The United States Health Care System \S COMBINING BUSINESS, HEALTH, AND DELIVERY SECOND EDITION Anne Austin, PhD, JD Vice Chancellor of Research, Planning & Assessment University of Arkansas Community College at Batesville Victoria Wetle, RN, EdD Retired Program Chair Health Services Management Chemeketa Community College Salem, Oregon Boston Columbus Indianapolis New York San Francisco Upper Saddle River Amsterdam Cape Town Dubai London Madrid Milan Munich Paris Montreal Toronto Delhi Mexico City Sao Paulo Sydney Hong Kong Seoul Singapore Taipei Tokyo
Contents Preface vii Acknowledgments Reviewers xiii xi PART ONE Overview and Payment 1 Health and Health Care in America: An Introduction 3 Introduction 4 Health and Health Care in the United States 4 The Health Care Industry 8 Health Care Policy 10 This Book's Approach 11 2 The Business Side of Health Care 15 Introduction 16 What Is Business? 17 The Health Care Industry', 20 The Impact of the Economy 20 The Role of Government 22 Integrating Business and Its Environment 2 5 3 The Payment Process: Insurance and Third-Party Payers 29 Introduction 30 What Is Health Insurance? 31 Who Is Insured? 31 How Does "Insurance" Work? 3 3 Types of Third-Party Payers 3 5 Regulation of Third-Party Payers 3 8 in
iv CONTENTS 4 The Payment Process: Government Payment Programs 41 Introduction 42 Medicare 43 Medicaid 45 SCHIP 47 Waste, Fraud, and Abuse 48 Programs for Special Populations 48 Workers' Compensation Insurance 49 Issues for Government Payment Programs 50 PART TWO Employment in Health Care 53 5 Health Care Providers: Physicians and Nurses 53 Introduction 55 The Physician's Role in Health Care Delivery 55 Types of Physicians and Medical Specialties 55 Characteristics of U.S. Physicians 57 Employment and Earnings of Physicians 57 Education and Training 58 Licensure and Certification 58 The Nurse's Role in Health Care Delivery 59 Characteristics of U.S. Nurses 60 : Types of Nurses 61 Education and Training 62 Licensure 63 Employment Options for Nurses 63 Issues in Health Care Delivery 65 6 Other Clinical and Non-Clinical Health Care Providers 69 Introduction 70 Office or Hospital Visit 71 Providers of Diagnostic Testing 73 Therapy Providers 75 Emergency Care Providers 77 Total Health Care Program 78 Health Care Employment in Non-Clinical Positions 80 Issues 82
CONTENTS PART THREE The Delivery Systems 81 7 Offices, Clinics, and Hospitals 87 Introduction 88 Providers' Offices and Clinics 89 Hospitals 93 8 The Long-Term Care Continuum 103 Introduction 104 Who Needs Long-Term Care? 105 Who Uses LTC? 105 Who Provides ETC Services? 107 ', How Do We Pay for LTC Services? Ill Ethical and Political Issues in LTC 112 9 Mental Health Services: A Combination of Systems 117 Introduction 118 What Is Mental Illness and Mental Health? 118 Scope of Mental Illness 119 \ Financing the System 120 Organizing the Mental Health System 121 History of Mental Health Care in the United States 122 Major Categories of Mental Illness 125 Ethical Issues in Mental Health 129 10 The Public Health System: The Government's Role 133 Introduction 134 What Is Public Health? 134 The History of Public Health 135 Key Public Health Functions 138 Role of Government in Public Health 140 Other Public Health Partners 143 Past Successes and Future Challenges 143 PART FOUR Health Care Industry and Issues 149 11 Medical Technology, Pharmaceuticals, and Pharmacological Research 149 Introduction 150
vi CONTENTS Medical Technology 150 ; Pharmaceuticals 155 i 12 Health Care Research and Prevention 167 Introduction 172 Health Care Research: A Pound of Cure 172, An Ounce of Prevention 175 13 Cultural Competency, Health Literacy, and Health Care^Ethics 185 Introduction 186 Culture and Health Care 186 Tools Used to Assess and Improve Health Literacy 191 Ethical Issues in Health Care 192 Justice and the Health Care System 193 14 International Health Care 201 Introduction 202 Health Care Delivery Systems 204 Mexico 204 Canada 205 India 207 Glossary 209 Index 217 : i