The United States Health Care System COMBINING BUSINESS, HEALTH, AND DELIVERY THIRD EDITION Anne Austin^PhD, JD Vice Chancellor of Research, Flanning & Assessment University of Arkansas Community College at Batesville Victoria Wetle, RN, EdD Retired Program Chair Health Services Management Chemeketa Community College Salem, Oregon PEARSON Boston Columbus Hoboken Indianapolis New York San Francisco Amsterdam CapeTown Dubai London Madrid Milan Munich Paris Montreal Toronto Delhi Mexico City Säo Paulo Sydney HongKong Seoul Singapore Taipei Tokyo
Contents Preface vii Acknowledgments Reviewers xii Photo Credits xiii xi PART ONE Overvieiv and Payment 3 1 Health and Health Care in America: An Introduction 3 Introduction 4 Health and Health Care in the United States 5 The Health Care Industry 8 Health Care Policy 11 This Book's Approach 13 2 The Business Side of Health Care 17 Introduction 18 What Is Business? 19 The Health Care Industry 23 The Impact of the Economy 2 3 The Role of Government 26 Integrating Business and Its Environment 29 3 The Payment Process: Insurance and Third-Party Payers 3 3 Introduction 34 What Is Health Insurance? 35 Who Is Insured? 36 How Does "Insurance" Work? 37 Types of Third-Party Payers 39 Regulation of Third-Party Payers 43 III
IV CONTENTS 4 The Payment Process: Government Payment Programs 47 Introduction 48 Medicare 49 Medicaid 51 CHIP 53 Waste, Fraud, and Abuse 54 Programs for Special Populations 55 Workers' Compensation Insurance 56 Issues for Government Payment Programs 56 PART TWO Employment in Health Care 61 5 Health Care Providers: Physicians and Nurses 61 Introduction 62 The Physicians Role in Health Care Delivery 63 Types of Physicians and Medical Specialties 64 Characteristics of U.S. Physicians 65 Employment and Earnings of Physicians 66 Education and Training 67 Licensure and Certification 67 The Nurse's Role in Health Care Delivery 68 Characteristics of U.S. Nurses 70 Types of Nurses 70 Education and Training 72 Licensure 72 Employment Options for Nurses 73 Issues in Health Care Delivery 75 6 Other Clinical and Non-Clinical Health Care Providers 79 Introduction 80 Office or Hospital Visit 82 Providers of Diagnostic Testing 83 Therapy Providers 86 Emergency Care Providers 88
CONTENTS V Total Health Care Program 89 Health Care Employment in Non-Clinical Position: 92 Issues 94 PART THREE The Delivery Systems 99 7 Offices, Clinics, and Hospitals 99 Introduction 101 Providers' Offices and Clinics 102 Hospitals 106 8 Aging in America 117 Introduction 118 LTC 119 Who Needs Long-Term Care? 119 Who Uses LTC? 120 Who Provides LTC Services? 123 How Do We Pay for LTC Services? 128 Ethical and Political Issues in LTC 128 9 Mental Health Services: A Combination of Systems 135 Introduction 136 What Is Mental Illness and Mental Health? 137 Scope of Mental Illness 137 Financing the System 138 Organizing the Mental Health System 139 History of Mental Health Care in the United States 141 Major Categories of Mental Illness 144 Ethical Issues in Mental Health 149 10 The Public Health System: The Government's Role 155 Introduction 156 What Is Public Health? 157 The History of Public Health 158 Key Public Health Functions 161
VI CONTENTS Role of Government in Public Health 165 Other Public Health Partners 167 Past Successes and Future Challenges 168 PART FOUR Health Care Industry and Issues 115 11 Medical Technology, Pharmaceuticals, and Pharmacological Research 175 Introduction 176 Medical Technology 178 Pharmaceuticals 182 12 Health Care Research and Prevention 193 Introduction 197 Health Care Research: A Pound of Cure 199 An Ounce of Prevention 205 13 Cultural Competency, Health Literacy, and Health Care Ethics 217 Introduction 218 Culture and Health Care 219 Tools Used to Asses: and Improve Health Literacy 224 Ethical Issues in Health Care 225 Justice and the Health Care System 227 14 International Health Care 237 Introduction 239 Health Care Delivery Systems 239 Mexico 241 Canada 242 India 243 Glossary 249 Index 257