Introduction to Health Care Services: Foundations and Challenges

BERNARD J. HEALEY, PHD, is professor of health care administration at King's College in Wilkes Barre, Pennsylvania. Dr. Healey has four books and over 100 articles about leadership in health care, public health, health policy, and health care partnerships.TINA MARIE EVANS, PHD, ATC, is associate professor and department head of applied health studies at Pennsylvania College of Technology. She is an active researcher, publishing and presenting on various allied health topics on the local, regional, national, and international levels.

• Figures, Tables, and Exhibits xiiiIntroduction xviiAcknowledgments xixAbout the Authors xxiAbout the Contributors xxiiiPart One: Overview of Health Care Service Delivery 1Chapter 1 An Overview of Health Care Delivery in the United States 3Bernard J. HealeyHealth Care Costs 4Health Care Access 15Health Levels and Outcomes 17Health Care Quality 24Summary 26Discussion Questions 27Chapter 2 The Forces of Change in Health Care  31Bernard J. HealeyConsequences of Forty Years of Health Care Cost Escalation 32Health Care Reform 38Summary 49Discussion Questions 51Part Two: The Major Players in Health Care Services 55Chapter 3 Providers of Health Care Services 57Tina Marie EvansPrimary Care Physicians and Primary Care Assistants 57Specialty Care Providers 59Dentists, Dental Hygienists, and Dental Assistants 61Mental Health Care Providers 62Nurses 66Radiologic and Imaging Professionals 67Allied Health Rehabilitation Professionals 70Collaboration in Health Care 73Employment Trends in the Health Care Sector 74Summary 77Discussion Questions 78Chapter 4 Hospitals 81Denice YanchikHistory of Hospitals 81Management of Hospitals 85Quality and Safety in Hospitals 93Magnet Recognition Program 96Challenges and the Future 99Summary 100Discussion Questions 101Chapter 5 Ambulatory Care Services 105Tina Marie EvansHistory of Ambulatory Care Services 107Reasons for the Expansion of Ambulatory Care 110Hospital-Based Ambulatory Care 112Non-Hospital-Based Ambulatory Care 114Primary Care Management 120Home Health Care Services 121Hospice Services 124Quality Assurance in Ambulatory Care 126Summary 127Discussion Questions 128Chapter 6 Health Insurance and Payment for Health Care Services 131Jeffrey R. Helton and Bernard J. HealeyBasics of U.S. Health Insurance 134History of Health Insurance 135How Health Insurance Markets Work 138Health Insurance Providers 139Reimbursement for Health Care Providers 145Why Health Insurance Is Such a Huge Problem in the United States 148Creative Destruction of Health Insurance 149Summary 152Discussion Questions 153Chapter 7 Managed Care 155Bernard J. HealeyConcepts of Managed Health Care 157History of Managed Health Care 158Types of Managed Care Plans 161Managed Care Utilization Control 163Managed Care Quality Issues 166Managed Care and Prevention of Disease 168Comparative Effectiveness Research 169Future of Managed Health Care 172Summary 174Discussion Questions 176Chapter 8 Long-Term Care 179Tina Marie EvansThe Aging of Americans 180History of Long-Term Care 184Organization of Long-Term Care 186Payment for Long-Term Care Services 193Chronic Diseases and Their Complications 198Challenges for Long-Term Care in the Future 202Summary 205Discussion Questions 205Chapter 9 Mental Health Care 209Tina Marie EvansHistory of Mental Health 210The Role of Stress 216Types of Mental Illnesses 218Mental Health Care Providers 226Mental Health Parity 229Summary 233Discussion Questions 234Chapter 10 Public Health Services 237Bernard J. HealeyHistory of Public Health 240Structure of Public Health Departments 242Determinants of Health 244Core Functions of Public Health 247Epidemiology and Public Health 248Population-Based Health 250Public Health Leadership 255Future of Public Health 258Summary 260Discussion Questions 261Part Three: Challenges in Health Care Delivery 265Chapter 11 The Pursuit of Quality Care 267Tina Marie EvansOrigins of the Quality Movement 268IOM Report on Medical Errors 274IOM Report on the Quality Chasm  278Quality Improvement Strategies 286Medical Errors 292Health Care–Associated Infections 293Summary 296Discussion Questions 297Chapter 12 The Chronic Disease Epidemic 299Bernard J. HealeyChronic Diseases and Their Complications 301Costs of Chronic Diseases 307Chronic Disease Prevention and Behavioral Changes 310Applying Business and Other Models to Chronic Disease Prevention 311Summary 318Discussion Questions 319Chapter 13 Leadership Solutions to Health Care Problems 323Bernard J. HealeyHealth Care Reform Beyond the ACA 325Reengineering the Health Care Sector 326Understanding Power in the Health Care Sector 327Changing the Health Care Environment 328How Leaders Can Meet These Challenges 337Summary 340Discussion Questions 341Chapter 14 Integrating Clinical Services and CommunityPrevention: The Community-Centered Health Home Model  345Larry Cohen, Leslie Mikkelsen, Jeremy Cantor, Rea Pa˜nares, Janani Srikantharajah, and Erica ValdovinosHistory of Clinical Services and Community Prevention Integration 346Elements of the Community-Centered Health Home 354Capacities Needed for Effective Implementation 365Overarching Systems Change Recommendations 367Summary 371Discussion Questions 372Chapter 15 A Look into the Future 375Bernard J. HealeyMajor Challenges Facing Health Care Delivery 376Areas of Future Concern 385How to Meet These Challenges 389Summary 396Discussion Questions 397Case Study 1 Innovation in Physician Leadership Education 401Francis G. BelardiCase Study 2 Using Marketing Tools to Increase Early Referrals of Children with Developmental and Behavioral Disorders 405Jeff Kile and Bernard J. HealeyCase Study 3 Fall Reduction at Geisinger Wyoming Valley Medical Center: ‘‘Above All, Do No Harm’’ 409Daniel J. AmorinoCase Study 4 The VA Reinvents Itself 419Joseph J. MarroneIndex 427