Health Experience and Choosing a Healthcare Insurance Plan Reflection Paper Reflection Assignment #1 Interview someone about a recent health experience or
Health Experience and Choosing a Healthcare Insurance Plan Reflection Paper Reflection Assignment #1
Interview someone about a recent health experience or event. Connect at least five (5) concepts from Chapter 1 to their health experience.
Reflection Assignment #2
If you were to have to choose a healthcare insurance plan today, what are the things that are important to you when choosing a healthcare plan. Explain why these things are important to you. In less than one-page.
Please write reflections in two separated files. Each reflection should be about one page. NINTH EDITION
Sultz & Youngs
Health
Care USA
Understanding Its Organization and Delivery
Kristina M. Young, MS
Clinical Assistant Professor Emerita
School of Public Health and Health Professions
State University of New York at Buffalo
Buffalo, New York
President
Kristina M. Young & Associates, Inc.
Buffalo, New York
Philip J. Kroth, MD, MS
Director, Biomedical Informatics Research, Training and Scholarship
Health Sciences Library and Informatics Center
Associate Professor and Section Chief for Clinical Informatics
Divisions of Translation Informatics and General Internal Medicine
University of New Mexico School of Medicine
Albuquerque, New Mexico
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Cover Design: Scott Moden
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Printing and Binding: RR Donnelley
Cover Printing: RR Donnelley
Names: Young, Kristina M., author. | Kroth, Philip J., author. | Preceded by
(work): Sultz, Harry A. Health care USA.
Title: Health care USA : understanding its organization and delivery / Kristina M. Young, Philip J. Kroth.
Description: Ninth edition. | Burlington, MA : Jones & Bartlett Learning, [2018] | Preceded by Health care USA : understanding its
organization and delivery / Harry A. Sultz, Kristina M. Young. 8th ed. c2014. | Includes bibliographical references and index.
Identifiers: LCCN 2016044745 | ISBN 9781284114676 (paperback)
Subjects: | MESH: Delivery of Health Care | Health Policy | United States
Classification: LCC RA395.A3 | NLM W 84 AA1 | DDC 362.10973–dc23 LC record available at https://lccn.loc.gov/2016044745
6048
Printed in the United States of America
21 20 19 18 17 10 9 8 7 6 5 4 3 2 1
This book is dedicated to our parents,
Jacob Jay and Marie Young, and Joseph R. Kroth and
Nathalie Baszczynski-Kroth. We owe each of them our
untold gratitude for the values they instilled and the
examples they provided.
Contents
Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Rural Health Networks. . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Priorities of Health Care. . . . . . . . . . . . . . . . . . . . . . . . . . 15
About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiv
Tyranny of Technology. . . . . . . . . . . . . . . . . . . . . . . . . . . 15
About the Contributor. . . . . . . . . . . . . . . . . . . . . . . . . xv
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvi
New to the Ninth Edition. . . . . . . . . . . . . . . . . . . . . . . xxi
Chapter 1?Overview of Health Care:
A Population Perspective. . . . . . . 1
Problems of Health Care. . . . . . . . . . . . . . . . . . . . . . . . . . 2
Understanding Health Care. . . . . . . . . . . . . . . . . . . . . . . 3
Why Patients and Providers Behave the
Way They Do. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Indexes of Health and Disease. . . . . . . . . . . . . . . 3
Natural Histories of Disease and the Levels
of Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Major Stakeholders in U.S. Healthcare
Industry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
The Public. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Employers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Providers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Hospitals and Other Healthcare
Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Governments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Complementary and Alternative
Therapists. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Health Insurers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Long-Term Care Industry . . . . . . . . . . . . . . . . . . . 12
Voluntary Facilities and Agencies . . . . . . . . . . . 12
Health Professions Education and Training
Institutions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Professional Associations . . . . . . . . . . . . . . . . . . . 13
Other Health Industry Organizations. . . . . . . . 13
Research Communities. . . . . . . . . . . . . . . . . . . . . 13
Social Choices of Health Care. . . . . . . . . . . . . . . . . . . . 16
Aging Population. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Access to Health Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Quality of Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Conflicts of Interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Health Cares Ethical Dilemmas. . . . . . . . . . . . . . . . . . .19
Continuing Challenges. . . . . . . . . . . . . . . . . . . . . . . . . . 20
Chapter 2?Benchmark Developments
in U.S. Health Care . . . . . . . . . . 23
The Great Depression and the Birth of
Blue Cross. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Dominant Influence of Government. . . . . . . . . . . . . 25
Three Major Health Care Concerns. . . . . . . . . . . . . . . 26
Efforts at Planning and Quality Control. . . . . . . . . . . 27
Managed Care Organizations. . . . . . . . . . . . . . . . . . . . 28
The Reagan Administration: Cost Containment
and Prospective Hospital Reimbursement. . . . . 28
Biomedical Advances: Evolution of
High-Technology Medicine. . . . . . . . . . . . . . . . . . . . 29
Technical Advances Bring New
Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Roles of Medical Education and
Specialization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Influence of Interest Groups . . . . . . . . . . . . . . . . . . . . .
The American Medical Association. . . . . . . . . .
Insurance Companies . . . . . . . . . . . . . . . . . . . . . .
Consumer Groups. . . . . . . . . . . . . . . . . . . . . . . . . .
Business and Labor. . . . . . . . . . . . . . . . . . . . . . . . .
Pharmaceutical Industry. . . . . . . . . . . . . . . . . . . .
Public Health Focus on Prevention. . . . . . . . . .
31
31
31
32
32
32
33
v
vi
Contents
Health Insurance Portability and
Accountability Act. . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
The Balanced Budget Act of 1997. . . . . . . . . . . . . . . . 34
Health Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Medicare and Medicaid. . . . . . . . . . . . . . . . . . . . . 73
Growth and Decline in Numbers of Hospitals . . . . 74
Oregon Death with Dignity Act and Other
End-of-Life Legislation . . . . . . . . . . . . . . . . . . . . . . . . 34
Types of Hospitals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Health Information and Technology for
Economic and Clinical Health Act . . . . . . . . . . . . . 35
Academic Health Centers, Medical Education,
and Specialization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
The Internet and Health Care. . . . . . . . . . . . . . . . . . . . 36
Hospital System of the Department of
Veterans Affairs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
The Patient Protection and Affordable Care
Act of 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Judicial Challenges to the Affordable
Care Act . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
The Affordable Care Act Implementation
Provisions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
New Consumer Protections. . . . . . . . . . . . . . . . . 38
Improving Quality and Lowering Costs. . . . . .38
Increasing Access to Affordable Care. . . . . . . . 39
Holding Insurance Companies
Accountable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Chapter 3?Health Information
Technology. . . . . . . . . . . . . . . . . 45
Historical Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Historical Challenges in Implementing Health
Information Technology. . . . . . . . . . . . . . . . . . . . . . . 46
The Federal Governments Response to Health
Information Technology Implementation
Challenges. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
HIT Opportunities: Improving Healthcare
Delivery Quality, Effectiveness, and
Efficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Health Information Exchanges. . . . . . . . . . . . . . . . . . . 56
The Veterans Administration Health
Information System. . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Electronic Health Record Adoption Progress
in the United States. . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Future Challenges. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Chapter 4?Hospitals: Origin, Organization,
and Performance. . . . . . . . . . . . 71
Historical Perspective. . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Effects of Insurance on the Hospital Industry. . . . . 73
Financial Condition of Hospitals. . . . . . . . . . . . . . . . . . 76
Structure and Organization of Hospitals. . . . . . . . . .
Medical Division. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Nursing Division. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Allied Health Professionals. . . . . . . . . . . . . . . . . .
Diagnostic Services. . . . . . . . . . . . . . . . . . . . . . . . .
Rehabilitation Services. . . . . . . . . . . . . . . . . . . . . .
Other Patient Support Services. . . . . . . . . . . . .
Nutritional Services. . . . . . . . . . . . . . . . . . . . . . . . .
Administrative Departments. . . . . . . . . . . . . . . .
Hotel Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Information Technologys Impact on
Hospitals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
78
78
79
80
80
81
81
81
82
82
82
Complexity of the System. . . . . . . . . . . . . . . . . . . . . . . .83
Types and Roles of Patients. . . . . . . . . . . . . . . . . . . . . .
Rights and Responsibilities of
Hospitalized Patients. . . . . . . . . . . . . . . . . . . . .
Informed Consent and Second
Opinions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Diagnosis-Related Group Hospital
Reimbursement System. . . . . . . . . . . . . . . . . . . . . . .
83
84
85
86
Discharge Planning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Post-Diagnosis-Related Group and Managed
Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Early Market Reforms. . . . . . . . . . . . . . . . . . . . . . . 87
Horizontal Integration. . . . . . . . . . . . . . . . . . . . . . 88
Vertical Integration. . . . . . . . . . . . . . . . . . . . . . . . . 89
Quality of Hospital Care. . . . . . . . . . . . . . . . . . . . . . . . . . 89
Hazards of Hospitalization. . . . . . . . . . . . . . . . . . 89
Variations in Medical Care. . . . . . . . . . . . . . . . . . .92
Nurse Shortage Staffing Crisis. . . . . . . . . . . . . . . 92
Research Efforts in Quality
Improvement. . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Responsibility of Governing Boards for
Quality of Care. . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Contents
Hospitalists. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Forces of Reform. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
The Affordable Care Act . . . . . . . . . . . . . . . . . . . . 96
Population Focus. . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Market Consolidations: Hospital Mergers
and Acquisitions. . . . . . . . . . . . . . . . . . . . . . . . . 97
Accountable Care Organizations. . . . . . . . . . . . 97
Reimbursement and Payment Revisions. . . . 98
Medicare Access & CHIP Reauthorization
Act of 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Continuing Change. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Chapter 5 Ambulatory Care. . . . . . . . . . . 109
Overview and Trends. . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Private Medical Office Practice. . . . . . . . . . . . . . . . . . 111
Integrated Ambulatory Care Models. . . . . . . . . . . .
Patient-Centered Medical Homes. . . . . . . . . .
Accountable Care Organizations. . . . . . . . . . .
Other Ambulatory Care Practitioners. . . . . . . . . . . .
114
115
119
120
vii
Delineation and Growth of Medical
Specialties. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Deficient Training of Medical
Specialists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Certification of Physicians with Board
Examinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Accreditation of Graduate Physician Training. . . . 150
Physician Workforce Supply and Distribution. . . . 151
Ratios of Generalist to Specialist Physicians
and the Changing Demand. . . . . . . . . . . . . . . . . . 152
Preventive Medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Changing PhysicianHospital Relationships. . . . . 155
Evidence-Based Clinical Practice
Guidelines. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Physician Report Cards and Physician
Compare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Health Information Technology and Physician
Practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Escalating Costs of Malpractice Insurance. . . . . . . 160
Ambulatory Care Services of Hospitals:
History and Trends. . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Ethical Issues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Hospital Emergency Services. . . . . . . . . . …
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