| |
| |
| Acknowledgments | |
| |
| |
| Introduction | |
| |
| |
| About the Author | |
| |
| |
| |
| History of the U.S. Healthcare Delivery System | |
| |
| |
| |
| Introduction | |
| |
| |
| |
| 1750 to 1850-The Early Days | |
| |
| |
| |
| 1850 to the Late Nineteenth Century-Shift from Care to Cure | |
| |
| |
| |
| 1900 to the Mid-Twentieth Century-Era of Standardization | |
| |
| |
| |
| Mid-Twentieth Century to Twenty-First Century | |
| |
| |
| |
| Start of the Twenty-First Century | |
| |
| |
| |
| Summary | |
| |
| |
| References | |
| |
| |
| Websites | |
| |
| |
| |
| Health Status: The Health of the Population | |
| |
| |
| |
| Introduction | |
| |
| |
| |
| Health Status | |
| |
| |
| |
| Mortality | |
| |
| |
| |
| Morbidity | |
| |
| |
| |
| Obesity | |
| |
| |
| |
| Health Determinants | |
| |
| |
| |
| Summary | |
| |
| |
| References | |
| |
| |
| Websites | |
| |
| |
| |
| Components of the Healthcare Delivery System | |
| |
| |
| |
| Introduction | |
| |
| |
| |
| Who Are the Players in Healthcare Delivery? | |
| |
| |
| |
| Healthcare Providers: Inpatient or Outpatient? | |
| |
| |
| |
| Scope and Size of Hospitals | |
| |
| |
| |
| Levels of Care | |
| |
| |
| |
| Other Categorizations of Healthcare Service Levels | |
| |
| |
| |
| Ambulatory Care | |
| |
| |
| |
| Subacute Care | |
| |
| |
| |
| Long-Term Care | |
| |
| |
| |
| Home Healthcare | |
| |
| |
| |
| Hospice Care | |
| |
| |
| |
| Respite and Day Care | |
| |
| |
| |
| Rehabilitation | |
| |
| |
| |
| Emergency Services | |
| |
| |
| |
| Mental Health and Substance Abuse | |
| |
| |
| |
| Summary | |
| |
| |
| References | |
| |
| |
| Websites | |
| |
| |
| |
| Structure of Healthcare Delivery | |
| |
| |
| |
| Introduction | |
| |
| |
| |
| Hospital Classifications | |
| |
| |
| |
| Ownership | |
| |
| |
| |
| Private Healthcare Entities | |
| |
| |
| |
| Community and Voluntary Providers of Care | |
| |
| |
| |
| Government/Public Hospitals and Clinics | |
| |
| |
| |
| Tax Status: Taxed or Tax-Exempt | |
| |
| |
| |
| Not-for-Profit | |
| |
| |
| |
| For-Profit | |
| |
| |
| |
| Geography | |
| |
| |
| |
| Types of Hospitals | |
| |
| |
| |
| General Acute Care Hospitals | |
| |
| |
| |
| Academic Medical Centers and Teaching Hospitals | |
| |
| |
| |
| Specialty Hospitals | |
| |
| |
| |
| Mental Health Hospitals | |
| |
| |
| |
| Hospital Operations | |
| |
| |
| |
| Structure of the Hospital-Physician Relationship | |
| |
| |
| |
| Integrated Delivery Networks | |
| |
| |
| |
| Summary | |
| |
| |
| References | |
| |
| |
| Websites | |
| |
| |
| |
| Doctors in the Healthcare Delivery Structure | |
| |
| |
| |
| Introduction | |
| |
| |
| |
| Physician Workforce | |
| |
| |
| |
| How Are Doctors Trained? | |
| |
| |
| |
| Number of Medical Schools and Their Enrollments | |
| |
| |
| |
| Typical Course of Study in Medical School | |
| |
| |
| |
| Preclinical Curriculum/Basic Sciences | |
| |
| |
| |
| Clinical Phase | |
| |
| |
| |
| Licensing | |
| |
| |
| |
| Graduate Medical Education: Becoming a Specialist | |
| |
| |
| |
| International Medical Graduates | |
| |
| |
| |
| Financial Support of Medical Education | |
| |
| |
| |
| How Doctors Work with Hospitals | |
| |
| |
| |
| The Physician's Source(s) of Income | |
| |
| |
| |
| Malpractice | |
| |
| |
| |
| Physician Supply | |
| |
| |
| |
| Summary | |
| |
| |
| References | |
| |
| |
| Websites | |
| |
| |
| |
| Workforce: Nurses and Others | |
| |
| |
| |
| Introduction | |
| |
| |
| |
| Nursing | |
| |
| |
| |
| Nursing Shortage | |
| |
| |
| |
| Registered Nurses | |
| |
| |
| |
| Registered Nursing (RN) Education | |
| |
| |
| |
| RN Licensing | |
| |
| |
| |
| Advanced Practice Nurses | |
| |
| |
| |
| Nurse Practitioners | |
| |
| |
| |
| Clinical Nurse Specialists | |
| |
| |
| |
| Licensed Practical Nurses | |
| |
| |
| |
| Physician Assistants | |
| |
| |
| |
| Pharmacists | |
| |
| |
| |
| Other Allied Health Professionals | |
| |
| |
| |
| Radiology Technologists | |
| |
| |
| |
| Physical, Occupational, and Speech Therapists | |
| |
| |
| |
| Other Allied Health Professionals | |
| |
| |
| |
| Supporting Professionals | |
| |
| |
| |
| Researchers | |
| |
| |
| |
| Shortage of Clinical Personnel in the United States | |
| |
| |
| |
| Administrative Management Professionals | |
| |
| |
| |
| Nursing Facility Administration | |
| |
| |
| |
| Summary | |
| |
| |
| References | |
| |
| |
| |
| The Legal and Regulatory Environment | |
| |
| |
| |
| Introduction | |
| |
| |
| |
| Government as Regulator | |
| |
| |
| |
| The Legislature: Healthcare Statutes | |
| |
| |
| |
| Hill-Burton | |
| |
| |
| |
| Medicare and Medicaid (Titles XVIII and XIX of the Social Security Amendments) | |
| |
| |
| |
| Certificate of Need (1973) | |
| |
| |
| |
| Prospective Payment (1982) | |
| |
| |
| |
| HMO Act (1973) | |
| |
| |
| |
| Emergency Medical Treatment and Active Labor Act (1986) | |
| |
| |
| |
| Stark Law-The Physician Self-Referral Act (Stark 1-1989 and Stark 11-1993) | |
| |
| |
| |
| Health Insurance Portability and Accountability Act of 1996 (HIPAA) | |
| |
| |
| |
| Malpractice | |
| |
| |
| |
| Summary | |
| |
| |
| References | |
| |
| |
| |
| Financing Healthcare | |
| |
| |
| |
| Introduction | |
| |
| |
| |
| How Much Does Healthcare Cost in the United States? | |
| |
| |
| |
| Medicare | |
| |
| |
| |
| Medicaid | |
| |
| |
| |
| Federal/State Matching Funding | |
| |
| |
| |
| Waivers | |
| |
| |
| |
| Medicaid Managed Care | |
| |
| |
| |
| State Children's Health Insurance Program | |
| |
| |
| |
| Impact of PPACA on Medicaid and SCHIP | |
| |
| |
| |
| Other Governmentally Financed Healthcare Programs | |
| |
| |
| |
| The VA | |
| |
| |
| |
| Indian Health Services | |
| |
| |
| |
| Private Sector in Healthcare Financing | |
| |
| |
| |
| Employer Plans | |
| |
| |
| |
| Managed Care Organizations | |
| |
| |
| |
| Fee for Service | |
| |
| |
| |
| PPACA: Health Reform | |
| |
| |
| |
| Summary | |
| |
| |
| References | |
| |
| |
| |
| Quality | |
| |
| |
| |
| Introduction | |
| |
| |
| |
| Defining Quality | |
| |
| |
| |
| What Is the Problem with Healthcare Quality? The IOM Reports | |
| |
| |
| |
| Challenge of Quality and Safety in Healthcare Delivery | |
| |
| |
| |
| Standardization/Accreditation | |
| |
| |
| |
| Joint Commission | |
| |
| |
| |
| DNV | |
| |
| |
| |
| National Committee for Quality Assurance | |
| |
| |
| |
| Quality Improvement Initiatives | |
| |
| |
| |
| National Organizations and Agencies on Quality | |
| |
| |
| |
| The National Quality Forum | |
| |
| |
| |
| Centers for Medicare and Medicaid Services | |
| |
| |
| |
| The Leapfrog Group | |
| |
| |
| |
| The Institute for Healthcare Improvement (IHI) and Pursuing Perfection | |
| |
| |
| |
| Payer Initiatives | |
| |
| |
| |
| Evidence-Based Medicine | |
| |
| |
| |
| The Medical Home | |
| |
| |
| |
| Tools for Quality Improvement | |
| |
| |
| |
| Dashboards | |
| |
| |
| |
| Benchmarking | |
| |
| |
| |
| Summary | |
| |
| |
| References | |
| |
| |
| |
| Public Health | |
| |
| |
| |
| Introduction | |
| |
| |
| |
| Role of Public Health | |
| |
| |
| |
| History of Public Health Service | |
| |
| |
| |
| Public Health at the Federal Level | |
| |
| |
| |
| Office of Public Health and Science | |
| |
| |
| |
| Office of the Surgeon General | |
| |
| |
| |
| U.S. Public Health Service Today | |
| |
| |
| |
| Summary | |
| |
| |
| References | |
| |
| |
| |
| Technology: Medical and Information Technologies | |
| |
| |
| |
| Introduction | |
| |
| |
| |
| Medical Technology | |
| |
| |
| |
| Pharmaceuticals | |
| |
| |
| |
| Clinical Trials Research | |
| |
| |
| |
| Preclinical Research | |
| |
| |
| |
| Basic Scientific Research | |
| |
| |
| |
| Genomics | |
| |
| |
| |
| Information Technology | |
| |
| |
| |
| Introduction | |
| |
| |
| |
| Why the EHR? | |
| |
| |
| |
| EMR or EHR: Which Is It? | |
| |
| |
| |
| Components of the EHR | |
| |
| |
| |
| Health Information Exchange (HIE) | |
| |
| |
| |
| Personal Health Record | |
| |
| |
| |
| Types of Information Systems in Healthcare | |
| |
| |
| |
| Challenges to IT Adoption | |
| |
| |
| |
| Summary | |
| |
| |
| References | |
| |
| |
| Index | |