Introduction to Health Care Services

Figures, Tables, and Exhibits xiii Introduction xvii Acknowledgments xix About the Authors xxi About the Contributors xxiii Part One: Overview of Health Care Service Delivery 1 Chapter 1 An Overview of Health Care Delivery in the United States 3 Bernard J. Healey Health Care Costs 4 Health Care Access 15 Health Levels and Outcomes 17 Health Care Quality 24 Summary 26 Discussion Questions 27 Chapter 2 The Forces of Change in Health Care 31 Bernard J. Healey Consequences of Forty Years of Health Care Cost Escalation 32 Health Care Reform 38 Summary 49 Discussion Questions 51 Part Two: The Major Players in Health Care Services 55 Chapter 3 Providers of Health Care Services 57 Tina Marie Evans Primary Care Physicians and Primary Care Assistants 57 Specialty Care Providers 59 Dentists, Dental Hygienists, and Dental Assistants 61 Mental Health Care Providers 62 Nurses 66 Radiologic and Imaging Professionals 67 Allied Health Rehabilitation Professionals 70 Collaboration in Health Care 73 Employment Trends in the Health Care Sector 74 Summary 77 Discussion Questions 78 Chapter 4 Hospitals 81 Denice Yanchik History of Hospitals 81 Management of Hospitals 85 Quality and Safety in Hospitals 93 Magnet Recognition Program 96 Challenges and the Future 99 Summary 100 Discussion Questions 101 Chapter 5 Ambulatory Care Services 105 Tina Marie Evans History of Ambulatory Care Services 107 Reasons for the Expansion of Ambulatory Care 110 Hospital-Based Ambulatory Care 112 Non-Hospital-Based Ambulatory Care 114 Primary Care Management 120 Home Health Care Services 121 Hospice Services 124 Quality Assurance in Ambulatory Care 126 Summary 127 Discussion Questions 128 Chapter 6 Health Insurance and Payment for Health Care Services 131 Jeffrey R. Helton and Bernard J. Healey Basics of U.S. Health Insurance 134 History of Health Insurance 135 How Health Insurance Markets Work 138 Health Insurance Providers 139 Reimbursement for Health Care Providers 145 Why Health Insurance Is Such a Huge Problem in the United States 148 Creative Destruction of Health Insurance 149 Summary 152 Discussion Questions 153 Chapter 7 Managed Care 155 Bernard J. Healey Concepts of Managed Health Care 157 History of Managed Health Care 158 Types of Managed Care Plans 161 Managed Care Utilization Control 163 Managed Care Quality Issues 166 Managed Care and Prevention of Disease 168 Comparative Effectiveness Research 169 Future of Managed Health Care 172 Summary 174 Discussion Questions 176 Chapter 8 Long-Term Care 179 Tina Marie Evans The Aging of Americans 180 History of Long-Term Care 184 Organization of Long-Term Care 186 Payment for Long-Term Care Services 193 Chronic Diseases and Their Complications 198 Challenges for Long-Term Care in the Future 202 Summary 205 Discussion Questions 205 Chapter 9 Mental Health Care 209 Tina Marie Evans History of Mental Health 210 The Role of Stress 216 Types of Mental Illnesses 218 Mental Health Care Providers 226 Mental Health Parity 229 Summary 233 Discussion Questions 234 Chapter 10 Public Health Services 237 Bernard J. Healey History of Public Health 240 Structure of Public Health Departments 242 Determinants of Health 244 Core Functions of Public Health 247 Epidemiology and Public Health 248 Population-Based Health 250 Public Health Leadership 255 Future of Public Health 258 Summary 260 Discussion Questions 261 Part Three: Challenges in Health Care Delivery 265 Chapter 11 The Pursuit of Quality Care 267 Tina Marie Evans Origins of the Quality Movement 268 IOM Report on Medical Errors 274 IOM Report on the Quality Chasm 278 Quality Improvement Strategies 286 Medical Errors 292 Health Care-Associated Infections 293 Summary 296 Discussion Questions 297 Chapter 12 The Chronic Disease Epidemic 299 Bernard J. Healey Chronic Diseases and Their Complications 301 Costs of Chronic Diseases 307 Chronic Disease Prevention and Behavioral Changes 310 Applying Business and Other Models to Chronic Disease Prevention 311 Summary 318 Discussion Questions 319 Chapter 13 Leadership Solutions to Health Care Problems 323 Bernard J. Healey Health Care Reform Beyond the ACA 325 Reengineering the Health Care Sector 326 Understanding Power in the Health Care Sector 327 Changing the Health Care Environment 328 How Leaders Can Meet These Challenges 337 Summary 340 Discussion Questions 341 Chapter 14 Integrating Clinical Services and CommunityPrevention: The Community-Centered Health Home Model 345 Larry Cohen, Leslie Mikkelsen, Jeremy Cantor, Rea Pa~nares, Janani Srikantharajah, and Erica Valdovinos History of Clinical Services and Community Prevention Integration 346 Elements of the Community-Centered Health Home 354 Capacities Needed for Effective Implementation 365 Overarching Systems Change Recommendations 367 Summary 371 Discussion Questions 372 Chapter 15 A Look into the Future 375 Bernard J. Healey Major Challenges Facing Health Care Delivery 376 Areas of Future Concern 385 How to Meet These Challenges 389 Summary 396 Discussion Questions 397 Case Study 1 Innovation in Physician Leadership Education 401 Francis G. Belardi Case Study 2 Using Marketing Tools to Increase Early Referrals of Children with Developmental and Behavioral Disorders 405 Jeff Kile and Bernard J. Healey Case Study 3 Fall Reduction at Geisinger Wyoming Valley Medical Center: ''Above All, Do No Harm'' 409 Daniel J. Amorino Case Study 4 The VA Reinvents Itself 419 Joseph J. Marrone Index 427