Introduction to the U.S. Health Care System: Principles and Management provides students with a framework for understanding and evaluating the health status of the populations they will eventually serve. This understanding draws on disciplines of finance, accounting, marketing, epidemiology, organizational design, and ethics, all covered in depth within the text. Students and readers learn how to develop a framework for understanding major health care issues; develop a acquire a working knowledge of key facts about the U. S. health care system; and develop a familiarity with key concepts of health care management. Readers will be able to understand the shortcomings of current systems and the important issues which must be addressed to create value in health care systems. This book presents a framework for understanding the dynamic relationships among stakeholders, including historical background and possible remedies to problems.
Part 1 is an overview of the U.S. health care system. From a basic description of the system, the author then looks at working models for how it all works, highlighting the tradeoffs that need to be made for proper function. Following these overviews, the author explores the reasons why people seek health services and how providers of care influence demand. In order to evaluate populations, a brief primer of managerial epidemiology follows.
Part 2 of the book focuses on the system’s stakeholders. These discussions incorporate history of those sectors, how they operate, what their major problems are and how they relate to other stakeholders with congruent or competing interests. The outcome of the current health care reform debate will be covered in Chapter 10, in particular.
Part 3 covers evaluation of the system. The aim of any health care system is to improve the health of the population it serves. Part 3 concludes by discussing the topic of quality, particularly what it is, how it is used and the advantages and disadvantages of different methods of evaluation.
Part 1. Background and features of the U.S. health care system
Chapter 1. Overview of the U.S. health care system
Chapter 2. Frameworks for understanding and analyzing health care systems
Part 2. Factors determining the utilization of health care services
Chapter 3. Utilization of health care services
Chapter 4. Patient-induced demand for services
Chapter 5. Provider-induced demand
Chapter 6. Managerial epidemiology
Part 3. Stakeholders
Section A. Providers
Chapter 7. Institutions: Hospitals, skilled nursing facilities and surgicenters
Chapter 8. Clinical professionals: Doctors, nurses and other professionals
Section B. Payers
Chapter 9. Principles of Insurance
Chapter 10. Government as payer: Medicare; Medicaid; S-CHIP
Chapter 11. Private insurance: Commercial insurance market; Managed Care (PPOs, POS Plans, HMOs); Employer sponsored plans; ERISA; Health Savings Accounts
Section C. Suppliers
Chapter 12. Pharmaceuticals/Biotechnology
Chapter 13. Medical Devices and Diagnostics
Chapter 14. Information Systems
Part 4. Evaluating the system
Chapter 15. Measuring and assessing the quality of care
Glossary of health care terms