Changing the u.s. Health Care System. Key Issues in Health Services Policy and Management

Description

The Fourth Edition of Changing the U.S. Health Care System addresses the key topics in health care policy and management, presenting evidence-based views of current issues. Each chapter is written by an expert in the field who integrates evidence to explain the current condition and presents support for needed change. The book examines all the levers in the setting and implementation of health policy, and includes extensive coverage of impact of the Affordable Care Act, particularly on Medicare, Medicaid, and large and small group insurance markets. Also new to this edition is expanded coverage of nursing, disease management, mental health, women's health, children's health, and care for the homeless.

Table of Contents

Figures and Tables
Foreword to the Third Edition
Foreword to the Fourth Edition
The Editor
The Authors
Introduction and Overview
Acknowledgments

PART ONE: ACCESS TO HEALTH CARE 1

1 The Patient Protection and Affordable Care Act of 2010 3
Gerald F. Kominski

• Learning Objectives 3
• Events Leading to the Enactment of the ACA 4
• Major Provisions of the ACA 7
• Future Directions 20
• Summary 25
• Key Terms 26
• Discussion Questions 28

2 Improving Access to Care 33
Ronald M. Andersen, Pamela L. Davidson, Sebastian E. Baumeister

• Learning Objectives 33
• Understanding Access to Health Care 34
• Future Directions 60
• Summary 63
• Key Terms 63
• Discussion Questions 64

3 Racial and Ethnic Disparities in Health Status 71
Antronette K. Yancey, Roshan Bastani, Beth A. Glenn

• Learning Objectives 71
• Epidemiology of Health Disparities 73
• Factors Underlying Chronic Disease-Related Disparities 82
• Future Directions 92
• Summary 94
• Key Terms 94
• Discussion Questions 95

4 Racial and Ethnic Disparities in Health Care 103
Arturo Vargas Bustamante, Leo S. Morales, Alexander N. Ortega

• Learning Objectives 103
• Definition of Disparity in Health Care 105
• Historical Overview of Disparities in Medical Care 109
• Scientific Evidence of Disparities in Health Care 115
• Future Directions 122
• Summary 125
• Key Terms 126
• Discussion Questions 126

5 Multilevel Social Determinants of Health 135
Ninez A. Ponce, Michelle Ko

• Learning Objectives 135
• Policy Frameworks for Social Determinants of Health 137
• Mechanisms by Which Social Context Affects Health Care 142
• Future Directions 147
• Summary 148
• Key Terms 149
• Discussion Questions 150

6 Public Health Insurance 157
Shana Alex Lavarreda, E. Richard Brown

• Learning Objectives 157
• Medicare, Medicaid, and CHIP 159
• Who is Left Out of Public Coverage? 169
• Enactment of the Affordable Care Act of 2010: A Political Success Story 179
• Future Directions 183
• Summary 183
• Key Terms 184
• Discussion Questions 185

7 Private Health Insurance 191
Nadereh Pourat, Gerald F. Kominski

• Learning Objectives 191
• Evolution of Private Health Insurance 192
• Concepts in Private Health Insurance 194
• Employment-Based Health Insurance 200
• Individually Purchased Health Insurance 207
• Significant Trends in Private Health Insurance 208
• Future Directions 213
• Summary 216
• Key Terms 216
• Discussion Questions 218

PART TWO: COST OF HEALTH CARE 223

8 Measuring Health Care Expenditures and Trends 225
Thomas H. Rice

• Learning Objectives 225
• Measuring Health Care Expenditures 226
• Trends in Health Care Expenditures 233
• Future Directions 239
• Summary 239
• Key Terms 242
• Discussion Questions 243

9 Containing Health Care Costs 245
Thomas H. Rice, Gerald F. Kominski

• Learning Objectives 245
• Framework 246
• Future Directions 263
• Summary 264
• Key Terms 264
• Discussion Questions 265

10 Promoting Pharmaceutical Access While Controlling Prices and Expenditures 269
Stuart O. Schweitzer, William S. Comanor

• Learning Objectives 269
• The Problem of Drug Expenditures 271
• Interpreting Pharmaceutical Price Data 275
• International Price Comparisons 279
• Determining Drug Prices 281
• Approaches for Containing Pharmaceutical Costs 289
• The Link Between Pharmaceutical Expenditures and Research 293
• Recent Events Surrounding Pharmaceutical Costs and Access 294
• Future Directions 298
• Summary 298
• Note 299
• Key Terms 299
• Discussion Questions 300

PART THREE: QUALITY OF HEALTH CARE 305

11 Measuring Health-Related Quality of Life and Other Outcomes 307
Patricia A. Ganz, Ron D. Hays, Robert M. Kaplan, Mark S. Litwin

• Learning Objectives 307
• Definition, Conceptualization, and Measurement of Quality of Life 310
• Contributions From the Literature 318
• Comparative Effectiveness Research 328
• Future Directions 331
• Summary 332
• Key Terms 333
• Discussion Questions 334

12 Evaluating the Quality of Care 343
Elizabeth A. McGlynn

• Learning Objectives 343
• The Multiple Dimensions of Quality 344
• Criteria for Evaluating Quality Measures 345
• A Conceptual Framework for Quality Assessment 347
• Structure 348
• Process 355
• Outcomes 365
• Future Directions 371
• Summary 372
• Key Terms 373
• Discussion Questions 374

13 Public Release of Information on Quality 381
Elizabeth A. McGlynn, John L. Adams

• Learning Objectives 381
• Public Information on Quality 383
• Some Methodological Issues in Performance Reporting 391
• What is Known About the Impact of Public Reporting? 402
• Future Directions 406
• Summary 406
• Key Terms 407
• Discussion Questions 408

14 Health Care Information Systems 413
Jeff Luck, Leah J. Vriesman, Paul Fu Jr.

• Learning Objectives 413
• Information Systems and Informatics 414
• Benefits, Implementation Barriers, and Federal Policy Responses 414
• Applications of Information Systems by Health Care Providers 417
• Public Health Informatics 434
• Applications of Information Systems by Health Plans and Payers 438
• Future Directions 441
• Summary 445
• Key Terms 445
• Discussion Questions 446

15 Performance Measurement of Nursing Care 455
Jack Needleman, Ellen T. Kurtzman, Kenneth W. Kizer

• Learning Objectives 455
• Why Measure Nursing Performance? 455
• The Scope of Nursing’s Contribution to Inpatient Hospital Care 457
• Issues in Constructing Nursing-Sensitive Performance Measures 461
• Measuring Nursing Performance 463
• Measuring Nursing Performance: The State of the Science 478
• Future Directions 485
• Summary 486
• Key Terms 487
• Discussion Questions 487

PART FOUR: SPECIAL POPULATIONS 493

16 Long-Term Services and Supports for the Elderly Population 495
Steven P. Wallace, Nadereh Pourat, Linda Delp, Kathryn G. Kietzman

• Learning Objectives 495
• Institutional Care 497
• Community-Based Services 502
• Informal Care 507
• Workers in the Long-Term Care System 509
• Future Directions 516
• Summary 517
• Note 517
• Key Terms 517
• Discussion Questions 518

17 HIV and AIDS in the Twenty-First Century 523
Erin G. Grinshteyn, William E. Cunningham

• Learning Objectives 523
• The Changing Epidemiology and Clinical Treatment of HIV/AIDS 525
• Prevention and Education 538
• Policy Implications and Research Needs for Management, Planning, and AIDS Policy 543
• Future Directions 546
• Summary 547
• Key Terms 548
• Discussion Questions 550

18 Children’s Health 559
Moira Inkelas, Neal Halfon, David Lee Wood

• Learning Objectives 559
• Special Health Needs of Children 561
• Health Service Delivery for U.S. Children 564
• Financing Children’s Health Care 569
• Improving the Child Health System 576
• Future Directions 585
• Summary 585
• Key Terms 586
• Discussion Questions 587

19 Homeless Persons 593
Lisa Arangua, Lillian Gelberg

• Learning Objectives 593
• A Profile of the Homeless 594
• Health Status 597
• Mental Illness and Substance Abuse 604
• Use of Physical Health Services 606
• Use of Mental Health and Substance Abuse Services 608
• Barriers to Health Care 609
• Future Directions 610
• Summary 612
• Key Terms 612
• Discussion Questions 613

PART FIVE: DIRECTIONS FOR CHANGE 621

20 Changing the Health Care Delivery System 623
Nadereh Pourat, Hector P. Rodriguez

• Learning Objectives 623
• Conceptual Framework: Intervention and Innovations to Correct System Failures 625
• Future Directions 641
• Summary 642
• Key Terms 642
• Discussion Questions 644

21 Medicare Reform 651
Gerald F. Kominski, Jeanne T. Black, Thomas H. Rice

• Learning Objectives 651
• Origin and Philosophy of Medicare 652
• Evolution of Medicare 656
• Is Medicare Facing a Crisis? 663
• Future Directions 670
• Summary 673
• Key Terms 674
• Discussion Questions 675

22 Public Health and Clinical Care 681
Jonathan E. Fielding, Lester Breslow, Steven M. Teutsch

• Learning Objectives 681
• Public Health’s Mission and Scope 682
• Prevention In Clinical Care Services 685
• Public Health and Provision of Clinical Care Services 689
• Direct Medical Service Delivery by Government 691
• Future Directions 692
• Summary 699
• Key Terms 700
• Discussion Questions 700

23 Strengthening the Safety Net 703
Dylan H. Roby

• Learning Objectives 703
• Defining the Safety Net 704
• Ensuring Access to Care for the Poor, Uninsured, and Underserved 705
• Financing the Safety Net 706
• Size and Scope of the Safety Net 707
• Reducing Costs 715
• Improving Quality 716
• Future Directions 719
• Summary 719
• Key Terms 720
• Discussion Questions 721

24 Ethical Issues in Public Health and Health Services 727
Pauline Vaillancourt Rosenau, Ruth Roemer, Frederick J. Zimmerman

• Learning Objectives 727
• Overarching Public Health Principles: Our Assumptions 730
• Ethical Issues in the Allocation of Resources 730
• Ethical Issues in Research 737
• Ethical Issues in Economic Support 738
• Ethical Issues in Management of Health Services 740
• Ethical Issues in Delivery of Care 741
• Future Directions 744
• Summary 745
• Key Terms 746
• Discussion Questions 747

Index 753

Author Information

Gerald F. Kominski, PhD, is professor, Department of Health Policy and Management in the UCLA Fielding School of Public Health, and director of UCLA Center for Health Policy Research. He is co-developer of the California Simulation of Insurance Markets (CalSIM) model currently being used to estimate eligibility and enrollment in health insurance exchanges in California and Hawaii.