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TABLE OF CONTENTS Foreword to the Sixth Edition Preface to the Sixth Edition Abbreviations CHAPTER 1: INTRODUCTION HEALTH AND HEALTH CARE What is Health? Determinants of Health Genetic Inheritance Physical Environment Social Environment Health Behavior Health Care as a Determinant of Health HEALTH CARE SYSTEMS Components of Health Care Systems Organization of Health Care Services Health Care System Management Health Care System Performance U.S. HEALTH CARE SYSTEM Components of the Health Care System Health Care Workforce Suppliers of Therapeutics The Production of Health Care Workforce and Knowledge Health Care Financing Organization of Health Care Services Government in Health Services Voluntary Agencies For-Profit Enterprises Providing Health Services Private Professional Practice Types of Health Services Primary Care Secondary and Tertiary Care Care of Special Populations and Disorders Health Care System Management Dominant Manager: Changes in the Physician--Patient Relationship Administration Planning Government Regulation Evaluation The Population Served: Demographics of U.S. Population Health Care System Performance Quality of Health Care Equity of Health Care Efficiency of Health Care FUTURE OF U.S. HEALTH CARE SYSTEM History of Change The Present Situation Future Directions REFERENCES Chapter 2: HEALTH CARE WORKFORCE OVERVIEW PHYSICIANS Some History Licensure Some Basic Data Private Medical Practice Patterns of Practice Medical Specialization Medical Education Physician Supply Physician Workforce Projections Current Physician Workforce New Entrants and Choice of Medical Specialty NURSING Some History Definition Categories of Nurses and Nursing Education From Nursing Shortage to Nursing Oversupply, and Back Again Nurses in Expanded Roles PHYSICIAN ASSISTANTS HEALTH CARE WORKFORCE OUTSIDE THE HOSPITAL AND PHYSICIAN OFFICE CONCLUSIONS REFERENCES Chapter 3: HOSPITALS AND OTHER HEALTH CARE INSTITUTIONS INTRODUCTION Some History Basic Data Sources Primary Definitions Community Hospital Hospital Type by Medical Condition Treated Hospital Type by Control or Ownership Hospital Beds Length of Patient Stay Average Daily Census SOME NUMBERS Overall Teaching Hospitals Distribution and Relative Bed Supply Characteristics of Hospitalized Patients HOSPITAL STRUCTURE Introduction Hospital Administration Medical Division The Departments Medical Staff Organization Other Hospital Health Care Divisions Hospital Governance in the Private Sector1 PUBLIC GENERAL HOSPITALS THE HOSPITAL IN THE PRESENT ERA Problems Solutions LONG-TERM CARE: THE EXAMPLE OF NURSING HOMES REFERENCES Chapter 4: PRIMARY AND AMBULATORY CARE PRIMARY CARE Introduction Functions Brief Historical Background Primary Care Workforce Primary Care and the Health Care Delivery System AMBULATORY CARE Definitions Utilization Hospital Outpatient Departments Introduction Some Historical Background Hospital Outpatient Department Utilization Hospital Outpatient Department Organization and Staffing Some Problems Faced by Clinic Patients Hospital Emergency Services Ambulatory Services Outside Hospitals Neighborhood and Community Health Centers Public Health Clinics Industrial Health Service Units Home Care and Hospice CONCLUSIONS REFERENCES Chapter 5: GOVERNMENT AND THE HEALTH CARE SYSTEM INTRODUCTION SOME HISTORY THE CONSTITUTIONAL BASIS OF GOVERNMENT AUTHORITY IN HEALTH CARE THE HEALTH CARE FUNCTIONS OF GOVERNMENT The Legislative Branch The Judiciary The Executive Branch Provision of Personal Health Services Provision of Community Health Services Health Services Financing THE FEDERAL GOVERNMENT AND THE PROVISION OF HEALTH SERVICES Department of Health and Human Services Public Health Service Other Federal Departments STATE GOVERNMENTS' ROLE IN HEALTH SERVICES Introduction Health Statistics Licensing LOCAL GOVERNMENTS' ROLE IN HEALTH SERVICES PROBLEMS IN PUBLIC HEALTH CONCLUSIONS REFERENCES Chapter 6: FINANCING AND PAYMENT OF HEALTH CARE INTRODUCTION HOW MUCH IS SPENT WHERE THE MONEY COMES FROM, WITHIN THE SYSTEM Overview Private Health Insurance Out-of-Pocket Expenditures Government Spending Medicare Medicaid State Children's Health Insurance Program Other Government Programs WHERE THE MONEY GOES HOW THE MONEY IS PAID OUT: PROVIDERS, PAYERS, AND PAYMENTS Provider Payment Approaches Cost/Cost-Plus Time & Materials Fee-For-Service Fixed-Price Capitation Value Risk Transfer and Good Intentions Third-Party Payers Insurance (Risk Management) Matching different provider and patient payment approaches Maintaining a Network of Providers Price and Provider Expertise CONCLUSIONS REFERENCES Chapter 7: HEALTH CARE SYSTEM PERFORMANCE INTRODUCTION QUALITY OF HEALTH CARE Population Health Outcomes Life Expectancy Infant Mortality Quality of Life Adjusted Measures Clinical Effectiveness Patient Safety A Health Care Quality Improvement Example: Nosocomial Infections What is the Magnitude of the Nosocomial Infection Problem? How Do We Attempt to Prevent Nosocomial Infections Now? Why Isn't the Current Approach More Successful? What Initiatives Have the Major Stakeholders Undertaken to Address the Problem? What Additional Improvement Efforts Are Needed? Organizations with Major Influence on Health Care Quality Joint Commission on Accreditation of Healthcare Organizations Federal Agencies Agency for Healthcare Research and Quality Centers for Medicare and Medicaid Services Centers for Disease Control and Prevention National Institutes of Health Public/Private Partnerships and Private Initiatives National Quality Forum Leapfrog Group Institute for Healthcare Improvement Legislative Initiatives EQUITY OF HEALTH CARE Equity and the Quality of Health Care Equity and Access to Health Care EFFICIENCY OF HEALTH CARE A NATIONAL SCORECARD DATA AND INFORMATION TECHNOLOGY Office of the National Coordinator for Health Information Technology Informing Clinicians Interconnecting Clinicians Personalizing Health Care Population Health A Health Information Example: National Healthcare Safety Network Participation Surveillance and Data Collection Data Analysis and Feedback CONCLUSION REFERENCES Chapter 8: FROM PREPAID GROUP MEDICAL PRACTICE TO MANAGED CARE INTRODUCTION MEDICAL GROUP PRACTICE Introduction Physicians in Group Practice Private Group Medical Practice Prepaid Group Practice Some History Forms of PGP The Advantages of Classic PGP HEALTH MAINTENANCE ORGANIZATIONS From PGP to HMO Definitions HMOs, Entering the 1990s and into the 21st Century MANAGED CARE Prologue More Questions, More Definitional Complications INTEGRATED DELIVERY SYSTEMS MANAGED CARE TODAY SOME POLICY ISSUES IN MANAGED CARE Why Managed Care Developed When It Did The Future For-Profit versus Not-for-Profit REFERENCES Chapter 9: HEALTH CARE REFORM INTRODUCTION HISTORY OF CHANGE NATIONAL HEALTH INSURANCE (NHI) World Historical Background History of NHI in the United States The Early Days During the New Deal and Its Aftermath Medicare and Medicaid National Health Insurance in the 1960s and 1970s National Health Insurance Proposals in the 1980s SOME CONTEMPORARY APPROACHES TO NHI NHI by Contract, or the Personal Health Care System National Health Insurance in the Early 1990s Single-Payor System Clinton Health Plan The Context: Change was Already Coming The Clinton Health Plan: An Overview How the Clinton Health Plan Would Have Worked The Opposition LOOKING AHEAD "Patient Choice" and the "Free Market" Public Health Concerns Costs of Scientific and Technological Advance Where Do We Go from Here? REFERENCES Epilogue Appendix I List of Critical Reports Appendix II Sources of Data Appendix III Glossary of Terms
Library of Congress Subject Headings for this publication:
Medical care -- United States.
Delivery of Health Care -- United States.
Health Services -- United States.