You can get there 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.

Table of Contents:
Part I: Foundations 1 1 The U.S Health Care System 1 Introduction 2 1.1 Gauging the Size of the Health Care Industry 2 Self-Check 4 1.2 Balancing Public and Private Health: Health Care Organizations 4 1.2.1 Protecting Populations: Public Health Care Organizations 5 1.2.2 Serving Individuals: Private Health Care Organizations 5 Self-Check 8 1.3 Identifying Health Systems 9 1.3.1 Types of Health Systems 9 1.3.2 Forming Health Systems 10 Self-Check 11 1.4 Classifying Health Care Industry Sectors 11 1.4.1 Financing 11 1.4.2 Institutional Providers 12 1.4.3 Individual Providers 12 1.4.4 Public Health Agencies 13 1.4.5 Enablers 13 1.4.6 Suppliers 13 1.4.7 Regulators 13 Self-Check 14 1.5 Defining Health and Disease 15 1.5.1 Causes of Disease 15 1.5.2 Analyzing U.S Health and Disease Status 16 Self-Check 18 1.6 Accessing Health Services in the United States 19 1.6.1 Triggers to Utilizing the Health Care System 19 1.6.2 Factors Affecting Utilization 20 1.6.3 The Role of Health Services Administration Research 21 Self-Check 23 Summary 23 Key Terms 23 Summary Questions 25 Review Questions 27 Applying This Chapter 28 You Try It 29 2 Boards and Governance 30 Introduction 31 2.1 Understanding the Role of Governing Boards 31 2.1.1 Determining Mission, Vision, and Values 32 2.1.2 Ensuring Management Performance 33 2.1.3 Ensuring Quality of Care 34 2.1.4 Ensuring Financial Health 34 Self-Check 35 2.2 Board Composition, Structure, and Infrastructure 35 2.2.1 Health Systems 36 2.2.2 Hospitals 37 Self-Check 38 2.3 Challenges Facing Boards 39 2.3.1 Liability of Board Members 39 2.3.2 Reporting and Disclosure of Accounting Information 40 2.3.3 Conflict of Interest 40 2.3.4 Board Performance 41 Self-Check 41 Summary 41 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 Introduction 48 3.1 Health Provision at a Glance: Specialty-Care versus Primary-Care 48 3.1.1 Primary-Care Model 49 3.1.2 Specialty-Care Model 49 Self-Check 50 3.2 Primary Care Reforms in the United States 50 3.2.1 Benefits of the Primary Care Model 51 3.2.2 Predicting Primary Care’s Future in the United States 52 Self-Check 52 3.3 Performance of the Primary Care Model in the United States 52 3.3.1 Accessibility 53 3.3.2 Continuity 53 3.3.3 Comprehensiveness 54 3.3.4 Coordination 54 3.3.5 Accountability to the Community 54 3.3.6 Its Effect on Primary Care Providers 55 Self-Check 55 3.4 Primary Care Innovations 55 3.4.1 The Primary Care Team 55 3.4.2 Chronic Care Model and Collaborative Care 56 Self-Check 57 3.5 Identifying the PCP 57 3.5.1 Permeable Boundaries Between Generalist, Specialist, and Other Functions 58 3.5.2 Specialists Providing Primary Care 58 3.5.3 Generalists Providing Secondary Care 58 3.5.4 Hospitalists Dedicated to General Inpatient Care 59 3.5.5 Nonphysician Primary Care Clinicians 60 Self-Check 60 3.6 PCPs and the Populations They Serve 60 3.6.1 Health Profession Shortage Areas (HPSAs) 61 3.6.2 Federal and State Strategies 62 Self-Check 63 Summary 63 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 Introduction 75 4.1 Changing Economic Dynamics 75 4.1.1 Increasing Expenditures 76 4.1.2 Reasons for the Increase 77 4.1.3 Affecting How Health Care is Financed 79 Self-Check 80 4.2 Flow of Funds through the System 80 4.2.1 Where the Money Comes From 80 4.2.2 Where the Money Goes 82 4.2.3 How It Gets There 82 Self-Check 84 4.3 Examining Who Has Health Insurance 84 Self-Check 87 4.4 Categorizing Health Insurance Plans 87 4.4.1 Indemnity plan 88 4.4.2 Service Benefit Plan 89 4.4.3 Managed Care Plan 90 Self-Check 91 4.5 Private Insurance Coverage: Voluntary Health Insurance (VHI) 92 4.5.1 Types of VHI Plans 92 4.5.2 Coverage Variations in VHI Plans 93 Self-Check 94 4.6 Government Insurance Programs: Medicare and Medicaid 94 4.6.1 Social Health Insurance: Medicare 94 4.6.2 Welfare Insurance: Medicaid 96 Self-Check 98 4.7 Health Maintenance Organizations (HMOs) 99 4.7.1 HMO Growth 99 4.7.2 HMO Models 99 Self-Check 101 Summary 101 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 Introduction 111 5.1 Sizing Up the Workforce 111 Self-Check 114 5.2 Understanding the Role of the Physician 114 5.2.1 Counting All Doctors 114 5.2.2 Specialists 116 5.2.3 General practitioners 117 5.2.4 Hospitalists 118 Self-Check 118 5.3 Training Doctors 118 5.3.1 Medical School 119 5.3.2 Residency and Fellowship 119 Self-Check 121 5.4 Nurses 121 5.4.1 Registered Nurses (RNs) 121 5.4.2 Training Requirements 123 5.4.3 Where the Nurses are 123 5.4.4 Other Nursing Personnel: LPNs and LVNs 124 Self-Check 125 5.5 Other Independent Health Professionals 125 5.5.1 Dentists 126 5.5.2 Chiropractors 126 5.5.3 Optometrists 127 5.5.4 Podiatrists 127 5.5.5 Pharmacists 128 Self-Check 129 5.6 Working in Concert with Physicians 129 5.6.1 Physical Therapists 129 5.6.2 Physician Assistants 130 Self-Check 131 Summary 131 Key Terms 132 Summary Questions 135 Review Questions 137 Applying This Chapter 139 You Try It 140 6 Research and Technology 141 Introduction 142 6.1 Understanding Medical Research 142 6.1.1 Advances in Knowledge 143 6.1.2 Advances in Diagnostic Techniques 145 6.1.3 Advances in Treatment Options and Therapeutic Interventions 146 6.1.4 Advances in Pharmaceuticals 147 6.1.5 Advances in Information and Communication Technologies 147 Self-Check 149 6.2 Research Facilities 149 6.2.1 Public Research Facilities: National Institutes of Health (NIHs) 149 6.2.2 Academic Health Centers 151 6.2.3 Private Research Facilities 152 6.2.4 Core Facilities 152 Self-Check 153 6.3 Funding Research: Knowing Where the Money Comes From 153 6.3.1 Public Funds 153 6.3.2 Private Donors/Benefactors 154 Self-Check 155 6.4 Assessment and Challenges of Continuing Medical Advancement 155 6.4.1 The Shift from Public to Private Research Endeavors 155 6.4.2 Issues Regarding Research in General Internal Medicine 155 6.4.3 The Impact on Academic Health Centers 156 6.4.4 Cost To Health Care 156 Self-Check 157 Summary 158 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 Introduction 166 7.1 The Evolution of Hospitals in the U.S 166 7.1.1 Forming Hospitals: the Refuge Stage 166 7.1.2 Hospitals As the Center of Health Care: Physician Workshop Stage 168 7.1.3 Becoming More Business Oriented: The Business Stage 169 7.1.4 Managing Complex Systems: The System Stage 169 Self-Check 170 7.2 Components and Cost of American Hospitals 170 7.2.1 Hospital Components 170 7.2.2 Hospital Costs 171 Self-Check 172 7.3 Classifying Hospitals 173 7.3.1 Length of Stay: Short-and Long-Term Hospitals 174 7.3.2 Type of Service: General and Specialty Hospitals 174 7.3.3 Ownership: Nonprofit, Proprietary, and Governmental 175 Self-Check 176 7.4 Care and Competition in the Twenty-First Century 177 7.4.1 Hospital Care 177 7.4.2 Competition in Health Care 178 Self-Check 179 Summary 179 Key Terms 180 Summary Questions 182 Review Questions 183 Applying This Chapter 184 You Try It 185 8 Ambulatory Care 186 Introduction 187 8.1 Understanding Ambulatory Care 187 8.1.1 The Growing Reliance on Ambulatory Care 188 8.1.2 Accessing Ambulatory Care 189 8.1.3 Paying For Ambulatory Care 189 8.1.4 Ambulatory Care Accreditation 190 Self-Check 191 8.2 Ambulatory Care Settings and Providers 191 8.2.1 Physician Offices: Solo and Group Practices 192 8.2.2 Emergency Rooms and Hospital Outpatient Departments 193 8.2.3 Urgent Care Facilities 194 8.2.4 Same-Day Surgery Centers 194 8.2.5 Community Health Centers and Clinics 195 8.2.6 Student Health Centres or Clinics 196 8.2.7 Occupational Health Programs 197 Self-Check 197 8.3 Home Health and Visiting Nurse Agencies 197 Self-Check 199 Summary 199 Key Terms 200 Summary Questions 201 Review Questions 202 Applying This Chapter 204 You Try It 205 9 Long-Term Care 206 Introduction 207 9.1 Understanding Long-Term Care 207 9.1.1 Typical Long-Term Care Services 207 9.1.2 People Who Need Long-Term Care 208 Self-Check 209 9.2 Personal Care Facilities 209 9.2.1 Assisted Living Facilities 210 9.2.2 Continuing Care Retirement Communities (CCRCs) 210 9.2.3 Congregate Care Facilities 211 9.2.4 Nursing Homes 211 9.2.5 Alzheimer’s /Dementia Facilities 213 Self-Check 214 9.3 Community-Based and Home Health Care 214 9.3.1 Receiving Care at Home 215 9.3.2 Taking Advantage of Community-Based Care 216 Self-Check 218 9.4 Rehabilitation Centers 218 Self-Check 219 9.5 Hospice Care 219 9.5.1 Hospice Service Providers 219 9.5.2 Hospice Services 220 9.5.3 Accessing Hospice Care 221 9.5.4 Financing Hospice Care 222 Self-Check 222 Summary 222 Key Terms 222 Summary Questions 225 Review Questions 226 Applying This Chapter 227 You Try It 229 10 Caring For Special Populations 230 Introduction 231 10.1 Caring For Mentally Ill Patients 231 10.1.1 Providing Mental Health Services 231 10.1.2 Paying For Mental Health Services 234 10.1.3 Challenges To Accessing And Providing Care For Mentally Ill Patients 235 10.1.4 Legal Issues Regarding Health Care for Mentally Ill Patients 237 Self-Check 239 10.2 Homeless Patients 239 10.2.1 Health Issues in the Homeless Population 240 10.2.2 Challenges in Providing Health Care to Homeless 240 Self-Check 241 10.3 Veterans 241 10.3.1 Health Issues For Veterans 241 10.3.2 Challenges in Providing Health Care to Veterans 242 Self-Check 243 10.4 Immigrants 243 10.4.1 Challenges in Providing Health Care to Immigrants 243 10.4.2 Legal Issues Regarding Health Care for Immigrants 244 Self-Check 245 10.5 Caring For Other Special Populations 245 10.5.1 People With AIDS and HIV 245 10.5.2 Victims of Violence 246 Self-Check 246 Summary 247 Key Terms 247 Summary Questions 249 Review Questions 251 Applying This Chapter 251 You Try It 253 11 Caring For Uninsured Patients 254 Introduction 255 11.1 Identifying Uninsured Patients 255 Self-Check 257 11.2 Accessing Health Care When Uninsured 257 11.2.1 Community Health Centers and Clinics 257 11.2.2 Urgent Care Facilities 257 11.2.3 Emergency Rooms 258 Self-Check 260 11.3 Challenges in Providing Health Care to Uninsured Patients 260 11.3.1 Health-Related Challenges 260 11.3.2 Financial-Related Challenges 261 Self-Check 263 11.4 Legal Issues and Uninsured Patients 263 Self-Check 264 Summary 264 Key Terms 264 Summary Questions 266 Review Questions 267 Applying This Chapter 267 You Try It 268 12 Managed Care 269 Introduction 270 12.1 Understanding Managed Care 270 12.1.1 Controlling Costs 270 12.1.2 Ensuring Quality 271 12.1.3 Understanding How Managed Care Works 272 Self-Check 272 12.2 Types of Managed Care Organizations 273 12.2.1 Health Maintenance Organizations (HMOs) 273 12.2.2 Preferred Provider Organizations (PPOs) 275 12.2.3 Point-Of-Service (POS) Plans 275 Self-Check 276 12.3 Assessing the Performance of Managed Care 276 12.3.1 Impact on Quality and Cost 276 12.3.2 Impact on Physicians and Health Care Providers 277 12.3.3 The Future of Managed Care 278 Self-Check 278 Summary 279 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 Introduction 287 13.1 Growing Complexity of the U.S Health Care System 287 13.1.1 The Effect on Governing Boards 288 13.1.2 The Challenge to Health Systems 289 Self-Check 290 13.2 Financing Health Care 290 13.2.1 Government Initiatives 291 13.2.2 Evolving Health Insurance and Health Plans 292 13.2.3 Funding Medicare 293 Self-Check 294 13.3 Aging Population 294 13.3.1 Demand and Cost for Short-Term Care 294 13.3.2 Demand For Long-Term Care 295 Self-Check 296 13.4 Challenges for Primary Care 296 13.4.1 The Cult of Specialization 296 13.4.2 Too Few Generalists; Too Many Specialists 298 13.4.3 The Unexpected Impact of Managed Care 298 13.4.4 The Lack of Government Direction Regarding Primary Care Physicians 299 13.4.5 Changing Medical Models 300 Self-Check 302 13.5 Examining The Underserved: Rural and Inner-City Areas 302 13.5.1 Lack of Racial and Ethnically Diverse Doctors 302 13.5.2 Declining Numbers of General Practitioners 303 13.5.3 Location of Practices 303 13.5.4 Lack of Coordinated Effort to Address Shortage 304 13.5.5 Role of Gender on Choice of Practice Location 305 Self-Check 305 13.6 Fixing the Problem of the Underserved 305 13.6.1 Bolstering Ethnically Diverse Workforce 305 13.6.2 Changing Medical Education System 306 13.6.3 Changing Reimbursement Strategies of Medicare and Medicaid 307 13.6.4 Changes in Existing Direct Federal and State Programs 307 13.6.5 Relying on the Impact of Managed Care 307 Self-Check 308 13.7 Other Challenges 309 13.7.1 Advancing Technology 309 13.7.2 Shortage of Nurses 309 13.7.3 Evolving Public Health Threats 310 13.7.4 Declining Financial Health of Hospitals 310 Self-Check 311 Summary 311 Key Terms 311 Summary Questions 313 Review Questions 315 Applying This Chapter 316 You Try It 318 14 Public Health Policy 319 Introduction 320 14.1 Public Health Services 320 14.1.1 Federal Health Agencies 322 14.1.2 State Health Agencies 323 14.1.3 Local Health Agencies 325 14.1.4 Private Initiatives in Public Health Policy 327 Self-Check 328 14.2 Federal and State Health Laws 328 14.2.1 Federal Statutes and Regulations 328 14.2.2 State Statutes and Regulations 329 Self-Check 330 14.3 Assessing U.S Health Policy 330 Self-Check 331 14.4 Comparing U.S Health Care to Health Care in Other Countries 332 14.4.1 Health Indicators 332 14.4.2 Characteristics of the Health System 332 14.4.3 Primary Care of Specialty Care-Based System 333 Self-Check 334 Summary 334 Key Terms 335 Summary Questions 336 Review Questions 337 Applying This Chapter 338 You Try It 340 Endnotes 341 Glossary 343 Index 359