In the newly revised Second Edition of Health Care in the United States: Organization, Management, and Policy, distinguished health and organizational researcher Dr. Howard P. Greenwald delivers a comprehensive exploration of the US health care system and the challenges its practitioners, professionals, and consumers face.
From organization to management, financing, and evaluation, this book discusses the critical concepts, trends, and features of this sprawling set of interlocking systems. It also examines the historical origins of modern health care and how it delivers services to over 300 million Americans. Readers will discover:
- Modern controversies in American health care that animate political debate and discussion, including the Affordable Care Act.
- Discussions of the health care labor force, as well as its history, background, and crucial challenges.
- Possible future directions for US health care, including preventive medicine, new policy initiatives, and proposals for reform.
Table of Contents
Tables and Figures x
Preface to the Second Edition xii
The Author xv
Acknowledgments xvi
About the Companion Website xvii
Part 1 The System and Its Tasks
1 Understanding Health Care 3
Health Care as a National Concern 3
Health Care Objectives and Goals 6
Essential Challenges in Health Care 7
Public Trust and Professional Ethics 10
Three Perspectives on Management and Policy 11
2 The U.S. Health Care System: Features, Development, and Controversies 16
The U.S. Health Care System’s Magnitude 16
Uniqueness of the System 16
American Values and Health Care 25
Controversies in U.S. Health Care 29
3 Major Health Problems in Modern Society 35
Conceptions of Health and Disease 35
The Causes of Disease 41
Epidemiology: The Science of the Denominator 46
Health, Illness, and Demand for Services 54
Future Threats to Human Health 57
4 Human Behavior, Health, and Health Care 62
The Behavioral Dimension 62
The Concept of the Sick Role 62
Health Risk Behavior 63
Use of Health Services 71
Adverse Patient Behavior 75
Health Literacy and Cultural Competence 77
Complementary and Alternative Medicine 80
Consumer Preferences and Health Care Marketing 81
Part 2 Means of Delivery
5 Health Care Organizations 89
The Importance of Organizations in Health Care 89
Health Service Industry Sectors 90
Ambulatory Care Organizations 93
The Hospital 98
The Managed Care Organization 108
Other Health Care Organizations 109
Organizational Management in Health Care 113
6 The Health Care Labor Force 118
Health Care Labor Force Issues 118
The Concept of Professionalism 119
History, Background, and Challenges in Three Key Fields 121
Clinicians as Managers 129
The Health Care Labor Force: Facts and Figures 130
Labor Force Dynamics in the Health Professions 133
Professional Oversight and Discipline 138
7 Health Care Expenditures, Financing, and Insurance 143
Funding Sources and Expenditures 143
Health Care Costs: A Global Issue 146
Cost Accelerators in the United States 148
The Health Insurance Landscape 151
Additional Insurance Concepts and Terminology 161
Medicare Specifics and Issues 162
Affordable Care Act Coverage Expansion 164
Uninsurance: The Continuing Problem 165
Continuing Issues 167
8 Biomedical Research and Program Evaluation 172
The Importance of Research 172
Principles of Experimental Design 172
Modern Research Designs 174
Outcome Measures 179
Program Evaluation 180
Cost-Effectiveness and Cost-Benefit Analysis 182
The Social and Economic Context of Research 183
Science Gone Wrong: Error, Distortion, and Fraud 187
Part 3 Paths Forward
9 Innovations and Outcomes 195
Importance and Background 195
Innovation Assessment: Measurement and Methods 198
Selective Contracting 201
Cost Sharing 202
Managed Care 204
Diagnosis Related Groups 206
The Affordable Care Act (ACA) 207
Other Innovations 210
Total Effects and Unanticipated Consequences 212
10 Disease Prevention and Health Promotion 217
The Importance of Prevention 217
Preventable Morbidity and Mortality 218
Prevention Dimensions 220
Prevention in Practice 221
Evidence-Based Prevention 224
Health Promotion 225
Challenges to Prevention 229
Does Prevention Save Money? 236
The Future: Prevention and U.S. Health Care 238
11 Government, Policy, and Politics in Health Care 243
Government and Health Care in the United States 243
The Need for Government Participation 244
How Government Shapes Health Care 246
Politics: The Driver of Policy 254
Political Money 258
Effective Health Care Politics: Case Studies in Legislation 259
The Case Against Government in Health Care 265
12 Looking into the Future 269
Challenges to Reform 269
Non-U.S. Health Care Systems 272
A System to Emulate? A Closer Look at Canada 276
Future Reform in the United States 279
Glossary 284
Abbreviations 290
Index 291
