Main description:

You can get there

Where do you want to go? You might already be working in a health care or business setting. You may be looking to expand your skills. Or, you might be setting out on a new career path.

Wherever you want to go, Introduction to U.S. Health Care will help you get there. Easy–to–read, practical, and up–to–date, this text not only helps you learn fundamental concepts of the American health care system; it also helps you master the core competencies and skills you need to succeed in the classroom and beyond. The book s brief, modular format and variety of built–in learning resources enable you to learn at your own pace and focus your studies.

With this book, you will be able to:  

• Understand the role of governing boards and the challenges they face.


• Compare and contrast the primary–care and specialty–care models.


• Explore recent health care reforms that affect the primary–care model.


• Examine how we pay for health care.


• Learn about the many different roles played by the health care workforce.


• Discover how medical miracles are financed.


• Trace the evolution of hospitals throughout the nation s history and through their current state.


• Assess the reasons behind the growing reliance on ambulatory care.


• Understand who needs long–term care, why, and what the choices are.


• Explore the challenges of providing health services for society s most vulnerable groups.


• Identify obstacles in caring for the uninsured.


• Examine the types of managed care organizations, such as HMOs, PPOs, and POS plans.


• Explore current and future challenges for the health care industry.


• Understand the impact of new and emerging laws, regulations, and initiatives.

Wiley Pathways helps you achieve your goals

When it comes to learning about health care, not everyone is on the same path. But everyone wants to succeed. The new Wiley Pathways series in Health Care Management helps you achieve your goals with its brief, inviting format, clear language, and focus on core competencies and skills.

The books in this series––Introduction to U.S. Health Care, Health Care Economics, Health Care Management, and Health Care Law and Ethics––offer a coordinated curriculum for learning health care management. Learn more at www.wiley.com/go/pathways.

Back cover:

You can get there

Where do you want to go? You might already be working in a health care or business setting. You may be looking to expand your skills. Or, you might be setting out on a new career path.

Wherever you want to go, Introduction to U.S. Health Care will help you get there. Easy–to–read, practical, and up–to–date, this text not only helps you learn fundamental concepts of the American health care system; it also helps you master the core competencies and skills you need to succeed in the classroom and beyond. The book s brief, modular format and variety of built–in learning resources enable you to learn at your own pace and focus your studies.

With this book, you will be able to:  

• Understand the role of governing boards and the challenges they face.


• Compare and contrast the primary–care and specialty–care models.


• Explore recent health care reforms that affect the primary–care model.


• Examine how we pay for health care.


• Learn about the many different roles played by the health care workforce.


• Discover how medical miracles are financed.


• Trace the evolution of hospitals throughout the nation s history and through their current state.


• Assess the reasons behind the growing reliance on ambulatory care.


• Understand who needs long–term care, why, and what the choices are.


• Explore the challenges of providing health services for society s most vulnerable groups.


• Identify obstacles in caring for the uninsured.


• Examine the types of managed care organizations, such as HMOs, PPOs, and POS plans.


• Explore current and future challenges for the health care industry.


• Understand the impact of new and emerging laws, regulations, and initiatives.

Wiley Pathways helps you achieve your goals

When it comes to learning about health care, not everyone is on the same path. But everyone wants to succeed. The new Wiley Pathways series in Health Care Management helps you achieve your goals with its brief, inviting format, clear language, and focus on core competencies and skills.

The books in this series––Introduction to U.S. Health Care, Health Care Economics, Health Care Management, and Health Care Law and Ethics––offer a coordinated curriculum for learning health care management. Learn more at www.wiley.com/go/pathways.

Contents:

Part I: Foundations 1

1 The U.S. Health Care System 1

Introduction 2

1.1 Gauging the Size of the Health Care Industry 2

Self–Check 4

1.2 Balancing Public and Private Health: Health Care Organizations 4

Self–Check 8

1.3 Identifying Health Systems 9

Self–Check   11

1.4 Classifying Health Care Industry Sectors 11

Self–Check 14

1.5 Defining Health and Disease 15

Self–Check 18

1.6 Accessing Health Services in the United States 19

Self–Check 23

Summary 23

Key Terms 23

Summary Questions 25

Review Questions 27

Applying This Chapter 28

You Try It. 29

2 Boards and Governance 30

Introduction 31

2.1 Understanding the Role of Governing Boards 31

Self–Check 35

2.2 Board Composition, Structure, and Infrastructure 35

Self–Check 38

2.3 Challenges Facing Boards 39

Self–Check   41

Summary 41

Key Terms 41

Summary Questions 44

Review Questions 44

Applying This Chapter 45

You Try It. 46

Part II: Health Care Organization and Financing 47

3 Health Care Provision 47

Introduction 48

3.1 Health Provision at a Glance: Specialty–Care versus Primary–Care 48

Self–Check 50

3.2 Primary Care Reforms in the United States 50

Self–Check 52

3.3 Performance of the Primary Care Model in the United States 52

Self–Check 55

3.4 Primary Care Innovations 55

Self–Check 57

3.5 Identifying the PCP 57

Self–Check 60

3.6 PCPs and the Populations They Serve  60

Self–Check 63

Summary 63

Key Terms 64

Summary Questions 66

Review Questions 68

Applying This Chapter 72

You Try It.73

4 Financing the U.S. Health Care System 74

Introduction 75

4.1 Changing Economic Dynamics 75

Self–Check 80

4.2 Flow of Funds through the System 80

Self–Check 84

4.3 Examining Who Has Health Insurance 84

Self–Check 87

4.4 Categorizing Health Insurance Plans 87

Self–Check 91

4.5 Private Insurance Coverage: Voluntary Health Insurance (VHI) 92

Self–Check 94

4.6 Government Insurance Programs: Medicare and Medicaid 94

Self–Check 98

4.7 Health Maintenance Organizations (HMOs) 99

Self–Check 101

Summary 101

Key Terms 102

Summary Questions 104

Review Questions 107

Applying This Chapter 108

You Try It 109

Part III: Health Care Resources 110

5 The Health Care Workforce 110

Introduction 111

5.1 Sizing Up the Workforce 111

Self–Check 114

5.2 Understanding the Role of the Physician 114

Self–Check 118

5.3 Training Doctors 118

Self–Check 121

5.4 Nurses 121

Self–Check 125

5.5 Other Independent Health Professionals 125

Self–Check 129

5.6 Working in Concert with Physicians 129

Self–Check 131

Summary 131

Key Terms 132

Summary Questions 135

Review Questions 137

Applying This Chapter 139

You Try It 140

6 Research and Technology 141

Introduction 142

6.1 Understanding Medical Research  142

Self–Check 149

6.2 Research Facilities 149

Self–Check 153

6.3 Funding Research: Knowing Where the Money Comes From 153

Self–Check 155

6.4 Assessment and Challenges of Continuing Medical Advancement 155

Self–Check 157

Summary 158

Key Terms 158

Summary Questions 159

Review Questions 161

Applying This Chapter 162

You Try It 164

Part IV: The Health Care Delivery System 165

7 Hospitals in the U.S. 165

Introduction 166

7.1 The Evolution of Hospitals in the U.S 166

7.1.1 Forming Hospitals: the Refuge Stage 166

Self–Check 170

7.2 Components and Cost of American Hospitals 170

Self–Check 172

7.3 Classifying Hospitals 173

Self–Check 176

7.4 Care and Competition in the Twenty–First Century 177

Self–Check 179

Summary 179

Key Terms 180

Summary Questions 182

Review Questions 183

Applying This Chapter 184

You Try It 185

8 Ambulatory Care 186

Introduction 187

8.1 Understanding Ambulatory Care 187

Self–Check 191

8.2 Ambulatory Care Settings and Providers 191

Self–Check 197

8.3 Home Health and Visiting Nurse Agencies. 197

Self–Check 199

Summary 199

Key Terms 200

Summary Questions 201

Review Questions 202

Applying This Chapter 204

You Try It 205

9 Long–Term Care 206

Introduction 207

9.1 Understanding Long–Term Care 207

Self–Check 209

9.2 Personal Care Facilities 209

Self–Check 214

9.3 Community–Based and Home Health Care 214

Self–Check 218

9.4 Rehabilitation Centers 218

Self–Check 219

9.5 Hospice Care 219

Self–Check 222

Summary 222

Key Terms 222

Summary Questions 225

Review Questions 226

Applying This Chapter 227

You Try It 229

10 Caring For Special Populations 230

Introduction 231

10.1 Caring For Mentally Ill Patients 231

Self–Check 239

10.2 Homeless Patients 239

Self–Check 241

10.3 Veterans 241

Self–Check 243

10.4 Immigrants 243

Self–Check 245

10.5 Caring For Other Special Populations 245

Self–Check 246

Summary 247

Key Terms 247

Summary Questions 249

Review Questions 251

Applying This Chapter 251

You Try It 253

11 Caring For Uninsured Patients 254

Introduction 255

11.1 Identifying Uninsured Patients 255

Self–Check 257

11.2 Accessing Health Care When Uninsured 257

Self–Check 260

11.3 Challenges in Providing Health Care to Uninsured Patients  260

Self–Check 263

11.4 Legal Issues and Uninsured Patients 263

Self–Check 264

Summary 264

Key Terms 264

Summary Questions 266

Review Questions 267

Applying This Chapter 267

You Try It 268

12 Managed Care 269

Introduction 270

12.1 Understanding Managed Care 270

Self–Check 272

12.2 Types of Managed Care Organizations 273

Self–Check 276

12.3 Assessing the Performance of Managed Care 276

Self–Check 278

Summary 279

Key Terms 279

Summary Questions 281

Review Questions 282

Applying This Chapter 284

You Try It 285

Part V: Challenges Of US Health Care 286

13 Promoting Health And Preventing Disease 286

Introduction 287

13.1 Growing Complexity of the U.S. Health Care System 287

Self–Check 290

13.2 Financing Health Care 290

Self–Check 294

13.3 Aging Population 294

Self–Check 296

13.4 Challenges for Primary Care 296

Self–Check 302

13.5 Examining The Underserved: Rural and Inner–City Areas 302

Self–Check 305

13.6 Fixing the Problem of the Underserved 305

Self–Check 308

13.7 Other Challenges 309

Self–Check 311

Summary 311

Key Terms 311

Summary Questions 313

Review Questions 315

Applying This Chapter 316

You Try It 318

14 Public Health Policy 319

Introduction  320

14.1 Public Health Services 320

Self–Check 328

14.2 Federal and State Health Laws 328

Self–Check 330

14.3 Assessing U.S. Health Policy 330

Self–Check 331

14.4 Comparing U.S. Health Care to Health Care in Other Countries 332

Self–Check 334

Summary 334

Key Terms 335

Summary Questions 336

Review Questions 337

Applying This Chapter 338

You Try It 340

Endnotes 341

Glossary 343

Index 359