.: An Introduction, Third Edition provides readers with the understanding required to navigate the healthcare provider field. In the intervening 8 years since the 2nd Edition was published, there have been significant developments in the healthcare delivery systems, including COVID-19, global health issues, and the evolution of the Affordable Care Act and other financing mechanisms. Brilliantly simple, yet comprehensive, this updated edition 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, delivering care during a pandemic, recent finance reform, new technologies, cyber security, 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.
Chapter 1: History of the U.S. Healthcare Delivery System
- Introduction
- 1700 – 1850 – The Early Days
- 1950 to the Late Nineteenth Century – Shift from Care to Cure
- 1900 to the Mid-Twentieth Century – Era of Standardization
- Mid to Late Twentieth Century
- Early 21st Century
- Summary
References
Chapter 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
Chapter 3: Components of the Healthcare Delivery System
3.1 Introduction
3.2 The Providers of 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 Care
3.3 Summary
References
Chapter 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
Chapter 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 How Doctors Work with Hospitals
5.7 Malpractice
5.8 Summary
References
Chapter 6: Workforce: Nurses, Allied Health, and Management
6.1 Introduction
6.2 Nursing
6.2.1 Registered Nurses
6.2.2 Advanced Practice Registered Nurses (APRNs)
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 Behind-the-Scenes Professionals
6.10 Administrative Management Professionals
6.11 Nursing Facility Administration
6.12 Summary
References
Chapter 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 (CON)
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
Chapter 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
8.9 Fee-for-Service
8.10 PPACA
8.11 Health Reform Options
8.12 Summary
References
Chapter 9: Quality of Care
9.1 Introduction
9.2 Defining Quality in Healthcare
9.3 The Healthcare Quality Problem and The IOM Reports
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
Chapter 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 SARS-CoV-2 Pandemic (COVID-19) and the Public Health
10.7 Summary
References
Chapter 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
Biography
Margaret F. Schulte, DBA, FACHE is immediate past President & CEO of the Commission on Accreditation of Healthcare Management Education (CAHME), the official accrediting body for over 100 graduate programs in healthcare management in the US and Canada. Prior to this role, she served on the faculty of the Northwestern University Masters of Science in Medical Informatics program in Chicago, IL and was Editor of Frontiers in Health Services Management, a publication of the American College of Healthcare Executives. Earlier, she served as Vice President of Education for the Healthcare Information and Management Systems Society (HIMSS) and as Director of Education for the Healthcare Financial Management Association. Previous positions included service as co-director of the Graduate Program in Healthcare Administration at Mercer University in Atlanta, GA and as Associate Professor in the Graduate Program in Healthcare Administration at Grand Valley State University in Grand Rapids, MI. Dr. Schulte holds a Doctorate in Business Administration from Nova Southeastern University, Ft. Lauderdale, FL and a Masters in Business Administration from Xavier University, Cincinnati, Ohio and is an Emeritus Fellow in the American College of Healthcare Executives. She is the author of “Healthcare Delivery in the U.S.A.: An Introduction”, and the contributor to multiple books and publications in healthcare management.
