Wiley Pathways Introduction to U.S. Health Care, 1st Edition
November 2006, ©2007
Where do you want to go? You might already be working in a health care or business setting. You may be looking to expand your skills. Or, you might be setting out on a new career path.
Wherever you want to go, Introduction to U.S. Health Care will help you get there. Easy-to-read, practical, and up-to-date, this text not only helps you learn fundamental concepts of the American health care system; it also helps you master the core competencies and skills you need to succeed in the classroom and beyond. The book's brief, modular format and variety of built-in learning resources enable you to learn at your own pace and focus your studies.
With this book, you will be able to:
* Understand the role of governing boards and the challenges they face.
* Compare and contrast the primary-care and specialty-care models.
* Explore recent health care reforms that affect the primary-care model.
* Examine how we pay for health care.
* Learn about the many different roles played by the health care workforce.
* Discover how medical miracles are financed.
* Trace the evolution of hospitals throughout the nation's history and through their current state.
* Assess the reasons behind the growing reliance on ambulatory care.
* Understand who needs long-term care, why, and what the choices are.
* Explore the challenges of providing health services for society's most vulnerable groups.
* Identify obstacles in caring for the uninsured.
* Examine the types of managed care organizations, such as HMOs, PPOs, and POS plans.
* Explore current and future challenges for the health care industry.
* Understand the impact of new and emerging laws, regulations, and initiatives.
Wiley Pathways helps you achieve your goals
When it comes to learning about health care, not everyone is on the same path. But everyone wants to succeed. The new Wiley Pathways series in Health Care Management helps you achieve your goals with its brief, inviting format, clear language, and focus on core competencies and skills.
The books in this series--Introduction to U.S. Health Care, Health Care Economics, Health Care Management, and Health Care Law and Ethics--offer a coordinated curriculum for learning health care management. Learn more at www.wiley.com/go/pathways.
Part I: Foundations 1
1 The U.S. Health Care System 1
1.1 Gauging the Size of the Health Care Industry 2
1.2 Balancing Public and Private Health: Health Care Organizations 4
1.3 Identifying Health Systems 9
1.4 Classifying Health Care Industry Sectors 11
1.5 Defining Health and Disease 15
1.6 Accessing Health Services in the United States 19
Key Terms 23
Summary Questions 25
Review Questions 27
Applying This Chapter 28
You Try It. 29
2 Boards and Governance 30
2.1 Understanding the Role of Governing Boards 31
2.2 Board Composition, Structure, and Infrastructure 35
2.3 Challenges Facing Boards 39
Key Terms 41
Summary Questions 44
Review Questions 44
Applying This Chapter 45
You Try It. 46
Part II: Health Care Organization and Financing 47
3 Health Care Provision 47
3.1 Health Provision at a Glance: Specialty-Care versus Primary-Care 48
3.2 Primary Care Reforms in the United States 50
3.3 Performance of the Primary Care Model in the United States 52
3.4 Primary Care Innovations 55
3.5 Identifying the PCP 57
3.6 PCPs and the Populations They Serve 60
Key Terms 64
Summary Questions 66
Review Questions 68
Applying This Chapter 72
You Try It.73
4 Financing the U.S. Health Care System 74
4.1 Changing Economic Dynamics 75
4.2 Flow of Funds through the System 80
4.3 Examining Who Has Health Insurance 84
4.4 Categorizing Health Insurance Plans 87
4.5 Private Insurance Coverage: Voluntary Health Insurance (VHI) 92
4.6 Government Insurance Programs: Medicare and Medicaid 94
4.7 Health Maintenance Organizations (HMOs) 99
Key Terms 102
Summary Questions 104
Review Questions 107
Applying This Chapter 108
You Try It 109
Part III: Health Care Resources 110
5 The Health Care Workforce 110
5.1 Sizing Up the Workforce 111
5.2 Understanding the Role of the Physician 114
5.3 Training Doctors 118
5.4 Nurses 121
5.5 Other Independent Health Professionals 125
5.6 Working in Concert with Physicians 129
Key Terms 132
Summary Questions 135
Review Questions 137
Applying This Chapter 139
You Try It 140
6 Research and Technology 141
6.1 Understanding Medical Research 142
6.2 Research Facilities 149
6.3 Funding Research: Knowing Where the Money Comes From 153
6.4 Assessment and Challenges of Continuing Medical Advancement 155
Key Terms 158
Summary Questions 159
Review Questions 161
Applying This Chapter 162
You Try It 164
Part IV: The Health Care Delivery System 165
7 Hospitals in the U.S. 165
7.1 The Evolution of Hospitals in the U.S 166
7.1.1 Forming Hospitals: the Refuge Stage 166
7.2 Components and Cost of American Hospitals 170
7.3 Classifying Hospitals 173
7.4 Care and Competition in the Twenty-First Century 177
Key Terms 180
Summary Questions 182
Review Questions 183
Applying This Chapter 184
You Try It 185
8 Ambulatory Care 186
8.1 Understanding Ambulatory Care 187
8.2 Ambulatory Care Settings and Providers 191
8.3 Home Health and Visiting Nurse Agencies. 197
Key Terms 200
Summary Questions 201
Review Questions 202
Applying This Chapter 204
You Try It 205
9 Long-Term Care 206
9.1 Understanding Long-Term Care 207
9.2 Personal Care Facilities 209
9.3 Community-Based and Home Health Care 214
9.4 Rehabilitation Centers 218
9.5 Hospice Care 219
Key Terms 222
Summary Questions 225
Review Questions 226
Applying This Chapter 227
You Try It 229
10 Caring For Special Populations 230
10.1 Caring For Mentally Ill Patients 231
10.2 Homeless Patients 239
10.3 Veterans 241
10.4 Immigrants 243
10.5 Caring For Other Special Populations 245
Key Terms 247
Summary Questions 249
Review Questions 251
Applying This Chapter 251
You Try It 253
11 Caring For Uninsured Patients 254
11.1 Identifying Uninsured Patients 255
11.2 Accessing Health Care When Uninsured 257
11.3 Challenges in Providing Health Care to Uninsured Patients 260
11.4 Legal Issues and Uninsured Patients 263
Key Terms 264
Summary Questions 266
Review Questions 267
Applying This Chapter 267
You Try It 268
12 Managed Care 269
12.1 Understanding Managed Care 270
12.2 Types of Managed Care Organizations 273
12.3 Assessing the Performance of Managed Care 276
Key Terms 279
Summary Questions 281
Review Questions 282
Applying This Chapter 284
You Try It 285
Part V: Challenges Of US Health Care 286
13 Promoting Health And Preventing Disease 286
13.1 Growing Complexity of the U.S. Health Care System 287
13.2 Financing Health Care 290
13.3 Aging Population 294
13.4 Challenges for Primary Care 296
13.5 Examining The Underserved: Rural and Inner-City Areas 302
13.6 Fixing the Problem of the Underserved 305
13.7 Other Challenges 309
Key Terms 311
Summary Questions 313
Review Questions 315
Applying This Chapter 316
You Try It 318
14 Public Health Policy 319
14.1 Public Health Services 320
14.2 Federal and State Health Laws 328
14.3 Assessing U.S. Health Policy 330
14.4 Comparing U.S. Health Care to Health Care in Other Countries 332
Key Terms 335
Summary Questions 336
Review Questions 337
Applying This Chapter 338
You Try It 340
- Pre-test: Pre-reading assessment tool in multiple-choice format. Introduces chapter material and helps students get an idea of what they know and where they need to focus their efforts.
- What You ll Learn in this Chapter and After Studying this Chapter: Presents the subject matter that the student will learn and emphasizes capabilities and skills students will build.
- Goals and Outcomes. These lists identify specific student capabilities that will result from reading the chapter. They help the student set expectations and show them what to reach for.
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- Key Terms and Glossary: A convenient list of all terms that appear in boldfaced throughout the chapter are listed at the end of the chapter and in the glossary.
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- Applying this Chapter Questions drive home key ideas by asking students to combine and apply chapter concepts to new, real-life situations and scenarios.
- You Try It! Questions encourage students to draw conclusions using chapter material applied to real-world situations, which promotes both mastery of the content and independent learning.
- Post-test should be taken after students have completed the chapter. It includes all of the questions in the pre-test, so that students can see how their learning has progressed and improved.
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