The United States Healthcare System: Overview, Driving Forces, and Outlook for the Future

by Stephen L. Wagner

Overview

The complexity of the United States healthcare system is well known, as are its challenges and shortcomings. A vital task in the years ahead will be to transition the system toward a new paradigm—one that more effectively balances quality, costs, and access to support the overall well-being of the American people. The United States Healthcare System: Overview, Driving Forces, and Outlook for the Future is intended for the healthcare professionals who will lead the transformation to optimized health and healthcare solutions. The book presents a broad overview of the system's numerous components, assesses the historical influences that brought us to our present state, and examines the trends and emerging opportunities through which we can attain a better future. Over the course of 14 chapters, the book examines such topics as the following: • The system's origins and development • The nature of health and well-being • Categories of health services delivery • The roles of organizations and providers • Financing mechanisms, past and present • Comparisons with other countries • Quality and safety improvement • The impact of technology • The politicization of healthcare • Ongoing reform efforts The book's chapters establish a firm knowledge base for each topic while also inviting deeper discussion and further exploration. Collectively, they aim to foster a thorough, multidimensional understanding of how the healthcare system functions, how it has evolved, and how it can be improved.

Product Details

ISBN-13:	9781640551695
Publisher:	Health Administration Press
Publication date:	06/17/2020
Sold by:	Barnes & Noble
Format:	eBook
Pages:	450
Sales rank:	480,892
File size:	45 MB
Note:	This product may take a few minutes to download.

About the Author

Stephen L. Wagner, PhD, FACHE, FACMPE, FAcEM, has been active in the healthcare field for more than 45 years, focusing on the US system and its ongoing transformation.

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

Editorial Reviews

Reviewer: Michael T Moonan, BSN, MBA (Advocate Aurora Health)
Description: This book presents a well-structured overview of the various forces impacting and influencing health care in the U.S. today, as well as a projection on the outlook for the future. After an introductory summary chapter, the book continues to expand on each of the 14 key factors identified as having the influence over today's modern healthcare system. The book is easy to read and well structured. Each chapter begins by listing a set of learning objectives, and ends with discussion questions that help the learners assess how well they processed the material. The book also has an ample glossary and a robust list of sources.
Purpose: The purpose of the book is to help readers identify key issues that are impacting the "triple aim" of health care: to reduce per capita costs, improve quality of the care that is delivered, and ensure fair and equitable access. These are worthy causes and are at the core of what every facet of the industry is trying to achieve. Overall, the book has achieved its objectives; however, the content on behavioral health is fairly thin. Many of the issues plaguing our country, especially when it comes to the subject of "access," are in the field of behavioral health.
Audience: The book is clearly targeted to students in healthcare administration, or perhaps even those obtaining an advanced degree in nursing, business administration, or another related field. The book effectively meets the needs of its intended audience; however, it has a heavier focus on providers when empathizing with the challenges faced in meeting the triple aim. Noticeably underrepresented is the nursing field. The author is a clear authority on the subject matter as a PhD with years of executive-level experience in the field. He currently teaches at Seton Hall in the Master of Healthcare Administration program.
Features: The book is an exceptionally easy read given the content matter covered. The author achieves this goal through the use of often humorous, sometimes poignant pop culture references sprinkled throughout. One by one, the author tackles the multitude of issues plaguing the United States healthcare delivery system. Dr. Wagner speaks to the challenges of achieving the triple aim, noting that in other industries these three goals could be viewed to be in conflict with each other. Specifically, throughout the course of the book, the author peels back the onion to reveal exactly how challenging it is to provide higher quality care to more people at a lesser cost. Some of the key forces detailed include values and beliefs, technology, policy issues, alternatives, and the various providers within the system. Again, if there is one critique of this otherwise exceptional overview, it is the lack of sufficient discussion on the stress of the healthcare system caused by the nation's underserved behavioral health population.
Assessment: This book is extremely well researched, covers most of the issues facing the nation's healthcare system in expert fashion, and is exceptionally easy to read, which can be a significant challenge given the material. It compares favorably to other similar titles covering this content. Jonas' Introduction to the U.S. Health Care System, 9th edition, Goldsteen (Springer Publishing Company, 2021) is a fair comparison as the reviews often cite the book as a great overview that is easy to read.

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