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| Foreword | |
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| Preface | |
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| List of Exhibits | |
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| List of Figures | |
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| List of Tables | |
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| List of Abbreviations/Acronyms | |
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| A Distinctive System of Health Care Delivery | |
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| Introduction | |
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| An Overview of the Scope and Size of the System | |
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| A Broad Description of the System | |
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| Basic Components of a Health Services Delivery System | |
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| A Disenfranchised Segment | |
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| Transition from Traditional Insurance to Managed Care | |
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| Primary Characteristics of the US Health Care System | |
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| Trends and Directions | |
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| Significance for Health Care Practitioners and Policymakers | |
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| Significance for Health Care Managers | |
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| Health Care Systems of Other Countries | |
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| The Systems Framework | |
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| Summary | |
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| Test Your Understanding | |
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| Review Questions | |
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| System Foundations | |
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| Beliefs, Values, and Health | |
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| Introduction | |
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| Significance for Managers and Policymakers | |
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| Basic Concepts | |
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| Health Promotion and Disease Prevention | |
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| Developmental Health | |
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| Public Health | |
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| Health Protection | |
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| Quality of Life | |
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| Determinants of Health | |
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| Overarching Factors and Implications for Health Care Delivery | |
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| A Social Model of Health | |
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| Equitable Distribution of Health Care | |
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| Justice in the US Health Delivery System | |
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| Equality in the US Health Care Delivery System | |
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| Integration of Individual and Community Health | |
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| Measures of Health Status | |
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| Evaluation of Health Status | |
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| Demographic Change | |
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| Measures of Mental Health | |
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| Measures of Social Health | |
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| Measures of Spiritual Health | |
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| Measures of Health Services Utilization | |
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| Summary | |
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| Test Your Understanding | |
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| Review Questions | |
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| The Evolution of Health Services in the United States | |
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| Introduction | |
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| Medical Services in Preindustrial America | |
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| Medical Services in Postindustrial America | |
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| Medical Care in the Corporate Era | |
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| Summary | |
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| Test Your Understanding | |
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| Review Questions | |
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| System Resources | |
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| Health Services Professionals | |
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| Introduction | |
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| Physicians | |
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| Some Key Issues in Medical Practice Involvement in the Development of Clinical Practice Guidelines | |
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| International Medical Graduates | |
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| Dentists | |
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| Pharmacists | |
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| Other Doctoral-Level Health Professionals | |
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| Nurses | |
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| Nonphysician Practitioners | |
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| Allied Health Professionals | |
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| Health Services Administrators | |
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| Summary | |
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| Test Your Understanding | |
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| Review Questions | |
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| List of Professional Associations | |
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| Medical Technology | |
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| Introduction | |
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| What Is Medical Technology? | |
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| Information Technology and Informatics | |
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| Innovation, Diffusion, and Utilization of Medical Technology | |
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| Managed Care and Technology Diffusion | |
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| The Government's Role in Technology Diffusion | |
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| The Impact of Medical Technology | |
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| The Assessment of Medical Technology | |
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| Current and Future Directions in Health Technology Assessment | |
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| Summary | |
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| Test Your Understanding | |
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| Review Questions | |
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| Health Services Financing | |
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| Introduction | |
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| The Role and Scope of Health Services Financing | |
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| Financing and Cost Control | |
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| The Insurance Function | |
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| Private Financing | |
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| Public Financing | |
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| Miscellaneous Private and Public Programs | |
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| The Payment Function | |
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| National Health Care Expenditures | |
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| Trends, Problems, and Issues in Insurance and Financing | |
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| Summary | |
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| Test Your Understanding | |
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| Review Questions | |
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| System Processes | |
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| Outpatient and Primary Care Services | |
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| Introduction | |
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| What Is Outpatient Care? | |
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| The Scope of Outpatient Services | |
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| Primary Care | |
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| Community-Oriented Primary Care | |
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| Primary Care Providers | |
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| Growth in Outpatient Services | |
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| Reasons for the Growth in Outpatient Services | |
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| Types of Outpatient Care Settings and Methods of Delivery | |
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| Utilization of Outpatient Services | |
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| Summary | |
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| Test Your Understanding | |
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| Review Questions | |
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| Inpatient Facilities and Services | |
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| Introduction | |
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| Transformation of the Hospital in the United States | |
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| The Expansion Phase: Late 1800s to Mid-1980s | |
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| The Downsizing Phase: Mid-1980s Onward | |
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| Some Key Utilization Measures and Operational Concepts | |
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| Hospital Employment | |
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| Types of Hospitals | |
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| What Makes a Hospital Nonprofit? | |
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| Some Management Concepts | |
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| Licensure, Certification, and Accreditation | |
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| Ethical and Legal Issues in Patient Care | |
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| Hospitals and Public Trust | |
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| Summary | |
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| Test Your Understanding | |
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| Review Questions | |
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| Managed Care and Integrated Organizations | |
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| Introduction | |
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| What Is Managed Care? | |
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| Evolution of Managed Care | |
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| Growth of Managed Care | |
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| Efficiencies and Inefficiencies in Managed Care | |
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| Cost Control Methods in Managed Care | |
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| Types of Managed Care Organizations | |
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| Trends in Managed Care | |
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| Impact on Cost, Access, and Quality | |
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| Managed Care Backlash, Regulation, and the Aftermath | |
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| Consolidation, Expansion, Diversification, and Integration | |
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| Integrated Delivery Systems | |
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| Types of Integration | |
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| Issues Related to Integration | |
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| Summary | |
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| Test Your Understanding | |
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| Review Questions | |
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| Long-Term Care | |
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| Introduction | |
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| The Nature of Long-Term Care | |
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| Long-Term Care Services | |
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| The Clients of Long-Term Care | |
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| Types of Community-Based Long-Term Care Services | |
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| Institutional Long-Term Care | |
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| Specialized Facilities | |
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| Nursing Home Industry and Patient Demographics | |
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| Patient Assessment and Prospective Payment for SNFs | |
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| Requirements of Participation | |
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| Summary | |
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| Test Your Understanding | |
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| Review Questions | |
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| Health Services for Special Populations | |
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| Introduction | |
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| Racial/Ethnic Minorities | |
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| The Uninsured | |
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| Children | |
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| Women | |
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| Rural Health | |
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| The Homeless | |
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| Mental Health | |
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| The Chronically Ill and Disabled | |
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| HIV/AIDS | |
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| Summary | |
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| Test Your Understanding | |
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| Review Questions | |
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| System Outcomes | |
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| Cost, Access, and Quality | |
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| Introduction | |
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| Cost of Health Care | |
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| Reasons for Cost Escalation | |
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| Cost Containment-Regulatory Approaches | |
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| Cost Containment-Competitive Approaches | |
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| Access to Care | |
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| Quality of Care | |
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| Dimensions of Quality | |
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| Quality Assurance | |
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| Quality Assessment | |
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| Quality Report Cards | |
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| Summary | |
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| Test Your Understanding | |
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| Review Questions | |
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| Health Policy | |
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| Introduction | |
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| What Is Health Policy? | |
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| The Principal Features of US Health Policy | |
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| The Development of Legislative Health Policy | |
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| Critical Policy Issues | |
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| The Future of Health Policy | |
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| Summary | |
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| Test Your Understanding | |
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| Review Questions | |
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| System Outlook | |
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| The Future of Health Services Delivery | |
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| Introduction | |
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| Trends in Private and Public Health Insurance | |
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| Future Options in Financing and Insurance | |
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| Future Challenges for Managed Care | |
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| Comprehensive Reform: If and When It Occurs | |
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| National and Global Challenges | |
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| Bioterrorism and the Transformation of Public Health | |
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| The Future Outlook for US Hospitals | |
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| Future of the Health Care Workforce | |
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| Work Organization | |
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| Enhanced Focus on Customer Service | |
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| New Frontiers in Clinical Technology | |
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| The Era of Evidence-Based Health Care | |
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| Summary | |
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| Test Your Understanding | |
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| Review Questions | |
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| Glossary | |
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| Selected Web Sites | |
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| Index | |