Introduction to Health Care Services: Foundations and Challenges

INTRODUCTION TO HEALTH CARE SERVICES FOUNDATIONS AND CHALLENGES

Nowhere are the changing times more apparent than in the health care industry, which is why aspiring managers and administrators in the field need to be prepared with an understanding of what the future holds. Introduction to Health Care Services: Foundations and Challenges gives undergraduate and graduate students an up–to–date understanding of health care today and tomorrow.

Unlike many texts, Introduction to Health Care Services provides an overview of health care that thoroughly addresses mental health and public health care services. It also focuses on the next major era in the United States health care industry: the shift toward preventative and ambulatory services.

Highlights include:

Roles for leadership in the health care industry Forces of change in health care, including the Patient Protection and Affordable Care Act The turn to quality health care outcomes and improved access to care Community–centered health home model of care, its analysis, and its future Four in–depth case studies demonstrating health care delivery principles

By taking a look into the future of health care, students will gain the ability to apply their creativity and to innovate in ways that will have a lasting impact at this exciting time of health care transformation.

Introduction

Acknowledgments

About the Authors

About the Contributors

Part 1: Overview of Health Care Service Delivery

Chapter 1 Overview of Health Care Delivery in the United States

Health Care Costs

Demographic and Population Changes Within the United States

Health Care in Germany

Health Care in the United Kingdom

Health Care in Canada

Evidence–Based Healthcare

Technology and Healthcare Costs

Healthcare Access

Disparate Populations

Health Levels and Outcomes

Changing Patterns of Disease in the United States

Patient and Community Involvement in Healthcare

The Use of Technology to Improve Outcomes

Quality of Healthcare

Chapter 2 The Forces of Change in Health Care

The Consequences of Forty Years of Health Care Cost Escalation

Medicare and Medicaid

The Chronic Disease Epidemic

Health Care Reform

Cost–Benefit Analysis and Cost Effectiveness Research

Electronic Medical Records (EMRs)

Health Promotion and Disease Prevention

Part 2: The Major Players in Health Care Services

Chapter 3 Providers of Health Care Services

Primary Care Physicians and Primary Care Assistants

Primary Care Physicians

Primary Care Assistants

Specialty Care Providers

Dentists, Dental Hygienists, and Dental Assistants

Mental Health Care Providers

Psychiatrists

Psychologists

Mental Health Clinical Nurses

Psychiatric Nurse Practitioners

Social Workers

Nurses

Radiologic and Imaging Professionals

Allied Health Rehabilitation Professionals

Collaboration in Healthcare

Employment Trends in the Healthcare Sector

Chapter 4 Hospitals

The History of Hospitals

The Management of Hospitals

Staffing

Horizontal and Vertical Integration of Hospitals

Quality and Safety in Hospitals

Magnet Recognition Programs

Challenges and the Future

Chapter 5 Ambulatory Care Services

History of Ambulatory Care Services

Reasons for the Expansion of Ambulatory Care

Institutionally–Based (Hospital–Based) Ambulatory Care

Non–Institutionally Based Ambulatory Care

Freestanding Emergency Centers and Urgent Care Centers

Retail Clinics

Ambulatory Surgery Centers

Primary Care Management

Home Health Care Services

Hospice

Working Towards Quality Assurance in Ambulatory Care

Chapter 6 Health Insurance

The Basics of Health Insurance in the United States

History of Health Insurance

How Health Insurance Markets Work

Blue Cross/Blue Shield

Medicare

Medicaid and the CHIP Program

State Health Insurance Exchanges

Reimbursement for Health Care Providers

Fee–For–Service

Capitation

Resource Based Relative Value Scale (RBRVS)

Pay for Performance (P4P)

Why Is Health Insurance Such a Large Problem in the United States?

The Creative Destruction of Health Insurance

Chapter 7 Managed Care

Concepts of Managed Care

History of Managed Health care

Types of Managed Care Plans

Health Maintenance Organizations (HMO)

Independent Practice Associations (IPA)

Preferred Provider Organizations (PPO)

Managed Care Utilization Control

Quality Issues in Managed Care

Managed Care Plans and Prevention of Disease

Comparative Effectiveness Research

Future of Managed Healthcare

Consumer Responsibility

Centers of Value

Prime Role For Primary Care

Chapter 8 Long–Term Care

The Aging of Americans

History of Long–Term care

Organization of Long–Term Care

Payment for Long–Term Care Services

Chronic Diseases and Their Complications

Challenges for Long–Term Care

Chapter 9 Mental Health Care

History of Mental Health

The Role of Stress

Types of Mental Illness

Psychotic Disorders

Non–Psychotic Disorders

Mood Disorders

Mental Health Parity

Chapter 10 Public Health Services

History of Public health

Structure of Public Health Departments

Determinants of Health

Health Disparities

Communicable and Chronic Disease Control

Core Functions of Public Health

Epidemiology and Public Health

Population–Based Health

Healthy People 2020

Health Promotion Programs

Public Health Leadership

The Future of Public Health

Part 3: Challenges in Health Care Delivery

Chapter 11 The Pursuit of Quality Care

Origins of the Quality Movement in Health Care Delivery

Institute of Medicine Report on Medical Errors (1999)

Institute of Medicine Report on the Quality Chasm

Quality Improvement Strategies

Medical Errors

Healthcare–Associated Infections

Chapter 12 The Chronic Disease Epidemic

Chronic Diseases and Their Complications

Heart Disease

Cancer

Stroke

Diabetes

Obesity as a Common Element in Chronic Diseases

The Costs of Chronic Diseases

Prevention and Changes to Behavioral Patterns

Applying Business and Other Models to the Prevention of Chronic Diseases

Prevention of Chronic Diseases

The Chronic Care Model

Business Models Applied to Chronic Diseases

Chapter 13 The Need for Leadership to Solve the Problems in Healthcare

Healthcare Reform

Reengineering the Healthcare Sector

Power in Healthcare

The Changing Healthcare Environment

Leadership

Trust

Outcomes

Prevention of Disease

Costs of Providing Healthcare

The Need to Empower Healthcare Employees

The Importance of the Organizational Structure in Healthcare

The Need for Innovation in Healthcare

Leadership As the Way to Meet These Challenges

Chapter 14 Integrating Clinical Services and Community Prevention: The Community–Centered Health Home Model

History of Clinical Services and Community Prevention Integration

The Importance of Community Prevention

Elements of the Community–Centered Health Home

Inquiry Elements

Aggregate Symptoms and Diagnosis Prevalence Data

Analysis Elements

Systematically Review Health and Safety Trends

Identify Priorities and Strategies With Community partners

Action Elements

Coordinate Activity with Community Partners

Advocate for Community Health

Mobilize Patient Populations

Strengthen Partnerships With Local Health Care Organizations

Establish Model Organizational Practices

Capacities Needed for Effective Implementation

Staff Training and Continuing Education

A Dedicated and Diverse Team

Innovative Leadership

Overarching Systems Change Recommendations

Structure Health Care Payment Systems to Support Community Prevention Activity

Align Data and Measurement Across Sectors

Strengthen and Utilize Networks Train Health Professionals to Work in CCHHs

Resources and Opportunities

Chapter 15 A Look into the Future

The Major Challenges Facing Healthcare Delivery

Physician Shortages

Quality of Healthcare Services

The Chronic Disease Epidemic

Pharmaceuticals

Medical Malpractice

Fraud and Waste in Healthcare Delivery

Accountable Care Organizations

Areas of Future Concern

Saving Medicare and Medicaid

Consolidation of Players

Strategies for Physician Employment

Health Policy Process

How To Meet These Challenges

Health Education Programs As a Potential Solution to Our Health Problems

Leadership Versus Management in Healthcare Services Delivery

Retail Clinics

Incentives Matter in the Health Care Sector

Case Study 1 Innovation in Physician Leadership Education

Case Study 2 The Use of Marketing Tools to Increase the Rate of Early Referrals to Physicians of Children With Developmental and Behavioral Disorders

Case Study 3 Fall Reduction at Geisinger Wyoming Valley Medical Center Above All, Do No Harm

Case Study 4 Reengineering Healthcare Delivery to Focus on Health Outcomes

Case Study 5 The Veterans Administration Re–Invents Itself 

 

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.