Our Unsystematic Healthcare System

A comprehensive and critical introduction to the U.S. healthcare system

Our Unsystematic Healthcare System presents readers with a comprehensive overview of the U.S. healthcare system with an emphasis on change. It opens with a comparison of U.S. life expectancy and national expenditures with those of other economically advanced countries. The chapters that follow outline the different sectors of the healthcare system including public health, physician and hospital networks, private and public health insurance plans, and the pharmaceutical industry. The book’s conclusion considers forces outside of the healthcare system that play a role in determining Americans’ health status and longevity. Our Unsystematic Healthcare System is the ideal book for introducing readers to the basics of the complex U.S. healthcare system in an accessible way.

New to this Edition:

• New chapter on public health outlines public health origins, workings, and achievements to give students the background needed to discuss current crises such as COVID-19 and the overturning of Roe v Wade (Chapter 2)
• New chapter on the pharmaceutical industry explores drug development, advertising, and legislation to explore why the cost of drugs is so high (Chapter 7)
• New chapter on the social determinants of health considers the World Health Organization's view that neither behavior nor healthcare arrangements are primarily responsible for people’s health (Chapter 9)

Preface

1 Introduction

2 Public Health

Public Health and Controversy

Public Health Origins and Development

State and Local Public Health Agencies

Non-Governmental Public Health

Public Health Accomplishments

Efficacy of the COVID Vaccine

A Recent Special Case

Another Recent Case

3 Private Health Insurance

Origins of Private Health Insurance

From a Community Rate to Risk Rating

From Prepaid Care to Health Maintenance

The Affordable Care Act

The Individual Mandate

The Employed Mandate

Health Insurance and Prices

Legislation Aimed at Health System Reform

4 Health Insurance – Public Programs

Origins of Medicare and Medicaid

Medicare

Part A

Part B

Part D

Part C – Medicare Advantage Plans

Medicare Advantage Business Operations

Medicaid

The ACA and Reform

Public Opinion and Medicaid

Medicaid and Managed Care

State Child Health Insurance Program

Continuing Policy Debates

5 Health Care Occupations

The Medical Profession

Medical Specialization

The Medical Education System

The Organization of Medical Practice

How Physicians Get Paid

Medical Professionalism

Medical Error and Malpractice

Nurses

Therapists

Technicians and Technologists

Other Practitioners

Administrators and Other Administrative Workers

6 Hospital and Other Healthcare Organizations

A Brief History of the Modern Hospital

Growth and Development

Rising Costs of Care

The Shorter Length of Stay

Hospitals and Quality of Care

Growth of the For-Profit Hospital Sector

Consolidation of Nonprofit Hospitals

The Chargemaster

Differences by Hospital Ownership

Other Healthcare Organizations

Initiatives Aimed at Reducing Costs

7 Pharmaceuticals

Steps Involved in Creating a Drug

Generic Drugs

Orphan Drugs

Pharmacy Benefit Managers

Getting Drugs to Market Sooner

Pharmacies

Pharmaceutical Companies and the COVID-19 Vaccine

Why Drugs Are So Expensive

Where Things Stand in Trying to Control Costs

8 Healthcare Systems in Other Countries

Canada

England

Switzerland

Japan

Spain

France

Germany

More On International Comparisons

Some Final Observations

9 Determinants of Health

Education and Inequality

Deaths of Despair

Health Disparities and Race

Social Support Networks

Upstream Versus Downstream Intervention

Final Thoughts

Addendum