Table of Contents
Tables and Figures vii
Preface xi
The Author xv
Acknowledgments xvi
Part 1 The System and its Tasks 1
1 Understanding Health Care 3
Health Care as a National Concern 4
Health Care Objectives and Goals 8
Essential Challenges in Health Care 9
Public Trust and Professional Ethics 13
Three Perspectives on Management and Policy 15
2 The U.S. Health Care System: Features, Development, and Controversies 19
The U.S. Health Care System's Magnitude 20
Uniqueness of the System 20
American Values and Health Care 29
Controversies In U.S. Health Care 35
3 Major Health Problems in Modern Society 41
Conceptions Of Health and Disease 42
The Causes Of Disease 42
Nondisease Threats to Health, Function, and Survival 55
Epidemiology: The Science of the Denominator 56
Health and Illness in the Twenty-First Century 62
Future Threats to Health 68
4 Human Behavior, Health, and Health Care 71
The Behavioral Dimension 72
The Concept of the Sick Role 72
Health Risk Behavior 73
Use of Health Services 83
Adverse Patient Behavior 88
Health Literacy and Cultural Competence 90
Complementary and Alternative Medicine 94
Consumer Preferences and Health Care Marketing 97
Part 2 Means of Delivery 101
5 Health Care Organizations 103
The Importance of Organizations in Health Care 104
Health Service Industry Sectors 105
Ambulatory Care Organizations 110
The Hospital 116
The Managed Care Organization 128
Other Health Care Organizations 130
Organizational Management in Health Care 135
6 The Health Care Labor Force 139
Health Care Labor Force Issues 140
The Concept of Professionalism 141
History, Background, and Challenges in Three Key Fields 143
Clinicians as Managers 154
The Health Care Labor Force: Facts and Figures 155
Labor Force Dynamics in the Health Professions 160
Professional Ethics, Oversight, and Discipline 165
7 Health Care Expenditures, Financing, and Insurance 171
Health Service Funding and Expenditures 172
Health Care Costs: A Global Issue 173
Cost Accelerators in the United States 175
Health Insurance 178
Additional Insurance Concepts and Terminology 192
Medicare Specifics and Issues 194
The Problem of Uninsurance 197
Continuing Issues 201
8 Biomedical Research and Program Evaluation 207
The Importance of Research 208
Principles of Experimental Design 209
Modern Research Designs 211
Program Evaluation 218
Cost-Effectiveness and Cost-Benefit Analysis 221
The Social and Economic Context of Research 221
Science Gone Wrong: Error, Distortion, and Fraud 226
Part 3 Paths Forward 231
9 Impact of Innovation: Utilization, Cost, and Quality of Care 233
Health Service Innovations: Strategic and Tactical 234
Innovations and Health Service Objectives 235
Outcomes of Strategic Innovation I: Selective Contracting 242
Outcomes of Strategic Innovation II: Cost Sharing 244
Outcomes of Strategic Innovation III: Managed Care 247
Outcomes of Tactical Innovations 250
10 Health Promotion and Disease Prevention 255
The Appeal of Prevention 256
The Scientific Rationale for Prevention 257
Prevention in Practice 266
Challenges to Prevention 272
Does Prevention Save Money? 281
The Future: Prevention and U.S. Health Care 285
11 Government, Policy, and Politics in Health Care 289
Government and Health Care in the United States 290
Government Participation in Health Care 294
The Public Environment 302
The Meaning of Public Policy 303
Politics: The Driver of Public Policy 304
Winning and Losing in Health Care Politics: Three Case Studies 310
Lessons Learned 316
The Case Against Government in Health Care 318
12 Choices for the Future 323
Opportunities and Barriers to Change 326
Non-U.S. Health Care Systems: Challenges and Lessons Learned 325
A System to be Emulated? Concerns about Canada 329
State-Level Initiatives in the United States 333
Recent Health Care Reform Efforts 334
Future Controversies and Options 336
Glossary 341
Notes 349
Index 369
