Details

The U.S. Healthcare System


The U.S. Healthcare System

Origins, Organization and Opportunities
1. Aufl.

von: Joel I. Shalowitz

73,99 €

Verlag: Wiley
Format: PDF
Veröffentl.: 03.07.2019
ISBN/EAN: 9781118418345
Sprache: englisch
Anzahl Seiten: 720

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Beschreibungen

<p><b>Provides a diverse, multi-faceted approach to health care evaluation and management</b></p> <p><i>The U.S. Health Care System: Origins, Organization and Opportunities</i> provides a comprehensive introduction and resource for understanding healthcare management in the United States. It brings together the many "moving parts" of this large and varied system to provide both a bird's-eye view as well as relevant details of the complex mechanisms at work. By focusing on stakeholders and their interests, this book analyzes the value propositions of the buyers and sellers of healthcare products and services along with the interests of patients.</p> <p>The book begins with a presentation of frameworks for understanding the structure of the healthcare system and its dynamic stakeholder inter-relationships. The chapters that follow each begin with their social and historical origins, so the reader can fully appreciate how that area evolved. The next sections on each topic describe the current environment and opportunities for improvement.</p> <p>Throughout, the learning objectives focus on three areas: frameworks for understanding issues, essential factual knowledge, and resources to keep the reader keep up to date.</p> <p>Healthcare is a rapidly evolving field, due to the regulatory and business environments as well as the advance of science. To keep the content current, online updates are provided at: <b>healthcareinsights.md.</b> This website also offers a weekday blog of important/interesting news and teaching notes/class discussion suggestions for instructors who use the book as a text.</p> <p><i>The U.S. Health Care System: Origins, Organization and Opportunities</i> is an ideal textbook for healthcare courses in MBA, MPH, MHA, and public policy/administration programs. In piloting the content, over the past several years the author has successfully used drafts of chapters in his Healthcare Systems course for MBA and MPH students at Northwestern University. The book is also useful for novice or seasoned suppliers, payers and providers who work across the healthcare field and want a wider or deeper understanding of the entire system.</p>
<p>List of Exhibits xiii</p> <p>Foreword xxi</p> <p>Acknowledgments xxiii</p> <p><b>One: </b><b>Understanding and Managing Complex Healthcare Systems 1</b></p> <p>Definitions 2</p> <p>Health System Structure and Features 7</p> <p>Who Pays? 8</p> <p>How Much Is Paid? 11</p> <p>Who and What Is Covered? 12</p> <p>Where Is Care Provided? 13</p> <p>Who Provides the Services and Products? 14</p> <p>Strategic Planning 17</p> <p>Stakeholders 17</p> <p>Health System Trade-offs and Value Propositions 20</p> <p>Putting It All Together 30</p> <p>Summary 32</p> <p><b>Two: </b><b>Determinants of Utilization of Healthcare Services 33</b></p> <p>Reasons Stakeholders Seek Healthcare 34</p> <p>Patient Characteristics That Influence Care-Seeking 36</p> <p>Age 37</p> <p>Gender/Sex 37</p> <p>Race 39</p> <p>Income 41</p> <p>Social Status 42</p> <p>Education 43</p> <p>Culture and Beliefs 44</p> <p>Multifactorial Causes 46</p> <p>Reducing Patient Demand for Healthcare 47</p> <p>Increase Out-of-Pocket Expenses 47</p> <p>Prevention 51</p> <p>Eliminate/Reduce Risky Behaviors 51</p> <p>End-of-Life Issues 52</p> <p>Healthy Lifestyle Promotion 54</p> <p>Consumer Behavior—Healthcare Market Segmentation 54</p> <p>Provider-Induced Demand for Healthcare 56</p> <p>Local (Small Area) Variations 61</p> <p>Summary 63</p> <p><b>Three: </b><b>Managerial Epidemiology 65</b></p> <p>Introduction 66</p> <p>What Is Epidemiology? 66</p> <p>Why Is It Important to Learn about Epidemiology? 66</p> <p>Definitions and Uses of Principles 67</p> <p>Morbidity and Mortality 67</p> <p>Incidence and Prevalence 67</p> <p>Validity 67</p> <p>Reliability 68</p> <p>Sensitivity, Specificity, Positive Predictive Value, and Negative Predictive Value 68</p> <p>Clinical Study Designs 70</p> <p>Case Control Studies 70</p> <p>Problems with Observational Research 72</p> <p>Benefits to Employing Observational Research 73</p> <p>Cohort Study 74</p> <p>Randomized Controlled Trial 78</p> <p>Summary 80</p> <p><b>Four: </b><b>Hospitals and Healthcare Systems 81</b></p> <p>A Brief History of Western Hospitals 82</p> <p>American Hospital Expansion in the 20th Century 88</p> <p>Hospital Definition and Classifications 94</p> <p>Definition 94</p> <p>Ways Hospitals May Be Classified and Special Related Issues 96</p> <p>Hospital Inpatient Payment Methods 137</p> <p>Organized (Integrated) Delivery Systems/Accountable Care Organizations 139</p> <p>Origins and Definition 139</p> <p>Eligibility 143</p> <p>Financial Arrangements 143</p> <p>Hospital Governance 153</p> <p>Definition and Purpose 153</p> <p>Legal Requirements 154</p> <p>Responsibilities 156</p> <p>Board Structure and Activities 159</p> <p>Summary 161</p> <p><b>Five: </b><b>Healthcare Professionals 163</b></p> <p>Physicians 164</p> <p>History of Western Medical Care 164</p> <p>History of American Medical Care 177</p> <p>Current Status of Medical Training 190</p> <p>Licensure 197</p> <p>Shortage of Physicians 199</p> <p>Employment Status 204</p> <p>Summary 206</p> <p>Nurses 206</p> <p>Registered Nurses 206</p> <p>Nurse Practitioners 208</p> <p>Nurse Anesthetists 209</p> <p>Midwives 210</p> <p>Education and Certification 212</p> <p>Physician Assistants 213</p> <p>Education and Certification 214</p> <p>Physician versus NP/PA Care 215</p> <p>Summary 216</p> <p><b>Six: </b><b>Payers 219</b></p> <p>Principles of Health Insurance 220</p> <p>The Loss Must Have Some Nontrivial Value Upon Which Both Insured and Insurer Agree 222</p> <p>The Peril Must Occur Randomly and Be Out of the Control of the Insured 222</p> <p>The Event Must Occur Neither Too Frequently Nor Too Rarely 225</p> <p>The Insurer Must Be Able to Write Large Numbers of Contracts to Indemnify Similar Risks 226</p> <p>Background and Current Status of Health Insurance in the United States 229</p> <p>Private Health Insurance 229</p> <p>Medicare 264</p> <p>Medicaid 318</p> <p>Children’s Health Insurance Program: Social Security Title XXI 335</p> <p>Other Federally Sponsored Programs 337</p> <p>Managed Care 357</p> <p>Principles 361</p> <p>Quality and Safety 361</p> <p>Summary 381</p> <p><b>Seven: </b><b>Healthcare Technology 385</b></p> <p>Definition and Frameworks for Study 386</p> <p>Major Trends in Healthcare Technology 388</p> <p>Safety 388</p> <p>History of Safety Problems and Corrective Legislation 390</p> <p>What Is Substantial Equivalence 404</p> <p>When a 510(k) Is Required 404</p> <p>Bringing Healthcare Technology to Market 435</p> <p>Evolving Industry Structure 438</p> <p>Globalization 444</p> <p>Generics 444</p> <p>Specialty Pharmaceuticals 446</p> <p>Patents 453</p> <p>Genomics and Precision Medicine 453</p> <p>Disruptive Innovation 458</p> <p>Healthcare Technology’s Contribution to Costs by Stage of Care 460</p> <p>Overview 460</p> <p>Quality-Adjusted Life Years 460</p> <p>Core Cost Issues 462</p> <p>Prevention 463</p> <p>Screening 464</p> <p>Diagnosis 464</p> <p>Treatment 466</p> <p>Other Considerations 470</p> <p>Religious Issues 470</p> <p>Ethical Issues 470</p> <p>End-of-Life Costs 471</p> <p>Media’s Role in Increasing Technology Costs 472</p> <p>Malpractice and Defensive Medicine 473</p> <p>Summary 474</p> <p><b>Eight: </b><b>Information Technology 475</b></p> <p>Introduction 476</p> <p>Definitions 477</p> <p>Background and Key Issues in Health Information Technology 479</p> <p>Collection, Classification, and Ordering of Data 479</p> <p>Terminology/Coding 486</p> <p>Interoperability 492</p> <p>Lessons Learned 529</p> <p>Challenges 529</p> <p>Sustainability 529</p> <p>Certification 534</p> <p>Privacy and Security of Information 537</p> <p>Management Considerations 547</p> <p>Other Issues and Trends 549</p> <p>Summary 563</p> <p><b>Nine: </b><b>Quality 565</b></p> <p>Introduction 566</p> <p>History of Healthcare Quality and Development of Key Concepts and Institutions 567</p> <p>Ancient Origins 567</p> <p>1900–1950 568</p> <p>1950–1970s 574</p> <p>1980s and Total Quality Management 580</p> <p>1990s 589</p> <p>2000–2010 592</p> <p>2010–Present 605</p> <p>Quality of Care and the Public’s Health 623</p> <p>The Centers for Disease Control and Prevention 623</p> <p>Healthy People 626</p> <p>Definition of Quality 630</p> <p>Key Questions for Successful Evaluation and Implementation of Quality Measures 632</p> <p>Choosing Standards 633</p> <p>Monitoring Standards 637</p> <p>Evaluating Results 639</p> <p>Volume/Quality Relationship 644</p> <p>Managing Quality Improvement 646</p> <p>Value Propositions 646</p> <p>Cost–Quality Trade-off 648</p> <p>Cost–Access Trade-off 648</p> <p>Quality–Access Trade-off 649</p> <p>Summary 649</p> <p>Index 651</p>
<p>Students of American health care’s history, structure, organization, management, regulation, and financing face a daunting challenge, confounded by the complexity and scale of that industry.  Until now, a modern comprehensive source book covering all of that terrain and more has been missing. </p> <p>The wait is over.  In The U.S. Healthcare System: Origins, Organization, and Opportunities, Professor Joel Shalowitz has provided a stunningly ambitious compendium with an unequaled combination of both scope and detail.  It covers both the current shape and the historical background of payment, classical and emerging organizational forms, professional roles, regulation, technology, efforts to measure, control, and improve the quality of care, and more.  It takes deep dives into the epidemiology of both disease and the utilization of care – important scientific foundations for proper health care policy and management.  Throughout it makes generous use of helpful figures and tables, as well as copious citations that mark this as a work of authentic scholarship.</p> <p>Professor Shalowitz’s book is a must-have resource for the library of any health care scholar who wants to have ready and efficient access to the fundamental facts that shape American health care today.</p> <p><b>Donald M. Berwick, MD, MPP</b></p> <p><b>Former CMS Administrator</b></p> <p><b>Professor of Health Policy and Management, Harvard School of Public Health </b></p> <p><b>President Emeritus and Senior Fellow, Institute for Healthcare Improvement, Boston, Massachusetts</b></p> <p> </p> <p>For anyone who picks up Joel Shalowitz’s book, The U.S. Healthcare System: Origins, Organization, and Opportunities, do NOT make the common mistake of skipping the prefatory material. The first two paragraphs of the “Foreword” (p. xxi) are worth the price of admission. As far as I am concerned, anyone teaching or taking an introductory survey course on our healthcare system needs to embrace and internalize the nuggets of wisdom here, obviously gleaned over thirty years of laboring on this topic.</p> <p>What are some these nuggets? First, we do not have a healthcare system. Rather, we have a series of inter-related parts that are not aligned in their goals and incentives. That means the parts don’t work together and are not meant to work together. What that means is abandon efforts to try to “align the incentives” of all the parties using payment changes and structural models; the divides go deeper than this. The lack of a system also means that the parts impact one another in sometimes opaque ways. This means that efforts to change this monster with simplistic, top-down programs that only address one part are likely to fail. Trying to get all parties to participate in some reform might resemble the idealistic scene depicted in Edward Hicks’ painting, “The Peaceable Kingdom” (with William Penn in the background!).</p> <p>Second, there is nothing new in our healthcare system. As Yogi Berra reputedly said, “it is déjà vu all over again”. Many of the problems we are trying to tackle today (improving quality, increasing access, controlling cost increases) are similar to problems we have tried to tackle in the past. The fact that we are still tackling them - - without realizing that we have been down this road before, unsuccessfully - - should send out warning signs to everyone. These problems are intractable. The only problem is that managers, policy-makers, and students of U.S. healthcare don’t know the history and the lessons learned from the last time we tried to tackle these issues, and thus don’t know (to quote an old management text) “the ropes to skip and the ropes to know”.</p> <p>These words are meant as praise for what Joel Shalowitz has achieved in this hefty tome. He takes nearly 700 pages to (a) present several important frameworks for understanding the U.S. healthcare system, (b) trace the history of this system, and (c) present the relevant fact base on its major sectors - - but with an emphasis on “understanding” how this system really works (or doesn’t work). Unlike other introductory texts, Joel has avoided the mindless presentation of statistics and charts. I do not think those help anyone; moreover, it is boring. Instead, his book is designed to be thoughtful and thought-provoking - - i.e., to help improve your critical thinking about our healthcare system through some important lessons.</p> <p>The lessons come quickly in this book. Chapter 1 introduces the reader to the three main policy goals pursued by the U.S. (and every other country) for decades: higher quality, improved access, and restrained rate of growth in healthcare costs. This framework needs to be on everyone’s learning agenda, since every country endorses it as their strategic aim (but have not yet solved it). Joel immediately gets to the task of explaining what each of these complex goals consists of - - not an easy task, since they are multi-dimensional in nature. More importantly, he correctly (I think) characterizes this tripartite set of goals as inherently contradictory and involving tradeoffs in their accomplishment. This will come as unwelcome news to many people who want to have it all and/or do not want to make tough choices. This is critical thinking that challenges many widely-held beliefs.</p> <p>Chapter 1 also introduces you to the many stakeholders in the U.S. healthcare system. This analysis should sober readers that “alignment” - - one of the most overused words in our field - - is going to be difficult given the plurality of interests involved. Anyone one who has studied plural societies (those with many, different ethnic or religious groups) should understand the difficulties of bringing all parties together for a common goal. Indeed, one of the strengths of this book is to emphasize the presence of stakeholders and their plurality in our healthcare system. Their mere existence tells the reader that, as far as “alignment” goes, “we have trouble in River City”. Efforts to cut costs in one area of healthcare are likely to “gore someone else’s ox” (e.g., income) and therefore be opposed and perhaps thwarted.</p> <p>And this is just the Foreword and Chapter 1! I could go on further about why this book makes an enormous contribution. Chapters 2 and 3 deal with epidemiology - - a topic worthy of a physician author, but also important for an MBA business school audience that is interested in marketing (the managerial version of epidemiology). This should come as no surprise since Joel has co-authored another major text with Phil Kotler. Subsequent chapters (4 and 5) deal ably with the two biggest sources of spending in our healthcare system: hospitals (and hospital systems) and healthcare professionals. Chapters 6-8 then cover the multitude of payers, the multitude of technologies that need to be paid for, and (in particular) the advances in information technology. The final chapter does a deep-dive into the whole issue of quality - - how to measure it, how to manage it, and the tradeoffs necessitated in doing so.</p> <p>I should acknowledge my biases. Like Joel, I have been teaching an introductory survey course on the U.S. healthcare system for over 30 years. It may take us that long to really appreciate what working in this non-system means. And, like Joel, I believe an understanding of the history of the system is important for anyone trying to work within it, let along trying to change it. And, like Joel, I have labored at this task in major business schools trying to teach MBA students about the importance of this all. So, I am already predisposed to like this book. I wish I had written it.</p> <p><b>Lawton R. Burns, PhD, MBA</b></p> <p><b>James Joo-Jin Kim Professor; Director, Wharton Center for Health Management and Economics; and </b></p> <p><b>Chairperson, Health Care Systems Department, Wharton School, University of Pennsylvania</b></p> <p> </p> <p>The U.S. Healthcare System: Origins, Organization and Opportunities is a tour de force— a must use textbook for those seeking to solve the problems of the U.S. health care system.</p> <p>It discusses each of the major stakeholders in an accessible, detailed, and authoritative voice and presents a compelling framework for understanding how they function.</p> <p>Coupled with Professor Shalowitz’s daily blog, https://www.healthcareinsights.md, which discussed current healthcare issues, this book will make for the lively, informed discussions that students of U.S. healthcare have been looking for.</p> <p><b>Regina E. Herzlinger, PhD</b></p> <p><b>Nancy R. McPherson Professor of Business Administration, Harvard Business School</b></p> <p> </p> <p>This remarkably well-documented text provides important information and knowledge about the U.S. healthcare system within the context of historical developments and interpretative frameworks. The chapter on Managerial Epidemiology distinguishes [the book] from many other texts in the field, and there are particularly strong chapters on Payers, Technology, and Information Technology. The text will help readers understand and navigate the complexity of the U.S. healthcare system, why it has developed the way that it has, and some of the implications for its future evolution.</p> <p><b>Stephen M. Shortell, PhD, MBA, MPH</b></p> <p><b>Distinguished Professor of Health Policy and Management Emeritus</b></p> <p><b>Dean Emeritus School of Public Health</b></p> <p><b>University of California, Berkeley</b></p> <p> </p> <p>No matter if you’re a seasoned executive or just entering the health care workforce, this book provides critical context about the history of care delivery and payment methodologies. This understanding is essential as we consider our health care future as a country, and the author has some fascinating ideas about possible paths forward for our industry. </p> <p><b>Susan Turney, MD, MS, FACP, FACPME</b></p> <p><b>CEO of Marshfield Clinic Health System</b></p> <p> </p> <p>To anyone who wants to really  understand the U.S. healthcare system, Dr.  Shalowitz’s book is a “must read”. Having participated in the healthcare industry for 40 years, this is the first time I have found a book that is comprehensive, factual and well-written.”</p> <p><b>Harry Kraemer, Jr., MBA</b></p> <p><b>Former Chairman & CEO, Baxter International </b></p> <p><b>Clinical Professor of Leadership, Kellogg School of Management, Northwestern University</b></p> <p><b>Executive Partner at Madison Dearborn Partners</b></p>
<p><b>JOEL I. SHALOWITZ, MD, MBA, FACP,</b> was Clinical Professor and Director of the Health Industry Management Program at the Kellogg School of Management for 28 years. In addition to practicing internal medicine, he has also been on Northwestern's Feinberg Medical School's faculty for more than 35 years, most recently as Professor of Preventive Medicine. He teaches and consults internationally, was the recipient of three Fulbright awards, and is currently a Senior Fellow at ETLA (the Research Institute of the Finnish Economy) and an Affiliate Professor at the Institute of Management of the Scuola Superiore Sant'Anna in Pisa.
<p><b>Provides a diverse, multi-faceted approach to health care evaluation and management</b> <p><i>The U.S. Health Care System: Origins, Organization and Opportunities</i> provides a comprehensive introduction and resource for understanding healthcare management in the United States. It brings together the many "moving parts" of this large and varied system to provide both a bird's-eye view as well as relevant details of the complex mechanisms at work. By focusing on stakeholders and their interests, this book analyzes the value propositions of the buyers and sellers of healthcare products and services along with the interests of patients. <p>The book begins with a presentation of frameworks for understanding the structure of the healthcare system and its dynamic stakeholder inter-relationships. The chapters that follow each begin with their social and historical origins, so the reader can fully appreciate how that area evolved. The next sections on each topic describe the current environment and opportunities for improvement.<i></i> <p>Throughout, the learning objectives focus on three areas: frameworks for understanding issues, essential factual knowledge, and resources to keep the reader keep up to date. <p>Healthcare is a rapidly evolving field, due to the regulatory and business environments as well as the advance of science. To keep the content current, online updates are provided at: www.HealthcareInsights.MD. This website also offers a weekday blog of important/interesting news and teaching notes/class discussion suggestions for instructors who use the book as a text. <p><i>The U.S. Health Care System: Origins, Organization and Opportunities</i> is an ideal textbook for healthcare courses in MBA, MPH, MHA, and public policy/administration programs. In piloting the content, over the past several years the author has successfully used drafts of chapters in his Healthcare Systems course for MBA and MPH students at Northwestern University. The book is also useful for novice or seasoned suppliers, payers and providers who work across the healthcare field and want a wider or deeper understanding of the entire system.

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