Anthony R. Kovner, PhD James R. Knickman, PhD. Editors. Steven Jonas, MD, MPH, MS. Founding Editor. i SPRINGER/ PUBLISHING COMPANY New York
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1 Anthony R. Kovner, PhD James R. Knickman, PhD Editors Steven Jonas, MD, MPH, MS Founding Editor i SPRINGER/ PUBLISHING COMPANY New York
2 Tables and Figures xi Foreword by Donald M. Berwick, MD, MPP xv Organization of This Book xix Contributors xxi ^ 1 0 ER DEW; THE STATE OF HEALTH CARE DELD ERY DN THE UNDTED STATES 2 James R. Knickman and Anthony R. Kovner O Defining Characteristics of the U.S. Health Care System 4 O Major Issues and Concerns 7 O Prospects for Change and Improvement 9 O The Importance of Engagement at the Ground Level 10 SUPPLEMENT: KEY CHARTS 13 Victoria Weisfeld O Good News About the U.S. Health Care System 14 O Influences on Health 16 O Getting the Preventive Care We Need 18 O The Changing U.S. Population 22 O Quality Versus Costs of Care 24 O Oral Health Care 26 O The Impact of Mental Disorders 28
3 VI Contents O Costly Medical Conditions 30 O Dissatisfaction With the U.S. Health Care System 32 2 MEASURING HEALTH STATUS 34 Mary Ann Chiasson and Steven Jonas 0 Quantitative Perspectives 37 O Understanding Numbers and Rates 40 O Census Data 41 O Vital Statistics 42 O Morbidity 46 O Health Status and Health-Related Behavior 49 O Utilization and Cost of Health Care Services 50 O Conclusion 53 3 FINANCING HEALTH CARE 56 Kelly A. Hunt and James R. Knickman O What the Money Buys 59 O How We Pay for Health Care 61 O Reimbursement Approaches 73 O Current Policy Issues 76 O Conclusion 79 4 PUBLIC HEALTH: POLICY, PRACTDCE, Laura C. Leviton, Scott D. Rhodes, and Carol S. Chang O Public Health Every Day 86 Who Is in Charge of Public Health? 90 O Defining Characteristics of Public Health 91 O Core Functions of Public Health 99 O Governmental Authority for Public Health 103 O Challenges and Opportunities 113 THE ROLE OF GOVERNMENT IN U.S. HEALTH CARE 126 Michael S. Sparer O The Government as Payer: The Health Insurance Safety Net 129 O The Government as Regulator 140 O The Government as Health Care Provider 144 O Key Issues on the Health Care Agenda 148
4 Contents VII Victor G. Rodwin O The Evolution of Health Systems and Policy in Wealthy Nations 154 O Overview of Health System Models 156 O Comparative Analysis of Health Systems 159 O Common Problems of Health Care Organization and Policy in Three Nations 164 O The U.S. Health System in Comparative Perspective 174 O New Approaches to Comparing Health Systems 179 O Conclusion Marc N. Gourevitch, Carol A. Caronna, and Gary E. Kalkut O The History of Acute Care 192 O Kinds of Acute Care Today 194 O Hospitals in the United States 200 O Current Issues in Acute Care 212 O Future Challenges 217 CARE 220 Gerard F. Anderson and James R. Knickman O Definition of and Prevalence of Chronic Conditions 223 O Chronic Conditions and Activity Limitations 225 O Paying for Chronic Care 226 O Dissatisfaction With the Current System 227 O The Evolving Health Care System 230 O International Trends 236 O Conclusion Penny Hollander Feldman, Pamela Nadash, and Michal D. Gursen O Long-Term Care Needs and Demands 241 O Costs and Financing of Long-Term Care 242
5 VIII Contents O The Goals of Long-Term Care 246 O Providers of Long-Term Care 246 O Challenging Issues 255 O Conclusion HEALTH-RELATED BEHAVIOR 266 C. Tracy Orleans and Elaine F. Cassidy O Behavioral Risk Factors: Overview and National Goals 269 O Changing Health Behavior 274 O Changing Provider Behavior 287 O Conclusion 294 Robin J. Strongin, Ron Geigle, and Victoria A. Wicks O Pharmaceuticals 300 O Biologic Products 313 O Medical Devices: Brief Overview 313 O Conclusion THE HEALTH CARE WORKFORCE 320 Carol S. Brewer and Thomas C. Rosenthal O Supply and Demand Factors 324 O Types of Health Care Workers 335 O Medical Practice 336 O Nursing Practice 339 O Mid-Level Professionals 342 O Other Health Care Workers 344 O Allied Health Professionals 346 O Health Care Workforce Issues 348 O Conclusion DNFORMATIQN MANAGEMENT 356 Roger Kropf O Improving Clinical Quality Through Information Technology 361 O Information Technology's Benefits for Patients 368 O Information Technology's Role in Controlling Health Care Costs 370 O Speeding Adoption of Health Care Information Technology 373 O Conclusion 379
6 Contents IX GOVERNANCE, MANAGEMENT, AND ACCOUNTABILITY 382 Anthony R. Kovner O Governance as a Process for Decision Making 384 O Measuring Organizational Performance 386 O Ownership of Health Care Organizations 387 O Current Governance Issues 392 O Management 394 O Managerial Work in Health Care Organizations 397 O Current Management Issues 399 O Accountability 402 O Conclusion THE COMPLEXITY OF HEALTH CARE QUALITY 408 Douglas S. Wakefield and Bonnie J. Wakefield O Health Care Quality: Fundamentals 411 O Complexity and the Health Care Quality Challenge 412 O Defining Quality of Health Care: Patients Versus Populations 414 O Pay for Performance (P4P): Make the Business Case for Quality 423 O Risk-Adjusted Quality Outcomes 427 O Trends in Quality Assessment 429 O Strategies for Managing Quality in the Health Care Zone of Complexity ACCESS TO CARE 444 John Billings and Joel C. Cantor O Economic Barriers to Care 448 O Noneconomic and Quasi-Economic Barriers to Care 454 O Noneconomic and Quasi-Economic Barriers: Preventable Hospitalizations 460 O Health Care Reform: Improving Access 464 O The Future: Continuing and Emerging Issues 470
7 Contents COSTS AND VALUE 478 Steven A. Finkler and Thomas E. Getzen O The Problem: Rising Costs 480 O Why Do Costs Rise? 483 O Cost to Whom and for What? 488 O Potential Solutions to Rising Health Care Costs 491 O Dilemmas: Spending Is a Political Act 502 O Conclusion 504 THE FUTURE QJF HEALTH CARE DELIVERY IN THE UNITED STATES 508. James R. Knickman and Anthony R. Kovner O Forecasting: Definition and Approaches 510 O Forecasting Methods 513 O Drivers of Change in the New Millennium 513 O Where Change Is Likely to Occur 517 O Conclusion 522 APPENDIX A: GLOSSARY 527 Anthony R. Kovner APPENDIX B: A GUIDE Tp SOURCES OF DATA 541 Jennifer A. Nelson and Mary Ann Chiasson APPENDIX C: USEFUL HEALTH CARE WEB SITES 557 Kelli A. Hurdle INDEX 571
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