Proposed Updates to the Sixth Edition of Health Care USA



Updates to the Sixth Edition of Health Care USA

Chapter 1: Overview: A Population Perspective

Contents: Problems of Health Care; Understanding Health Care; Why Patients and Providers Behave the Way They Do; Indices of Health, Disease; Natural Histories of Disease and the Levels of Prevention; Major Stakeholders; Alternative Therapies; Managed Care; Other Insurers; Long-Term Care; Mental Health; Voluntary Facilities, Agencies; Health Professions Education Professional Associations; Other Health Organizations; Research; Development of Managed Care; Rural Health Networks; Health Care Priorities; Tyranny of Technology; Social Choices; Aging Population; Access; Quality; Conflicts of Interest; Ethical Dilemmas

Changes:

• Updated data on size and cost of the U.S. health care system

Net page change: 0

Chapter 2: Benchmark Developments

Contents: Great Depression; Birth of Blue Cross; Influence of Government; Medicare and Medicaid; Planning, Regulation, Consumer Protection; Managed Care; New Federalism; Evolution of High-Tech Medicine; Medical Education and Specialization; Interest Groups; Influences of Business and Labor; Public Health Focus on Prevention; Economic Influences, Rising Costs; The Uninsured; Aging; Values and Assumptions Guiding Priorities; Oregon Death with Dignity Act; HIPPA; Internet and Health Care; Basic Issues.

Changes:

• Updated section on Managed Care Organizations and current status of PPOs and HMOs

• Updated discussion of physician supply

• New data regarding effect of Oregon Death with Dignity Legislation

Net page change: 0

Chapter 3: Hospitals: Origin, Organization, and Performance

Historical Perspective; Forces That Shaped Hospital Industry; Medicare, Medicaid; Hospital Growth and Decline; Types, Financial Condition; Academic Health Centers, Medical Education, Specialization; Balanced Budget Act; Hospitals of Department of Veterans Affairs; Structure and Organization of Hospitals; Complexity of System; Types and Roles of Patients; Rights and Responsibilities of Patients; Important Decisions, Informed Consent, Second Opinions; Diagnosis-Related Group Hospital Reimbursement System; Discharge Planning; Subacute Care; Integrated Health Systems; Quality of Hospital Care; Landmark Studies of Quality of Hospital Care; Nurse Shortage; Forces of Reform: Cost, Quality, and Access;

Changes:

• Updates to all data regarding number, types, and services of U.S. hospitals

• New discussion of the rapidly increasing number of physician-owned specialty hospitals and surgical centers and their effects on public and voluntary hospitals

• Updated information on the variety of efforts of hospitals to reduce medical errors, e.g. Institute for Health Care Improvement, 100,000 Lives Initiative

• New discussion of the new Medicare website on hospital performance standards

• Updated information on the efforts of hospitals to reduce hospital-transmitted infections

• New discussion of the community-wide over-capacity of hospital beds and under-utilization costs

• New discussion of the advances in non-invasive technology, i.e. MRI/CT/PET in coronary artery disease diagnosis and implications for hospitals, providers and patients

• New information on the increasing interest in challenging tax-exempt status of hospitals providing little or no charitable care

Net page change: + 2

Chapter 4: Ambulatory Care

Contents: Overview and Trends; Private Medical Office Practice; Other Ambulatory Care Practitioners; Ambulatory Care Services of Hospitals: History and Trends; Hospital Emergency Services; Free Standing Services; Primary Care Centers; Urgent/Emergent Care Centers; Ambulatory Surgery Centers; Community Health Centers; Public Health Services; Voluntary Agencies; Continued

Expansion

Changes:

• Updated data on physician practice characteristics

• Updated information on hospital ambulatory clinics activity relative to hospital revenues

• New discussion of the increasing hospital competition with privately owned outpatient facilities

• Updated emergency department utilization data and current issues in ED capacity

• New discussion of the continuing proliferation of hospital and privately owned free standing emergent care centers.

• Updated data on freestanding surgery centers

• Expanded discussion of and updated data on the role of federally funded Community Health Centers as community “safety-nets.”

• Updated data and expanded discussion of roles of State and local health departments in emergency preparedness and epidemic control planning and management

• Voluntary Agencies: New discussion about the pressures for consolidation and collaboration from government and private funders to eliminate duplication of overhead and services.

Net page change: 0

Chapter 5: Medical Education and the Changing Practice of Medicine

Contents: Flexner Report and Medical School Reforms; Academic Medical Centers; Graduate Medical Education Consortia; Delineation and Growth of Medical Specialties; Specialty Boards and Residency Performance; Funding of Graduate Medical Education; Physician Workforce and U.S. Medical Schools; Generalist/Specialist Imbalance; Primary Care Physicians; Preventive Medicine; Changing Physician/Hospital Relationships, Cost Containment, Restructuring Medical Practice; Hold Harmless Clauses; Clinical Practice Guidelines; Physician Report Cards; Escalating costs of Malpractice Insurance; Growing Concern About Ethical Issues; Physicians and the Internet; Provider Network Contracting; Management Service Organizations; Future of Medical Practice.

Changes:

• Updated data on the number and roles of hospitalists; new discussion about continuity of care

• Removed section on now defunct Physician-Hospital Organizations

• New section on the significant decline of physician incomes in the last decade in contrast to rising incomes of other professionals.

• New information about how managed care organizations undervaluing of the services of primary care physicians has led to a decline in availability of general practitioners and predictions of a dire shortage in primary care services.

• New remarks about how the growing concerns of serious physician shortages in near future has stimulated medical schools to increase class size.

Net page change: -1

Chapter 6: Health Care Personnel

Contents: Health Professions; Health Care Personnel; Health Care Reforms; Credentialing and Regulating Health Professionals; Health Care Occupations; Alternative Therapists; Factors Influencing Demand for Health Personnel; Health Care Workforce Issues;

Changes:

• Updated Department of Labor estimates of number and types of health care personnel.

• Updated information on the factors that influence the demand and utilization of health care personnel with particular reference to changing hospital and managed care practices.

• Updated information on the influence of technological innovations on the functions of specific health care professionals.

Net page change: 0

Note: Chapters 7 and 8 are now combined. The Chapter 7 title “Financing Health Care” was retained but now includes the discussion of managed care which was formerly Chapter 8.

Chapter 7: Financing Health Care (includes former Chapter 8)

Contents: Health Care Expenditures in Perspective; New Diagnostic and Treatment Technology; Growth of Specialized Medicine; The Uninsured and Underinsured; A Labor-Intensive Industry; Economic Incentives That Fuel Rising Costs; Components of Health Care Expenditures; Sources of Health Care Payment; Evolution of Health Insurance: Third-Party Payment; Self-Funded Insurance Programs; Government as a Source of Payment; Balanced budget Act of 1997; Other Services Funded by the Government; The Future: Continuing Change

Contents: Chapter 8: Historical Perspective; Managed Care Fundamentals; HMO Act of 1973; Evolution of Managed Care; Emerging Developments in Managed Care; Medicare and Medicaid Managed Care; Managed Care Organizations and Quality; The Future of Managed Care

Changes: (combining former Chapters 7 and 8:)

• Updated National Health Care Expenditures Data through latest available data.

• Updated data on the number of un-underinsured Americans with impact to costs

• A new historical overview of Medicare and Medicaid programs: definitions and history

• Updated data on the sources of payment and payment recipients

• New explanation of the role of Managed Care as the primary mode of US health insurance coverage

• New discussion of the programmatic and cost implications of the Medicare Prescription Drug Improvement and Modernization Act of 2003.

• Shorter discussion of the Balanced Budget Act of 1997 to just an historical perspective

• Updated information on current Medicare and Medicaid program expenditure data

• Updated trends in Medicare and Medicaid cost containment strategies

• Updated fiscal challenges for employers at the federal, state and local levels

• Updated “Consumer Driven” health insurance initiatives

• New discussion of government and private insurer cost savings initiatives through education and case management. .

Net page change: -20

Chapter 8: Long Term Care (Former Chapter 9)

Contents: Long-Term Care and the Continuum of Care; Development of Long-Term Care Services; Modes of Delivery of Long-Term Care Services; Skilled Nursing Care; Assisted Living; Hospice Care; Respite Care; Adult Day Care; Innovations in Long-Term Care; Long-Term Care Insurance; The Future of Long-Term Care.

Changes:

• Updated long term care industry trends

• Updated statistics on needs, use, and costs for:

o Skilled nursing care

o Home Care

o Assisted Living Arrangements

o Hospice

o Respite

o Adult Day Care

o Continuing Care Retirement and Long Term Care Communities

• Updated information on Federal Administration on Aging demonstration “Aging in Place” projects.

• Updated report on long term care insurance enrollments: ongoing challenges.

Net page change: -3

Chapter 9: Mental Health Services (Former Chapter 10)

Contents: Historical Overview; Recipients of Mental Health Services; Children and Adolescents; Older Adults; The Organization and Funding of Mental Health Services; Health Insurance Coverage and Managed Behavioral Health Care; Barriers to Accessing Services; Priorities for Mental Health Services; Need for Further Research

Changes:

• Updated profile of affected populations

• New discussion of the prevalence of dementia disorders in older adults; add discussion of preventive behavioral services.

• New information on pharmacological advances in treatment of dementias

• Updated data on insurance coverage for behavioral health

• Updated information on implementation progress on the NIMH Plan

• Updated developments from the “Freedom Commission on Mental Health” initiative

Net page change:0

Chapter 10: Public Health and the Role of Government in Health Care (Former Chapter 11)

Contents: Historical Perspective; Public Health and Government-supported Services; Decline of the Public Health Service; Responsibilities of the Public Health Sector; Relationships of Public Health and Private Medicine; Resource Priorities Favoring Curative Medicine; Health Care Reform and the Public Health/Medicine Relationship; Hospital-Sponsored Public Health Activities; Public Health Services of Voluntary Agencies; Changing Roles of Government in Public Health; Public Health in an Era of Privatization and Managed Care; State Children’s Health Insurance Program; Federal Support to Address Emerging Health Issues; Future Role of Government in Promoting the Public’s Health.

Changes:

• Updated budget and description of the U.S. Public Health Service

• Updated budget and description of services of the U.S. Veteran Administration’s Medical Centers

• New discussion of the effect of influx of Iraq War casualties on VA services.

• Update federal, state and local public health initiatives in emergency preparedness for terrorist activities and avian influenza

Net page change: 0

Chapter 11: Research: How Health Care Advances (Former Chapter 12)

Contents: The Focus of Different Types of Research; Research in Health and Disease; Epidemiology; Health Services Research; Agency for Health Care Policy and Research; Health Services Research and Health Policy; Quality Improvement; Medical Errors; Evidence-Based Medicine; Outcomes Research; Patient Satisfaction; Research Ethics; Future Challenges

Changes:

• Revise section on “Research Ethics” to reflect growing concerns about financial ties between pharmaceutical companies and supposedly “independent” researchers who judge the safety and effectiveness of newly developed drugs.

• Update section on Federal Drug Administration to reflect latest administrative and performance activities.

Net page change: 0

Chapter 12: The Future of Health Care (Former Chapter 13)

Contents: The Paradox of U.S. Health Care; Major Challenges; Growing Number of Uninsured; Demand for Greater Accountability; Technological Growth and Innovation; Changing Population Composition; New Physician Roles; Academic Health Centers; Health Professions; Nurses, Nurse Practitioners; Physician Assistants; Increased Scrutiny of Costs; New Health Insurance Plan; Changing Composition of Health System; Corporate Growth in Health Care; Corporate Alliances; Information Management; Future Role of the Federal Government; Conclusion

Changes

• New remarks on the increasing number and changing characteristics of Americans without health insurance

• Condensed section on “Demand for Greater Accountability.”

• Updated discussion of future supply and roles of physicians, nurses, physician assistants and nurse practitioners.

• Updated and condensed sections on “Corporate Growth” and “Corporate Alliances” in health care.

• Condensed “Conclusion” section of this chapter.

Net page change: -3

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