Table of Contents
Acknowledgments xv
Preface xvii
Chapter 1 Introduction and Overview of the United States Healthcare System 1
Learning Objectives 1
Understanding the Challenge Before Us 3
General Characteristics That Distinguish the US Healthcare System 5
Spread of Global Disease 8
Information Technology 9
Physical Environment and Geography 10
Legal Issues 10
The Conundrum 11
Values, Attitudes, and Beliefs 11
A Large and Growing Problem: The Number of People with Chronic Medical Conditions 12
A Perfect Storm 12
Major Obstacles to Reform 14
Transitioning Toward Value 15
The Graying of America: US Census Projections 19
Equality Is a Healthcare Issue 19
End-of-Life Care 22
Physician Shortages 22
The United States Leads the World in Many Ways 22
Discussion Questions 24
References 24
Chapter 2 History and Development of the US Healthcare System 35
Learning Objectives 35
The Modern Healthcare System Is a Recent Development 35
Medicine in the 1700s and 1800s 36
Medicine from the Late 1800s to Mid-1900s 41
The US Healthcare System as We Know It 45
Major Advances in Healthcare Delivery 50
The History of Healthcare Reform Efforts in the United States, from the 1880s to the Present 54
Discussion Questions 62
References 63
Chapter 3 American Beliefs, Values, and Attitudes About Health and Healthcare 75
Learning Objectives 75
What Is Health? 76
Illness and Disease 77
What Determines Our Health? 78
Why Is the American Healthcare System So Different from Those of Other Countries? 82
Cultural Competence 83
Americans' Expectations for Their Healthcare System 88
What Do Americans Believe About Our Healthcare System? 88
Summary 94
Discussion Questions 95
References 95
Chapter 4 Comparing the US Healthcare System with Those of Other Developed Countries 103
Learning Objectives 103
Healthcare Systems vs. Health Systems 103
Examples of Healthcare Systems Around the World 106
Approaches to Comparing and Ranking Healthcare Systems 114
The US Healthcare System, by the Numbers 115
How Does the United States Compare? 118
Why Is Global Health Important to the United States? 124
Summary of Important Differences Between the United States and Other Countries 125
Discussion Questions 126
References 126
Chapter 5 Components of the US Healthcare System 133
Learning Objectives 133
Hospitals and Inpatient Services 135
Outpatient Services 148
End-of-Life and Long-Term Care 154
Special Healthcare Systems in the United States 158
Integration and Modern Structural Forms 159
Other Major Components of the Healthcare System 164
Organization Governance 166
Discussion Questions 168
References 168
Chapter 6 People and Providers of Healthcare 179
Learning Objectives 179
Physicians 181
Advanced Practice Professionals 186
Nurses 188
Dentists, Dental Hygienists, and Dental Assistants 192
Executive and Administrative Staff 192
Discussion Questions 197
References 198
Chapter 7 Patient Care: The Purpose of the System 205
Learning Objectives 205
Improving Health and Well-Being 205
Categories of Patient Care 209
What Constitutes Accountable Care? 212
Key Issues in Patient Care 213
Discussion Questions 234
References 234
Chapter 8 Financing a Massive System 247
Learning Objectives 247
Five Main Funding Models 248
Health Insurance in the United States 251
Managed Care 261
The Affordable Care Act and Commercial Insurance 267
Government-Sponsored Insurance 269
Complexity of the Financing Function 275
Discussion Questions 275
References 275
Chapter 9 Quality and Safety-Easier Said Than Done 287
Learning Objectives 287
Quality and Safety: A Philosophical Background 288
The State of the Art in Process Improvement 293
Continued Quality Concerns 300
Patient Experience and Satisfaction 303
A Focus on People 305
Leadership and Governance for Quality 310
The Need for a Balanced Approach 313
Discussion Questions 313
References 314
Chapter 10 The Impact of Technology on US Healthcare 325
Learning Objectives 325
Medical and Information Technology 325
Medical Technologies in Constant Development 328
Telemedicine, E-health, and Telehealth 329
Information Management 332
Electronic Health Records and Electronic Medical Records 333
Information Technology and Value-Based Care 338
Cybersecurity 340
Technology and Cost 342
Innovation and Leadership 343
The Technological Imperative 344
Discussion Questions 346
References 346
Chapter 11 The Pharmaceutical Industry in the United States 357
Learning Objectives 357
Origins and Growth of the US Pharmaceutical Industry 358
The Food and Drug Administration 360
The Role of the Federal Trade Commission 366
Pharmaceutical Industry Associations 367
Pharmaceutical Pricing and Cost 369
The Opioid Crisis 378
The Future of Pharmaceuticals 381
Discussion Questions 382
References 382
Chapter 12 Complementary and Alternative Medicine 399
Learning Objectives 399
Introduction 399
Natural Products 401
History and Development of Natural Products and CAM 403
The Current Regulatory Situation 405
Botanical Drugs: A Potential Integrative Breakthrough 406
Integrating CAM into Conventional Healthcare: Evidence-Based Preventive Medicine 408
Conclusion 415
Discussion Questions 416
References 416
Chapter 13 Health Policy and Economics 423
Learning Objectives 423
The Role of Government in Healthcare 425
Levels of Government 426
Voters Care About Healthcare 427
Making Health Policy 430
Significant Federal Regulations 434
Overcoming Fragmentation 438
The Outlook for US Health Policy 440
Discussion Questions 445
References 446
Chapter 14 The Future of Healthcare in the United States 457
Learning Objectives 457
The Good, the Bad, and the Ugly 457
Fundamental Questions 459
The Future Is Change 460
Approaching New Technologies 463
Telemedicine and Related Modalities 464
Artificial Intelligence and Big Data 466
Genomics and Precision Medicine 468
Robotics 472
Cybersecurity Threats 472
Social Media 473
Ever-Larger Systems of Providers 474
New Organizational Structures and Care Models 475
Wellness and an Aging Population 477
Comparative Effectiveness Research 481
Climate Change and Health 481
New and Evolving Disease Threats 482
Mental and Behavioral Health 486
Behavioral Economics 486
A Post-ACA Healthcare Insurance World 488
Closing Thoughts 490
Discussion Questions 491
References 491
Appendix A Organizations and Websites 509
Appendix B Recommended Publications Relating to Healthcare Administration 511
Glossary 513
Index 523
About the Author 563