Healthcare in the United States: Clinical, Financial, and Operational Dimensions

by Kenneth L. Johnson PhD, Stephen L. Walston PhD

Overview

Healthcare in the United States: Clinical, Financial, and Operational Dimensions offers an introductory overview of the American healthcare system by exploring its many organizations, populations, professions, structures, financing, and delivery models, as well as their impact. Authors Stephen L. Walston and Kenneth L. Johnson delve into the many conflicting issues related to cost, access, and quality. The book’s 14 chapters cover the following and more: a comprehensive review of the health professions and types of healthcare organizations; an exploration of how medical providers are paid; major challenges currently facing physicians, hospitals, and the pharmaceutical industry; an examination of the long-term and mental healthcare sectors and the increasing demands for their services; the significant role of the government in healthcare, including the influence of politics; the basics of population health, including an in-depth look at how changing social, demographic, and economic conditions in the United States affect healthcare; the connections between health behaviors, health insurance, and health outcomes; information technology’s role in healthcare; a comparison of US healthcare to that in other countries, with a focus on the four basic models on which most healthcare systems are created. To enhance and assess students’ learning, each of the book’s chapters features case studies, thought-provoking questions and assignments, sidebars, and key terms accompanied by definitions. As they read, future healthcare administrators and clinicians will obtain a grounding in the multifaceted US healthcare system, thus enabling them to better address its multiple priorities, controversies, and opportunities.

Product Details

ISBN-13:	9781640551459
Publisher:	Health Administration Press
Publication date:	12/11/2020
Edition description:	New Edition
Pages:	375
Product dimensions:	8.00(w) x 10.00(h) x 0.90(d)

About the Author

Kenneth L. Johnson, PhD, FACHE, serves as the associate dean and professor at the Dumke College of Health Professions at Weber State University in Ogden, Utah. He holds a PhD in health education and has taught primarily in the areas of healthcare administration and population health. He is a past chair of the Association of University Programs in Health Administration and a past president of the National Association of Local Boards of Health. He is a fellow of both the American College of Healthcare Executives and the Association of Schools of Advancing Health Professions, representing the latter on the Healthy People Curriculum Task Force. Stephen L. Walston, PhD, has worked as both a professor and a healthcare administrator. Currently, he serves as the director of the University of Utah’s master of healthcare administration (MHA) program. Previously, he served as the vice president for academic affairs at the University of Utah Asia Campus at the Incheon Global Campus in Songdo, Korea. He was also the associate dean for academic affairs at the University of Oklahoma’s College of Public Health, an MHA program director at Indiana University, and a faculty member at Cornell University. Dr. Walston received his PhD in healthcare systems and management from the University of Pennsylvania's Wharton School.

Table of Contents

Preface xv

Chapter 1 The History of US Healthcare and the Demographics of Disease 1

The History of the US Healthcare System 2

The "Iron Triangle" of Healthcare 6

Aging and Chronic Disease 9

Diversity and Healthcare 11

Healthcare Cost Variations 13

Life Expectancy, Lifestyle, and Chronic Disease 15

New Diseases 16

Summary 18

Questions 19

Assignments 20

Cases 20

References 22

Chapter 2 Healthcare Professions 30

Clinical Care Positions 31

Administrative Positions 44

Summary 48

Questions 49

Assignments 49

Cases 50

References 51

Chapter 3 Hospitals and Healthcare Systems 57

Levels of Care 58

Types of Care 60

Types of Hospitals 61

Hospital Competition 69

Organization and Leadership of Hospitals 70

Outpatient Versus Inpatient Care 71

The Future of Hospitals 74

Summary 75

Questions 77

Assignments 77

Cases 78

References 79

Chapter 4 The Pharmaceutical and Medical Device Industries 85

Pharmaceutical Industry 86

Clinical Trials 95

Over-the-Counter Drugs 97

Medical Device Industry 97

Summary 100

Questions 101

Assignments 102

Cases 102

References 103

Chapter 5 Long-Term Care 110

A Historical Look at Long-Term Care 111

Long-Term Care Today 114

Long-Term Care Settings 115

Unpaid Caregivers 118

The Formal Long-Term Care Workforce 120

Paying for Long-Term Care 122

Quality of Long-Term Care 126

Elder Abuse 128

The Future of Long-Term Care 129

Summary 131

Questions 132

Assignments 132

Cases 133

References 134

Chapter 6 Mental Health 141

The History of Mental Health Care 142

Types of Mental Health Providers 146

Ownership of Mental Health Facilities 147

Mental Health Treatment Settings 147

Substance Abuse and Mental Illness 151

Challenges in Mental Health Care 152

Summary 155

Questions 156

Assignments 156

Cases 157

References 158

Chapter 7 Government Involvement in US Healthcare 165

Regulation 166

Licensure 167

Government as a Purchaser of Healthcare 170

Government as a Provider of Healthcare 177

Government-Sponsored Health Services Research and Training 180

Major Legislation 182

The Contested Role of Government in Healthcare 183

Summary 184

Questions 185

Assignments 186

Cases 186

References 187

Chapter 8 The Economics of Healthcare 194

The Healthcare Production Process 195

Supply and Demand 197

Unique Qualities of the Healthcare Market 199

Macroeconomics of Healthcare 206

Summary 209

Questions 211

Assignments 211

Cases 212

References 213

Chapter 9 Health Insurance 217

The Concept of Health Insurance 219

Healthcare Actuaries 220

The History of Health Insurance in the United States 220

Community Rating Versus Experience Rating 222

Indemnity Versus Managed Care Model 222

Healthcare Costs Beyond Insurance Premiums 224

Reasons for Higher Premiums 225

Medical Loss Ratios 227

Challenges of Third-Party Payment 228

How Health Insurance Premiums Are Spent 229

Why Have Health Insurance? 229

Essential Health Benefits 230

Who Provides Health Insurance? 231

Major Private Insurance Companies 232

The Financial Burden of Healthcare Costs 233

Paying for Deductibles and Coinsurance 234

Fully Insured and Self-Insured Companies 235

How Companies Can Lower Healthcare Costs 236

How Patients Can Lower Healthcare Costs 236

Balance Billing 237

Common Types of Health Insurance Networks 237

The Future of Health Insurance 239

Summary 242

Questions 244

Assignments 244

Cases 245

References 246

Chapter 10 The Quality of US Healthcare 256

Defining Quality 257

The Iron Triangle 261

Initiatives to Improve Healthcare Quality 263

Medical and Surgical Errors 265

Accrediting Organizations 267

Sentinel Events 268

Quality Improvement Tools 270

Value-Based Care 276

Inequalities and Quality 277

Summary 278

Questions 279

Assignments 280

Cases 280

References 282

Chapter 11 Health Information Technology 289

Electronic Health Records 290

HIPAA and Interoperability 295

Cloud Computing and Big Data 295

Telemedicine 296

mHealth 297

Mobile App Technology 299

Secondary Uses of Health Information 300

The Future of Health Information Technology 301

Summary 302

Questions 303

Assignments 304

Cases 304

References 305

Chapter 12 Population Health 311

What Is Population Health? 312

Determinants of Health 313

Health Disparities 315

Population Health Management 318

Healthcare's Role in Population Health 325

Summary 328

Questions 329

Assignments 329

Cases 330

References 331

Chapter 13 The US Healthcare System in Comparison with Other Countries 339

Types of Healthcare Systems 340

Comparison of Healthcare Systems 342

Innovative Approaches to Lower Costs and Improve Care 354

Efficiency of Healthcare Systems 355

Common Problems in All Healthcare Systems 356

Summary 357

Questions 358

Assignments 358

Cases 359

References 360

Chapter 14 The Future of Healthcare in the United States 366

Focus on Prevention Versus Treatment 367

Is Healthcare a Right or a Privilege? 368

The Impact of Healthcare Costs 369

Waste in Healthcare 370

Healthcare Costs and Outcomes Compared with Other Countries 371

The Challenge of Substance Abuse 372

Fragmented Delivery of Healthcare 373

Expansion of Healthcare Competition to Tech Companies 375

Integrating Social Determinants of Health 376

Health Disparities 377

Aging and Chronic Conditions 377

Lack of Transparency and Variation of Prices 378

New Technology 380

Summary 381

Questions 382

Assignments 383

Cases 383

References 384

Glossary 393

Index 403

About the Authors 431