Introduction
Acknowledgments
About the Authors
About the Contributors
Part 1: Overview of Health Care Service Delivery
Chapter 1 Overview of Health Care Delivery in the United States
Health Care Costs
Demographic and Population Changes Within the United States
Health Care in Germany
Health Care in the United Kingdom
Health Care in Canada
Evidence-Based Healthcare
Technology and Healthcare Costs
Healthcare Access
Disparate Populations
Health Levels and Outcomes
Changing Patterns of Disease in the United States
Patient and Community Involvement in Healthcare
The Use of Technology to Improve Outcomes
Quality of Healthcare
Chapter 2 The Forces of Change in Health Care
The Consequences of Forty Years of Health Care Cost Escalation
Medicare and Medicaid
The Chronic Disease Epidemic
Health Care Reform
Cost-Benefit Analysis and Cost Effectiveness Research
Electronic Medical Records (EMRs)
Health Promotion and Disease Prevention
Part 2: The Major Players in Health Care Services
Chapter 3 Providers of Health Care Services
Primary Care Physicians and Primary Care Assistants
Primary Care Physicians
Primary Care Assistants
Specialty Care Providers
Dentists, Dental Hygienists, and Dental Assistants
Mental Health Care Providers
Psychiatrists
Psychologists
Mental Health Clinical Nurses
Psychiatric Nurse Practitioners
Social Workers
Nurses
Radiologic and Imaging Professionals
Allied Health Rehabilitation Professionals
Collaboration in Healthcare
Employment Trends in the Healthcare Sector
Chapter 4 Hospitals
The History of Hospitals
The Management of Hospitals
Staffing
Horizontal and Vertical Integration of Hospitals
Quality and Safety in Hospitals
Magnet Recognition Programs
Challenges and the Future
Chapter 5 Ambulatory Care Services
History of Ambulatory Care Services
Reasons for the Expansion of Ambulatory Care
Institutionally-Based (Hospital-Based) Ambulatory Care
Non-Institutionally Based Ambulatory Care
Freestanding Emergency Centers and Urgent Care Centers
Retail Clinics
Ambulatory Surgery Centers
Primary Care Management
Home Health Care Services
Hospice
Working Towards Quality Assurance in Ambulatory Care
Chapter 6 Health Insurance
The Basics of Health Insurance in the United States
History of Health Insurance
How Health Insurance Markets Work
Blue Cross/Blue Shield
Medicare
Medicaid and the CHIP Program
State Health Insurance Exchanges
Reimbursement for Health Care Providers
Fee-For-Service
Capitation
Resource Based Relative Value Scale (RBRVS)
Pay for Performance (P4P)
Why Is Health Insurance Such a Large Problem in the United States?
The Creative Destruction of Health Insurance
Chapter 7 Managed Care
Concepts of Managed Care
History of Managed Health care
Types of Managed Care Plans
Health Maintenance Organizations (HMO)
Independent Practice Associations (IPA)
Preferred Provider Organizations (PPO)
Managed Care Utilization Control
Quality Issues in Managed Care
Managed Care Plans and Prevention of Disease
Comparative Effectiveness Research
Future of Managed Healthcare
Consumer Responsibility
Centers of Value
Prime Role For Primary Care
Chapter 8 Long-Term Care
The Aging of Americans
History of Long-Term care
Organization of Long-Term Care
Payment for Long-Term Care Services
Chronic Diseases and Their Complications
Challenges for Long-Term Care
Chapter 9 Mental Health Care
History of Mental Health
The Role of Stress
Types of Mental Illness
Psychotic Disorders
Non-Psychotic Disorders
Mood Disorders
Mental Health Parity
Chapter 10 Public Health Services
History of Public health
Structure of Public Health Departments
Determinants of Health
Health Disparities
Communicable and Chronic Disease Control
Core Functions of Public Health
Epidemiology and Public Health
Population-Based Health
Healthy People 2020
Health Promotion Programs
Public Health Leadership
The Future of Public Health
Part 3: Challenges in Health Care Delivery
Chapter 11 The Pursuit of Quality Care
Origins of the Quality Movement in Health Care Delivery
Institute of Medicine Report on Medical Errors (1999)
Institute of Medicine Report on the Quality Chasm
Quality Improvement Strategies
Medical Errors
Healthcare-Associated Infections
Chapter 12 The Chronic Disease Epidemic
Chronic Diseases and Their Complications
Heart Disease
Cancer
Stroke
Diabetes
Obesity as a Common Element in Chronic Diseases
The Costs of Chronic Diseases
Prevention and Changes to Behavioral Patterns
Applying Business and Other Models to the Prevention of Chronic Diseases
Prevention of Chronic Diseases
The Chronic Care Model
Business Models Applied to Chronic Diseases
Chapter 13 The Need for Leadership to Solve the Problems in Healthcare
Healthcare Reform
Reengineering the Healthcare Sector
Power in Healthcare
The Changing Healthcare Environment
Leadership
Trust
Outcomes
Prevention of Disease
Costs of Providing Healthcare
The Need to Empower Healthcare Employees
The Importance of the Organizational Structure in Healthcare
The Need for Innovation in Healthcare
Leadership As the Way to Meet These Challenges
Chapter 14 Integrating Clinical Services and Community Prevention: The Community-Centered Health Home Model
History of Clinical Services and Community Prevention Integration
The Importance of Community Prevention
Elements of the Community-Centered Health Home
Inquiry Elements
Aggregate Symptoms and Diagnosis Prevalence Data
Analysis Elements
Systematically Review Health and Safety Trends
Identify Priorities and Strategies With Community partners
Action Elements
Coordinate Activity with Community Partners
Advocate for Community Health
Mobilize Patient Populations
Strengthen Partnerships With Local Health Care Organizations
Establish Model Organizational Practices
Capacities Needed for Effective Implementation
Staff Training and Continuing Education
A Dedicated and Diverse Team
Innovative Leadership
Overarching Systems Change Recommendations
Structure Health Care Payment Systems to Support Community Prevention Activity
Align Data and Measurement Across Sectors
Strengthen and Utilize Networks Train Health Professionals to Work in CCHHs
Resources and Opportunities
Chapter 15 A Look into the Future
The Major Challenges Facing Healthcare Delivery
Physician Shortages
Quality of Healthcare Services
The Chronic Disease Epidemic
Pharmaceuticals
Medical Malpractice
Fraud and Waste in Healthcare Delivery
Accountable Care Organizations
Areas of Future Concern
Saving Medicare and Medicaid
Consolidation of Players
Strategies for Physician Employment
Health Policy Process
How To Meet These Challenges
Health Education Programs As a Potential Solution to Our Health Problems
Leadership Versus Management in Healthcare Services Delivery
Retail Clinics
Incentives Matter in the Health Care Sector
Case Study 1 Innovation in Physician Leadership Education
Case Study 2 The Use of Marketing Tools to Increase the Rate of Early Referrals to Physicians of Children With Developmental and Behavioral Disorders
Case Study 3 Fall Reduction at Geisinger Wyoming Valley Medical Center “Above All, Do No Harm”
Case Study 4 Reengineering Healthcare Delivery to Focus on Health Outcomes
Case Study 5 The Veterans Administration Re-Invents Itself