Healthcare Delivery in the U.S.A.: An Introduction, Second Edition

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Features

  • Explores how new health care reform will impact hospitals and health systems
  • Discusses new organizational structures driven by governmental mandates and initiatives
  • Includes examples to illustrate principles and concepts
  • Addresses topics critical to understanding the U.S. healthcare system including the quality of care movement and financing reform
  • Examines the global market including medical tourism

Summary

With the same clarity that made the previous edition a bestseller, Healthcare Delivery in the U.S.A.: An Introduction, Second Edition provides readers with the understanding required to navigate the healthcare provider field. Brilliantly simple, yet comprehensive, this updated edition explains how recent health care reform will impact hospitals and health systems. It includes updated case studies and describes the new organizational structures being driven by current market conditions.

Focusing on healthcare management, the book addresses the range of topics critical to understanding the U.S. healthcare system, including the quality of care movement, recent finance reform, and the recent increase in merger and acquisition activity.

Dr. Schulte walks readers through the history of the development of U.S. healthcare delivery. She describes the various venues of care delivery as well as the different elements of the financing system. Offering a glimpse into the global market and medical tourism, the text includes coverage of legal and regulatory issues, workforce, and the drivers and barriers that are shaping healthcare delivery around the world.

Painting a clear and up-to-date picture, this quick-and-easy read provides you with the understanding of the terminology, structures, roles, relationships, and nuances needed to interact effectively and efficiently with anyone in the healthcare provider field.

Table of Contents

History of the U.S. Healthcare Delivery System
Introduction
1750 to 1850—The Early Days
1850 to the Late Nineteenth Century—Shift from Care to Cure
1900 to the Mid-Twentieth Century—Era of Standardization
Mid-Twentieth Century to Twenty-First Century
Start of the Twenty-First Century
Summary
References
Websites

Health Status: The Health of the Population
Introduction
Health Status
Mortality
Morbidity
Obesity
Health Determinants
Summary
References
Websites

Components of the Healthcare Delivery System
Introduction
Who Are the Players in Healthcare Delivery?
     Healthcare Providers: Inpatient or Outpatient?
     Scope and Size of Hospitals
     Levels of Care
     Other Categorizations of Healthcare Service Levels
          Ambulatory Care
          Subacute Care
          Long-Term Care
          Home Healthcare
          Hospice Care
          Respite and Day Care
          Rehabilitation
          Emergency Services
          Mental Health and Substance Abuse
Summary
References
Websites

Structure of Healthcare Delivery
Introduction
Hospital Classifications
     Ownership
          Private Healthcare Entities
          Community and Voluntary Providers of Care
          Government/Public Hospitals and Clinics
     Tax Status: Taxed or Tax-Exempt
          Not-for-Profit
          For-Profit
     Geography
Types of Hospitals
     General Acute Care Hospitals
     Academic Medical Centers and Teaching Hospitals
     Specialty Hospitals
     Mental Health Hospitals
Hospital Operations
     The Structure of the Hospital-Physician Relationship
Integrated Delivery Networks
Summary
References
Websites

Doctors in the Healthcare Delivery Structure
Introduction
Physician Workforce
How Are Doctors Trained?
     Number of Medical Schools and Their Enrollments
     Typical Course of Study in Medical School
     Preclinical Curriculum/Basic Sciences
     Clinical Phase
     Licensing
     Graduate Medical Education: Becoming a Specialist
International Medical Graduates
Financial Support of Medical Education
How Doctors Work with Hospitals
The Physician’s Source(s) of Income
Malpractice
Physician Supply
Summary
References
Websites

Workforce: Nurses and Others
Introduction
Nursing
     Nursing Shortage
Registered Nurses
     Registered Nursing Education
     RN Licensing
     Advanced Practice Nurses
     Nurse Practitioners
     Clinical Nurse Specialists
     Licensed Practical Nurses
Physician Assistants
     Pharmacists
     Other Allied Health Professionals
     Radiology Technologists
     Physical, Occupational, and Speech Therapists
Other Allied Health Professionals
     Supporting Professionals
     Researchers
Shortage of Clinical Personnel in the United States
     Administrative Management Professionals
     Nursing Facility Administration
Summary
References

The Legal and Regulatory Environment
Introduction
     The Government as Regulator
The Legislature: Healthcare Statutes
     Hill–Burton
Medicare and Medicaid (Titles XVIII and XIX of the Social Security Amendments)
     Certificate of Need (1973)
     Prospective Payment (1982)
HMO Act (1973)
Emergency Medical Treatment and Active Labor Act (1986)
Stark Law—The Physician Self-Referral Act (Stark I—1989 and Stark II—1993)
HIPAA (1986)
Malpractice
Summary
References

Financing Healthcare
Introduction
How Much Does Healthcare Cost in the United States?
Medicare
Medicaid
     Federal/State Matching Funding
     Waivers
     Medicaid Managed Care
State Children’s Health Insurance Program
The Impact of PPACA on Medicaid and SCHIP
Other Governmentally Financed Healthcare Programs
     The VA
     Indian Health Services
The Private Sector in Healthcare Financing
     Employer Plans
     Managed Care Organizations
Fee for Service
PPACA: Health Reform
Summary
References

Quality
Introduction
Defining Quality
What Is the Problem with Healthcare Quality?
The Challenge of Quality and Safety in Healthcare Delivery
Standardization/Accreditation
     The Joint Commission
     DNV
     The National Committee for Quality Assurance
Quality Improvement Initiatives
     National Organizations and Agencies on Quality
          The National Quality Forum
          Centers for Medicare and Medicaid Services
          Quality Improvement Organizations
          Premier Hospital Quality Incentive Demonstration
          "Hospital Compare" Public Reporting of Performance Measures
          Never Events
     The Leapfrog Group
     The IHI and Pursuing Perfection
Payer Initiatives
Evidence-Based Medicine
The Medical Home
Tools for Quality Improvement
     Dashboards
     Benchmarking
Summary
References

Public Health
Introduction
Role of Public Health
History of Public Health Service
Public Health at the Federal Level
     Office of Public Health and Science
     The Office of the Surgeon General
U.S. Public Health Service Today
Summary
References

Technology: Medical and Information Technologies
Introduction
Medical Technology
Pharmaceuticals
     Clinical Trials Research
          Preclinical Research
     Basic Scientific Research
     Genomics
Information Technology
     Introduction
Why the HER?
EMR or EHR: Which Is It?
Components of the EHR
Health Information Exchange (HIE)
The Personal Health Record
Types of Information Systems in Healthcare
Challenges to IT Adoption
Summary
References

Author Bio(s)

Margaret F. Schulte, DBA, FACHE, CPHIMS, works independently, serving several organizations in various capacities. She is an instructor in Northwestern University’s Masters in Medical Informatics, adjunct faculty in the Masters in Health Administration at Penn State, editor of Frontiers of Health Services Management for the American College of Healthcare Executives, editor of Go-Live Smart Strategies from Davies Award-Winning EHR Implementations, and consultant to the Health Information and Management Systems Society for its Meaningful Use OneSource website. She previously served as vice president of education for the Healthcare Information and Management Systems Society (HIMSS), where she was responsible for the professional education programs of this membership association of IT professionals. In this role, she led the development of conference education for the society’s annual conference, which is attended by over 25,000 professionals, and she was responsible for global healthcare IT conferences in Europe and Asia and for other HIMSS education offerings in online and seminar formats.

Dr. Schulte held positions as vice president of research and development for the publishing division of the American Hospital Association and as director of education with the Healthcare Financial Management Association. She served on the faculty of the graduate program in Healthcare Policy and Management at Mercer University in Atlanta, Georgia, where she also served as adjunct faculty to the Mercer University School of Medicine. Previously, she held various management and executive positions in hospitals and in the governmental sector.

Dr. Schulte recently served as a commissioner with the Council for Accreditation of Healthcare Management Education (CAHME) and is on the advisory board of Main Stay Therapeutic Riding Program. She holds a doctorate in business administration from Nova Southeastern University, Fort Lauderdale, Florida, and a master’s in business administration from Xavier University, Cincinnati, Ohio. Dr. Schulte is a fellow in the American College of Healthcare Executives (FACHE) and holds the CPHIMS designation.

Editorial Reviews

Praise for the Bestselling First Edition:

This brief but remarkable book is balanced in its consideration of the history and scope of health care in the US today … The volume comes too late to be a factor in the 2009 congressional debate over health care reform. Although Schulte (Grand Valley State Univ.) avoids legislative recommendations, this work should have been required reading for every member of Congress and all lobbyists seeking to impose their own, more limited agendas before Congress took up the challenge … Everyone should read this book.
—D.R. Shanklin, University of Chicago, CHOICE, Vol. 47, No. 09, May 2010

Margaret Schulte provides a concise introduction to the history, issues, terminology and structure of a very complex and often unwieldy industry – healthcare. This book would be helpful for those early in their careers or transitioning in from other industries to help improve quality and processes. I certainly wish I had this guide when I was starting in healthcare.
—Mark Graban, Shingo Prize-winning author of Lean Hospitals

Because traditional approaches to health reform aren’t working, the business of medical care obviously needs new thinking from skilled professionals who can approach it from fresh perspectives. Many creative problem solvers from other industries would surely relish the opportunity to bring their insights to health care, but first they need to understand the industry and to speak its special language. Dr. Margaret Schulte has written the perfect book to bridge the gap. Healthcare Delivery in the U.S.A. is the resource that outsiders need to join the conversation and start teaching the medical sector lessons it must learn from other industries. The more non-health professionals who read this book, the sooner we’ll see efficiency and effectiveness in medical care.
—Jeff Bauer, Ph.D., Management Consulting Partner and Director of the Futures Practice, Affiliated Computer Services Healthcare Solutions, Author of Paradox and Imperatives in Health Care

I wish a book like this had been available when I entered health care.  In easy-to-understand terms, Dr. Schulte lays out the components of the healthcare system so those of us who enter can be oriented to the terms and to the various entities we will be encountering. As the level of complexity of the healthcare system continues to increase, books such as this can help us deconstruct the system into understandable components. As we know, in order to improve, we must first understand. Dr. Schulte helps us understand.
—Dean Bliss, Lean Improvement Specialist, Iowa Health System

Selling technology solutions to hospitals is challenging because it requires knowing what’s important to different people – patients, doctors, and employees – without any margin for error. Dr. Schulte’s book is 'Healthcare 101' for any sales professional striving to understand the healthcare industry. It couldn’t be more timely with the new economic stimulus package which includes $20 billion for healthcare IT.
—Linda Ewing, Regional Sales Director, Amcom Software