Florida International University HAS 3111 Lack of Medical Insurance Cover Essay

Florida International University HAS 3111 Lack of Medical Insurance Cover Essay ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Florida International University HAS 3111 Lack of Medical Insurance Cover Essay Florida Internat Why is it that, despite public and private health insurance programs, some US citizens are without health care coverage? Florida International University HAS 3111 Lack of Medical Insurance Cover Essay Two paragraphs leiyu_shi__douglas_a._singh_____delivering_health_care_in_america__a_systems_approach_jones___bartlett___publishers__2017_.pdf Delivering Health Care in America A SYSTEMS APPROACH SEVENTH EDITION Leiyu Shi, DrPH, MBA, MPA Professor, Bloomberg School of Public Health Director, Johns Hopkins Primary Care Policy Center Johns Hopkins University Baltimore, Maryland Douglas A. Singh, PhD, MBA Associate Professor Emeritus of Management School of Business and Economics Indiana University, South Bend South Bend, Indiana JONES & BARTLETT LEARNING Copyright Page World Headquarters Jones & Bartlett Learning 5 Wall Street Burlington, MA 01803 978-443-5000 [email protected] www.jblearning.com Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones & Bartlett Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jblearning.com. Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available to corporations, professional associations, and other qualified organizations. For details and specific discount information, contact the special sales department at Jones & Bartlett Learning via the above contact information or send an email to [email protected]. 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Delivering Health Care in America: A Systems Approach, Seventh Edition is an independent publication and has not been authorized, sponsored, or otherwise approved by the owners of the trademarks or service marks referenced in this product. There may be images in this book that feature models; these models do not necessarily endorse, represent, or participate in the activities represented in the images. Any screenshots in this product are for educational and instructive purposes only. Any individuals and scenarios featured in the case studies throughout this product may be real or fictitious, but are used for instructional purposes only. This publication is designed to provide accurate and authoritative information in regard to the Subject Matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting, or other professional service. If legal advice or other expert assistance is required, the service of a competent professional person should be sought. 21285-3 Production Credits VP, Executive Publisher: David D. Cella Publisher: Michael Brown Associate Editor: Danielle Bessette Production Editor: Vanessa Richards Senior Marketing Manager: Sophie Fleck Teague Manufacturing and Inventory Control Supervisor: Amy Bacus Composition: codeMantra U.S. LLC Cover Design: Scott Moden Rights & Media Specialist: Merideth Tumasz Media Development Editor: Shannon Sheehan Cover Image (Title Page, Part Opener, Chapter Opener): © f11photo/ShutterStock Printing and Binding: LSC Communications Cover Printing: LSC Communications Library of Congress Cataloging-in-Publication Data Names: Shi, Leiyu, author. | Singh, Douglas A., 1946- author.Florida International University HAS 3111 Lack of Medical Insurance Cover Essay Title: Delivering health care in America : a systems approach / Leiyu Shi, Douglas A. Singh. Description: Seventh edition. | Burlington, Massachusetts : Jones & Bartlett Learning, [2019] | Includes bibliographical references and index. Identifiers: LCCN 2017015329 | ISBN 9781284124491 (pbk.) Subjects: | MESH: Delivery of Health Care | Health Policy | Health Services | United States Classification: LCC RA395.A3 | NLM W 84 AA1 | DDC 362.10973— dc23 LC record available at https://lccn.loc.gov/2017015329 6048 Printed in the United States of America 21 20 19 18 17 10 9 8 7 6 5 4 3 2 1 © f11photo/Shutterstock Contents Preface List of Exhibits List of Figures List of Tables List of Abbreviations/Acronyms Chapter 1 An Overview of U.S. Health Care Delivery Introduction An Overview of the Scope and Size of the System A Broad Description of the System Basic Components of a Health Care Delivery System Insurance and Health Care Reform Role of Managed Care Major Characteristics of the U.S. Health Care System Trends and Directions Significance for Health Care Practitioners Significance for Health Care Managers Health Care Systems of Other Countries Global Health Challenges and Reform The Systems Framework Summary Test Your Understanding References PART I System Foundations Chapter 2 Beliefs, Values, and Health Introduction Significance for Managers and Policymakers Basic Concepts of Health Quality of Life Risk Factors and Disease Health Promotion and Disease Prevention Disease Prevention Under the Affordable Care Act Public Health Health Protection and Preparedness in the United States Determinants of Health Measures Related to Health Anthro-Cultural Beliefs and Values Integration of Individual and Population Health Summary Test Your Understanding References Chapter 3 The Evolution of Health Services in the United States Introduction Medical Services in the Preindustrial Era Medical Services in the Postindustrial Era Medical Care in the Corporate Era Globalization of Health Care The Era of Health Care Reform Summary Test Your Understanding References PART II System Resources Chapter 4 Health Services Professionals Introduction Physicians Issues in Medical Practice, Training, and Supply International Medical Graduates Dentists Pharmacists Other Doctoral-Level Health Professionals Nurses Advanced Practice Nurses Midlevel Providers Allied Health Professionals Health Services Administrators Global Health Workforce Challenges Summary Test Your Understanding References Appendix 4-A List of Professional Associations Chapter 5 Medical Technology Introduction What Is Medical Technology? Information Technology and Informatics The Internet, E-Health, M-Health, and E-Therapy Telemedicine, Telehealth, and Remote Monitoring Innovation, Diffusion, and Utilization of Medical Technology The Government’s Role in Technology Diffusion The Impact of Medical Technology The Assessment of Medical Technology Directions and Issues in Health Technology Assessment Health Care Reform and Medical Technology Summary Test Your Understanding References Chapter 6 Health Services Financing Introduction The Role and Scope of Health Services Financing Financing and Cost Control The Insurance Function Private Health Insurance Private Coverage and Cost Under the Affordable Care Act Public Health Insurance The Payment Function National Health Care Expenditures Current Directions and Issues Summary Florida International University HAS 3111 Lack of Medical Insurance Cover Essay Test Your Understanding References PART III System Processes Chapter 7 Outpatient and Primary Care Services Introduction What Is Outpatient Care? The Scope of Outpatient Services Primary Care Primary Care and the Affordable Care Act New Directions in Primary Care Primary Care Providers Growth in Outpatient Services Types of Outpatient Care Settings and Methods of Delivery Complementary and Alternative Medicine Utilization of Outpatient Services Primary Care in Other Countries Summary Test Your Understanding References Chapter 8 Inpatient Facilities and Services Introduction Hospital Transformation in the United States The Expansion Phase: Late 1800s to Mid-1980s The Downsizing Phase: Mid-1980s Onward Some Key Utilization Measures and Operational Concepts Factors That Affect Hospital Employment Hospital Costs Types of Hospitals Expectations for Nonprofit Hospitals Some Management Concepts Licensure, Certification, and Accreditation The Magnet Recognition Program Ethical and Legal Issues in Patient Care Summary Test Your Understanding References Chapter 9 Managed Care and Integrated Organizations Introduction What Is Managed Care? Evolution of Managed Care Growth of Managed Care Efficiencies and Inefficiencies in Managed Care Cost Control in Managed Care Types of Managed Care Organizations Trends in Managed Care Impact on Cost, Access, and Quality Managed Care Backlash, Regulation, and the Aftermath Organizational Integration Basic Forms of Integration Highly Integrated Health Care Systems Summary Test Your Understanding References Chapter 10 Long-Term Care Introduction The Nature of Long-Term Care Long-Term Care Services Users of Long-Term Care Level of Care Continuum Home- and Community-Based Services Institutional Long-Term Care Continuum Specialized Care Facilities Continuing Care Retirement Communities Institutional Trends, Utilization, and Costs Insurance for Long-Term Care Summary Test Your Understanding References Chapter 11 Health Services for Special Populations Introduction Framework to Study Vulnerable Populations Racial/Ethnic Minorities The Uninsured Children Women Rural Health Migrant Workers The Homeless Mental Health The Chronically Ill HIV/AIDS Summary Test Your Understanding References PART IV System Outcomes Chapter 12 Cost, Access, and Quality Introduction Cost of Health Care Reasons for Cost Escalation Cost Containment: Regulatory Approaches Cost Containment: Competitive Approaches Cost Containment Under Health Reform Access to Care The Affordable Care Act and Access to Care Quality of Care Dimensions of Quality Quality Assessment and Assurance Public Reporting of Quality The Affordable Care Act and Quality of Care Summary Test Your Understanding References Chapter 13 Health Policy Introduction What Is Health Policy? Principal Features of U.S. Health Policy The Development of Legislative Health Policy The Policy Cycle Policy Implementation Critical Policy Issues Summary Test Your Understanding References PART V System Outlook Chapter 14 The Future of Health Services Delivery Introduction Forces of Future Change The Future of Health Care Reform The Health Care Delivery Infrastructure of the Future The Future of Long-Term Care Global Threats and International Cooperation New Frontiers in Clinical Technology The Future of Evidence-Based Health Care Summary Test Your Understanding References Glossary Index © f11photo/Shutterstock Preface With this Seventh Edition, we celebrate 20 years of serving instructors, students, policymakers, and others, both at home and overseas, with up-to-date information on the dynamic U.S. health care delivery system. Much has changed, and much will continue to change in the future, as the nation grapples with critical issues of access, cost, and quality. Florida International University HAS 3111 Lack of Medical Insurance Cover Essay Indeed, much of the developing and developed world will also be contending with similar issues. People in the United States, in particular, have just gotten a taste of a far-reaching health care reform through President Barack Obama’s signature Affordable Care Act (ACA), nicknamed “Obamacare.” To date, this law has produced mixed results that are documented in this new edition. At the time this edition went to press, we were left with promises of another reform under the slogan “Repeal and replace Obamacare,” a move championed by President Donald Trump, who had made it one of the centerpieces of his presidential campaign. Much remains to be seen as to how this promise will play out. On May 4, 2017, the U.S. House of Representatives passed the American Health Care Act (AHCA) by a vote of 217 to 213, with Republican support. The bill is likely to undergo significant changes in the U.S. Senate. Hence, what the new law may eventually look like was unknown at the time this manuscript went to press. As was the case with the ACA, for which the Democratic Party played an exclusive role in its passage, contentious debates, partisanship, and deal making among both Republicans and Democrats have marked the progress in moving the new law through Congress. Although we have chosen to sidestep any premature speculation about the fate of the ACA and the shape of its replacement, wherever possible, we have presented trends and facts that support certain conclusions. Mainly, experiences and outcomes under the ACA have been highlighted in this edition. On his first day in office in January 2017, President Trump signed an executive order to “waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the [Affordable Care] Act that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, health care providers, health insurers, patients, recipients of health care services, purchasers of health insurance, or makers of medical devices, products, or medications.” This executive order effectively repealed small portions of the ACA that deal with taxation and fees. Going forward, the issues of universal coverage and affordability of insurance and health care will be critical. Under the ACA, approximately 27 million people remained uninsured, even though the uninsurance rate in the United States dropped from 13.3% to 10.9% between 2013 and 2016. The majority of the newly insured individuals were covered under Medicaid, the nation’s safety net health insurance program for the poor. Another thorny issue will be how to provide health care for the millions of illegal immigrants who obtain services mainly through hospital emergency departments, and through charitable sources to some extent. Is there a better, more cost-effective way to address their needs? The affordability of health insurance in the non-employment-based private market was severely eroded under the ACA, mainly for those who did not qualify for federal subsidies to buy insurance. The reason for the rate hikes in this segment was that few young and healthy people enrolled in health care plans under the ACA. Consequently, for many people, premium costs rose to unaffordable levels in 2016. People who really needed to use health care enrolled in much larger numbers than healthier individuals. Such an adverse selection prompted the chief executive of Aetna Insurance, Mark Bertolini, to remark that the marketplace for individual health insurance coverage was in a “death spiral.” Some large insurance companies either pulled out of the governmentsponsored health care exchanges or were planning to do so because of financial losses sustained under the ACA. ? New to This Edition This edition continues to reference some of the main features of the ACA wherever it was important to provide contextual discussions from historical and policy perspectives. Florida International University HAS 3111 Lack of Medical Insurance Cover Essay Several chapters cover the main provisions of the 21st Century Cures Act, which, after a long delay, was finally passed by Congress and signed by President Obama in December 2016. As in the past, this text has been updated throughout with the latest pertinent data, trends, and research findings available at the time the manuscript was prepared. Copious illustrations in the form of examples, facts, figures, tables, and exhibits continue to make the text come alive. Following is a list of the main additions and revisions: Chapter 1 Updates the impact of the Affordable Care Act (ACA) Critical global health issues and health care reforms in other countries Chapter 2 Health insurance under the ACA Evaluation of progress made toward the Healthy People 2020 goals Information on global pandemics and infectious diseases Chapter 3 Expanded section: Reform of mental health care Complete revision of the section: Era of health care reform Chapter 4 Major issues related to the health care workforce Updated information on nonphysician providers Chapter 5 New section: Electronic health records and quality of care Global trends in biomedical research and a new table on R&D expenditures New section: Drugs from overseas New section: Health care reform and medical technology Chapter 6 New section: Private coverage and cost under the Affordable Care Act New section: Medicaid experiences under the ACA New section: Issues with Medicaid New section: Long-term care hospital payment systems New section: Value-based reimbursement (discusses the MACRA and Medicare Shared Savings Program) Updated current directions and issues in financing Chapter 7 Research findings using the Primary Care Assessment Tool Measurement and achievement of the patient-centered medical home The impact of community health centers Chapter 8 New section: Comparative data from the Organization for Economic Cooperation and Development on hospital access and utilization Comparative hospital prices in selected countries New section: Factors that affect hospital employment New section: Rise in bad debts New section: State mental health institutions Update on physician-owned specialty hospitals Medicare designations of sole community hospitals and Medicaredependent hospitals Patient outcomes at Magnet hospitals New section: Hospital costs Chapter 9 “Any willing provider” and “freedom of choice” laws under managed care regulations The latest on accountable care organizations Chapter 10 New section: Recent policies for community- based services Chapter 11 Updated information on vulnerable subpopulations Expanded coverage on chronically ill patients Chapter 12 Current issues in health care costs, access, and quality Pay-for-performance in health care Quality initiatives in both the public and private sectors Chapter 13 Current critical policy challenges Future health policy issues in both the United States and abroad Chapter 14 Almost all sections have been completely updated New section: No single payer New section: Reforming the reform New section: Universal coverage and access New section: Toward population health As in the previous editions, our aim is to continue to meet the needs of both graduate and undergraduate students. We have attempted to make each chapter complete, without making it overwhelming for beginners. Instructors, of course, will choose the sections they decide are most appropriate for their courses. As in the past, we invite comments from our readers. Communications can be directed to either or both authors: Leiyu Shi Department of Health Policy and Management Bloomberg School of Public Health Johns Hopkins University 624 North Broadway, Room 409 Baltimore, MD 21205-1996 [email protected] Douglas A. Singh [email protected] We appreciate the work of Hailun Liang and Megha Parikh in providing assistance in the preparation of selected chapters of this text. © f11photo/Shutterstock List of Exhibits Exhibit 3-1 Evolution of the U.S. Health Care Delivery System Exhibit 3-2 Groundbreaking Medical Discoveries Exhibit 4-1 Definitions of Medical Specialties and Subspecialties Exhibit 4-2 Examples of Allied Health Professionals Exhibit 6-1 Key Differences Between a Health Reimbursement Arrangement and a Health Savings Account Exhibit 6-2 Medicare Part A Financing, Benefits, Deductible, and Copayments for 2017 Exhibit 6-3 Medicare Part B Financing, Benefits, Deductible, and Coinsurance for 2017 Exhibit 6-4 Medicare Part D Benefits and Individual Out-of-Pocket Costs for 2017 Exhibit 9-1 The Evolution of Managed Care Exhibit 11-1 The Vulnerability Framework Exhibit 11-2 Predisposing, Enabling, and Need Characteristics of Vulnerability Exhibit 12-1 Regulation-Based and Competition-Based CostContainment Strategies Exhibit 13-1 Key Health Care Concerns of Selected Interest Groups Exhibit 13-2 Arguments for Enhancing States’ Role in Health Policy Making © f11photo/Shutterstock List of Figures Figure 1-1 Basic health care delivery functions. Figure 1-2 External forces … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10