"Health care managers, practitioners, and students must both operate as effectively as they can within the daunting and continually evolving system at hand and identify opportunities for reform advances… Health Care Delivery in the United States has been an indispensable companion to those preparing to manage this balance. The present edition demonstrates once again why this volume has come to be so prized. It takes the long view – charting recent developments in health policy, and putting them side-by-side with descriptions and analysis of existing programs in the United States and abroad."

—Sherry Glied, PhD, Dean and Professor of Public Service, NYU Wagner, From the Foreword

This fully updated and revised 11th edition of a highly esteemed survey and analysis of health care delivery in the United States keeps pace with the rapid changes that are reshaping our system. Fundamentally, this new edition presents the realities that impact our nation’s achievement of the so-called Triple Aim: better health and better care at a lower cost. It addresses challenges and responses to the Affordable Care Act (ACA), the implementation of Obamacare, and many new models of care designed to replace outmoded systems. Leading scholars, practitioners, and educators within population health and medical care present the most up-to-date evidence-based information on health disparities, vulnerable populations, and immigrant health; nursing workforce challenges; new information technology; preventive medicine; emerging approaches to control health care costs; and much more.

Designed for graduate and advanced undergraduate students of health care management and administration and public health, the text addresses all of the complex core issues surrounding our health care system in a strikingly readable and accessible format. Contributors provide an in-depth and objective appraisal of why and how we organize health care the way we do, the enormous impact of health-related behaviors on the structure, function, and cost of the health care delivery system, and other emerging and recurrent issues in health policy, health care management, and public health. The 11th edition features the writings of such luminaries as Michael K. Gusmano, Carolyn M. Clancy, Joanne Spetz, Nirav R. Shah, Michael S. Sparer, and Christy Harris Lemak, among others. Chapters include key words, learning objectives and competencies, discussion questions, case studies, and new charts and tables with concrete health care data. Included for instructors is an Instructor’s Manual,
PowerPoint slides, Syllabus, Test Bank, Image Bank, Supplemental e-chapter on the ACA, and a transition guide bridging the 10th and 11th editions.

Key Features:

• Integration of the ACA throughout the text, including a supplementary e-chapter devoted to this major health care policy innovation
• The implementation of Obamacare
• Combines acute and chronic care into organizations of medical care
• Nursing workforce challenges
• Health disparities, vulnerable populations, and immigrant health
• Strategies to achieve the Triple Aim (better health and better care at lower cost)
• New models of care including accountable care organizations (ACOs), patient homes, health exchanges, and integrated health systems
• Emerging societal efforts toward creating healthy environments and illness prevention
• Increasing incentives for efficiency and better quality of care
• Expanded discussion of information technology
• A new 5-year trend forecast

Contents

LIST OF TABLES AND FIGURES

FOREWORD Sherry Glied

ACKNOWLEDGMENTS

ORGANIZATION OF THIS BOOK

CONTRIBUTORS

PART I: HEALTH POLICY

CHAPTER 1 THE CHALLENGE OF HEALTH CARE DELIVERY AND HEALTH POLICY

James R. Knickman and Anthony R. Kovner

Context

The Importance of Good Health to American Life

Defining Characteristics of the U.S. Health System

Major Issues and Concerns

Key Stakeholders Influencing the Health System

Organization of This Book

Discussion Questions

Case Study

Bibliography

CHAPTER 2 A VISUAL OVERVIEW OF HEALTH CARE DELIVERY IN THE UNITED STATES

Catherine K. Dangremond

The U.S. Health Care System: A Period of Change

The Shared Responsibility for Health Care

Where the Money Comes From, and How It Is Used

A Comparative Perspective

Population Health: Beyond Health Care

Access to Care and Variation in Health Outcomes

Health and Behavior

The Health Care Workforce

Variations in Health Care Delivery

Health Care Quality

Health Care Cost and Value

The Future of Health Care Delivery

References

CHAPTER 3 GOVERNMENT AND HEALTH INSURANCE: THE POLICY PROCESS

Michael S. Sparer and Frank J. Thompson

Context

The Government as Payer: The Health Insurance Safety Net

Government and Health Insurance: The Policy Process

Conclusion

Discussion Questions

Case Study

References

CHAPTER 4 COMPARATIVE HEALTH SYSTEMS

Michael K. Gusmano and Victor G. Rodwin

Overview

Health System Models

NHS and NHI Systems Compared With the United States

The Health Systems in England, Canada, France, and China

Lessons

Discussion Questions

Case Study

References

PART II: KEEPING AMERICANS HEALTHY

CHAPTER 5 POPULATION HEALTH

Pamela G. Russo

Context

The Population Health Model

The Medical Model

Comparing the Medical and Population Health Models

The Influence of Social Determinants on Health Behavior and Outcomes

Leading Determinants of Health: Weighting the Different Domains

Health Policy and Returns on Investment

Conclusion

Discussion Questions

Case Study

References

CHAPTER 6 PUBLIC HEALTH: A TRANSFORMATION FOR THE 21ST CENTURY

Laura C. Leviton, Paul L. Kuehnert, and Kathryn E. Wehr

Who’s in Charge of Public Health?

A Healthy Population Is in the Public Interest

Core Functions of Public Health

Governmental Authority and Services

Rethinking Public Health for the 21st Century

Discussion Questions

Case Study

References

CHAPTER 7 HEALTH AND BEHAVIOR

Elaine F. Cassidy, Matthew D. Trujillo, and C. Tracy Orleans

Behavioral Risk Factors: Overview and National Goals

Changing Health Behavior: Closing the Gap Between Recommended and Actual Health Lifestyle Practices

Changing Provider Behavior: Closing the Gap Between Best Practice and Usual Care

Conclusion

Discussion Questions

Case Study

References

CHAPTER 8 VULNERABLE POPULATIONS: A TALE OF TWO NATIONS

Jacqueline Martinez Garcel, Elizabeth A. Ward, and Lourdes J. Rodríguez

Understanding Vulnerable Populations and Their Context

The Growing Number of Vulnerable Populations

Organization and Financing of Health Care and Other Services for Vulnerable Populations

Social Service Needs

Federal and State Financing of Care for Vulnerable Populations

Challenges for Service Delivery and Payment

Emerging and Tested Ideas for Better Health Delivery

Conclusion

Discussion Questions

Case Study

References

PART III: MEDICAL CARE: TREATING AMERICANS’ MEDICAL PROBLEMS

CHAPTER 9 ORGANIZATION OF CARE

Amy Yarbrough Landry and Cathleen O. Erwin

Description of the Current Care Delivery System

The Future of the Delivery System

Best Practices

Looking Forward

Discussion Questions

Case Study

References

CHAPTER 10 THE HEALTH WORKFORCE

Joanne Spetz and Susan A. Chapman

Who Is Part of the Health Workforce?

Traditional Approaches to Health Workforce Planning

Health Workforce Education

Critical Issues for the Health Workforce

Conclusion: Building the Future Health Care Workforce

Discussion Questions

Case Study

References

CHAPTER 11 HEALTH CARE FINANCING

James R. Knickman

General Overview of Health Care Financing

What the Money Buys and Where It Comes From

How Health Insurance Works

How Providers Are Paid for the Health Services They Deliver

Specialized Payment Approaches Used by Payers

Issues Shaping the Future of Health Care Financing

Conclusion

Discussion Questions

Case Study

References

CHAPTER 12 HEALTH CARE COSTS AND VALUE

Thad Calabrese and Keith F. Safian

The Issue of Health Care Spending Growth

Conclusion

Discussion Questions

Case Study

References

CHAPTER 13 HIGH-QUALITY HEALTH CARE

Carolyn M. Clancy and Irene Fraser

Defining Quality

How Are We Doing?

How Do We Improve Quality?

How Do We Incentivize Quality Care?

What Are Major Recent Developments Affecting Quality?

Core Competencies for Health Administrators

Conclusion

Discussion Questions

Case Study

References

CHAPTER 14 MANAGING AND GOVERNING HEALTH CARE ORGANIZATIONS

Anthony R. Kovner and Christy Harris Lemak

Governing Boards and Owners

Management Work

Conclusion

Discussion Questions

Case Study

References

CHAPTER 15 HEALTH INFORMATION TECHNOLOGY

Nirav R. Shah

HIT Defined

The Backing of Government

Transformative Powers of HIT

HIT at the VA

The New York Experience

Implementing HIT

Challenges and Shortcomings of HIT

Toward the Future

Discussion Questions

Case Study

References

PART IV: FUTURES

CHAPTER 16 THE FUTURE OF HEALTH CARE DELIVERY AND HEALTH POLICY

James R. Knickman and Anthony R. Kovner

Dynamics Influencing Change

Aspects of the Health System That Are Set to Change by

Future Prospects for Different Stakeholders in the Health Enterprise

Conclusion

Discussion Questions

Case Study

Bibliography

APPENDIX Major Provisions of the Patient Protection and Affordable Care Act of 2010

GLOSSARY

INDEX