Basics of the U.S. Health Care System

Author: Nancy Niles, PhD, MPH, MS, MBA
Affiliation: Associate Professor, Rollins College, Winter Park, Florida
Publisher: Jones & Bartlett Learning
Publication Date: 2018
ISBN 10: 1284102882
ISBN 13: 9781284102888
eISBN: 9781284102949
Edition: 3rd

Description:

Basics of the U.S. Health Care System, Third Edition provides a broad, fundamental introduction to the workings of the healthcare industry. Engaging and activities-oriented, the text offers an accessible overview of the major concepts of healthcare operations, the role of government, public and private financing, as well as ethical and legal issues. Each chapter features review exercises and internet resources that make studying this complex industry both enjoyable and stimulating. Students of various disciplines—including healthcare administration, business, nursing, public health, and others—will discover a practical guide that prepares them for professional opportunities in this rapidly growing sector. The Third Edition has been updated substantially to reflect the many recent changes as a result of the Affordable Care Act and its mandates. This edition also offers: • A new activity at the end of each chapter that engages the reader in relating the chapter content to current events using internet research. • Expanded coverage of law, ethics, and bioethical issues including end-of-life care and advanced directives. • New sections addressing issues related to the health and legal rights of the LGBT population

Table of Contents

Front Matter

  • ABOUT
  • About the Author
  • Acknowledgments
  • Preface

CHAPTER 1: History of the U.S. Healthcare System

  • Introduction
  • Consumer Perspective on Health Care
  • Milestones of the Hospital System
  • Milestones of Public Health
  • Milestones of the Health Insurance System
  • Current System Operations
  • Assessing Your Healthcare System Using the Iron Triangle
  • Conclusion
  • Wrap-Up
  • References
  • Notes
  • Student Activity 1-1
  • Student Activity 1-2
  • Student Activity 1-3
  • Student Activity 1-4
  • Student Activity 1-5

CHAPTER 2: Impact of the Affordable Care Act on Healthcare Services

  • Introduction
  • Legal Issues with the Affordable Care Act
  • Major Provisions of the Affordable Care Act
  • Conclusion
  • Wrap-Up
  • References
  • Notes
  • Student Activity 2-1
  • Student Activity 2-2
  • Student Activity 2-3
  • Student Activity 2-4
  • Student Activity 2-5

CHAPTER 3: Current Operations of the Healthcare System

  • Introduction
  • Overview of the Current System Update
  • Major Stakeholders in the Healthcare Industry
  • Stakeholders’  Environment
  • Healthcare Statistics
  • Conclusion
  • Wrap-Up
  • References
  • Notes
  • Student Activity 3-1
  • Student Activity 3-2
  • Student Activity 3-3
  • Student Activity 3-4
  • Student Activity 3-5

CHAPTER 4: Government’s Role in U.S. Health Care

  • Introduction
  • History of the Role of Government in Health Care
  • U.S. Government Agencies
  • Conclusion
  • Wrap-Up
  • References
  • Notes
  • Student Activity 4-1
  • Student Activity 4-2
  • Student Activity 4-3
  • Student Activity 4-4
  • Student Activity 4-5

CHAPTER 5: Public Health’s Role in Health Care

  • Introduction
  • What Is Health?
  • Origins of Public Health
  • What Is Public Health?
  • The Epidemiology Triangle
  • Epidemiologic Surveillance
  • Environmental Health
  • Emergency Preparedness
  • State and Local Response to Disasters
  • Bioterrorism
  • Public Health Functions and Administration
  • Healthy People Reports
  • Public Health Infrastructure
  • Public Health Education and Health Promotion
  • Collaboration of Public Health and Private Medicine
  • Conclusion
  • Wrap-Up
  • References
  • Notes
  • Student Activity 5-1
  • Student Activity 5-2
  • Student Activity 5-3
  • Student Activity 5-4
  • Student Activity 5-5

CHAPTER 6: Inpatient and Outpatient Services

  • Introduction
  • History of Hospitals
  • Hospital Types by Ownership
  • Hospital Types by Specialty
  • Other Hospital Classifications
  • Hospital Governance
  • Hospital Licensure, Certification, and Accreditation
  • Patient Rights
  • Current Status of Hospitals
  • Outpatient Services
  • Other Health Services
  • Conclusion
  • Wrap-Up
  • References
  • Notes
  • Student Activity 6-1
  • Student Activity 6-2
  • Student activity 6-3
  • Student Activity 6-4
  • Student Activity 6-5

CHAPTER 7: U.S. Healthcare Workforce

  • Introduction
  • Primary, Secondary, and Tertiary Care
  • Physician Education
  • Generalists and Specialists
  • Differences Between Primary and Specialty Care
  • Types of Healthcare Providers
  • Other Independent Healthcare Professionals
  • Allied Health Professionals
  • Non-CAAHEP Allied Health Professionals
  • Conclusion
  • Wrap-Up
  • Notes
  • Student Activity 7-1
  • Student Activity 7-2
  • Student Activity 7-3
  • Student Activity 7-4
  • Student Activity 7-5

CHAPTER 8: Healthcare Financing

  • Introduction
  • Healthcare Spending by Service Type
  • Healthcare Spending by Sources of Funds
  • Health Insurance as a Payer for Healthcare Services
  • Types of Health Insurance
  • Cost Sharing of Health Services
  • Types of Health Insurance Plans
  • Public Financing of Healthcare Services
  • Reimbursement Methods of Private Health Insurance Plans
  • Governmental Reimbursement Methods for Healthcare Services
  • Healthcare Financial Management
  • Funds Disbursement
  • Conclusion
  • Wrap-Up
  • References
  • Notes
  • Student Activity 8-1
  • Student Activity 8-2
  • Student Activity 8-3
  • Student Activity 8-4
  • Student Activity 8-5

CHAPTER 9: Managed Care Impact on Healthcare Delivery

  • Introduction
  • History of Managed Care
  • The Managed Care Organization Payment Plan
  • Cost-Control Measures of Managed Care Organizations
  • Medicare and Medicaid Managed Care
  • Assessment of Managed Care Models
  • Managed Care Accreditation
  • Issues with Managed Care Operations
  • Challenges to Managed Care
  • Conclusion
  • Wrap-Up
  • References
  • Notes
  • Student Activity 9-1
  • Student Activity 9-2
  • Student Activity 9-3
  • Student Activity 9-4
  • Student Activity 9-5

CHAPTER 10: Information Technology Impact on Health Care

  • Introduction
  • History of Information Technology in the Healthcare Industry
  • Electronic Health Records
  • Barriers to Electronic Health Record Implementation
  • Clinical Decision Support Systems
  • Pharmacy Benefit Managers
  • Drug–Drug Interactions
  • Telehealth
  • Avera Ecare
  • Million Hearts
  • Chief Information Officer
  • Council for Affordable Quality Health Care
  • Other Applications
  • Applied Health Information Technology
  • The Importance of Health Information Technology
  • Conclusion
  • Wrap-Up
  • References
  • Notes
  • Student Activity 10-1
  • Student Activity 10-2
  • Student Activity 10-3
  • Student Activity 10-4
  • Student Activity 10-5

CHAPTER 11: Healthcare Law

  • Introduction
  • Basic Concepts of Healthcare Law
  • Tort Reform
  • The Legal Relationship between the Provider and Consumer
  • Healthcare-Related Legislation
  • Patient Bill of Rights
  • Healthcare Fraud
  • Employment-Related Legislation
  • Other Employment-Related Legislation
  • Conclusion
  • Wrap-Up
  • References
  • Notes
  • Student Activity 11-1
  • Student Activity 11-2
  • Student Activity 11-3
  • Student Activity 11-4
  • Student Activity 11-5

CHAPTER 12: Healthcare Ethics

  • Introduction
  • Healthcare Stakeholder Management Model
  • Basic Concepts of Ethics in the Healthcare Workplace
  • Healthcare Codes of Ethics
  • Workplace Bullying
  • Ethics and the Doctor–Patient Relationship
  • Physician–Patient Relationship Model
  • Pharmaceutical Marketing to Physicians
  • Decision Model for Healthcare Dilemmas
  • Ethics and Public Health
  • Ethics and Research
  • Bioethical Issues
  • Conclusion
  • Wrap-Up
  • References
  • Notes
  • Student Activity 12-1
  • Student Activity 12-2
  • Student Activity 12-3
  • Student Activity 12-4
  • Student Activity 12-5

CHAPTER 13: Mental Health Issues

  • Introduction
  • History of U.S. Mental Health Care
  • Background of Mental Health Services
  • Family and Caregivers
  • Special Populations
  • Mental Health and Culture, Race, and Ethnicity
  • Mental Health Issues and Disasters, Trauma, and Loss
  • Mental Health and Veterans
  • Managed Behavioral Health Care
  • National Institute for Mental Health Strategic Plan
  • The Virginia Tech Massacre: A Case Study of the Mental Health System
  • Alternative Approaches to Mental Health Care
  • Americans with Disabilities Act of 1990 and Mental Health
  • Conclusion
  • Wrap-Up
  • References
  • Notes
  • Student Activity 13-1
  • Student Activity 13-2
  • Student Activity 13-3
  • Student Activity 13-4
  • Student Activity 13-5

CHAPTER 14: Analysis of the U.S. Healthcare System

  • Introduction
  • Highlights of the U.S. Healthcare System
  • Affordable Care Act Impact
  • Government’s Role
  • Public Health
  • Hospital and Outpatient Services
  • Information Technology
  • Healthcare Law
  • Healthcare Ethics
  • Mental Health
  • Trends in Health Care
  • International Healthcare Systems
  • Universal Healthcare Concepts
  • Local Government Healthcare Reform
  • Lessons to Be Learned from Other Healthcare Systems
  • Conclusion
  • Wrap-Up
  • References
  • Notes
  • Student Activity 14-1
  • Student Activity 14-2
  • Student Activity 14-3
  • Student Activity 14-4

Glossary