“Health care managers, practitioners, and students must both operate as effectively as they can within the daunting and con- tinually evolving system at hand and identify opportunities for reform advances… Health Care Delivery in the United States has been an indispensable companion to those preparing to manage this balance. The present edition demonstrates once again why this volume has come to be so prized. It takes the long view – charting recent developments in health policy, and putting them side-by-side with descriptions and analysis of existing programs in the United States and abroad.”
—Sherry Glied, PhD, Dean and Professor of Public Service, NYU Wagner, From the Foreword
This fully updated and revised 11th edition of a highly esteemed survey and analysis of health care delivery in the United States keeps pace with the rapid changes that are reshaping our system. Fundamentally, this new edition presents the realities that impact our nation’s achievement of the so-called Triple Aim: better health and better care at a lower cost. It addresses challenges and responses to the Affordable Care Act (ACA), the implementation of Obamacare, and many new models of care designed to replace outmoded systems. Leading scholars, practitioners, and educators within population health and medical care present the most up-to-date evidence-based information on health disparities, vulnerable populations, and immigrant health; nursing workforce challenges; new information technology; preventive medicine; emerging approaches to control health care costs; and much more.
Designed for graduate and advanced undergraduate students of health care management and administration and public health, the text addresses all of the complex core issues surrounding our health care system in a strikingly readable and accessible format. Contributors provide an in-depth and objective appraisal of why and how we organize health care the way we do, the enormous impact of health-related behaviors on the structure, function, and cost of the health care delivery system, and other emerging and recurrent issues in health policy, health care management, and public health. The 11th edition features the writings of such luminaries as Michael K. Gusmanno, Carolyn M. Clancy, Joanne Spetz, Nirav R. Shah, Michael S. Sparer, and Christy Harris Lemak, among others. Chapters include key words, learning objectives and competencies, discussion questions, case studies, and new charts and tables with concrete health care data. Included for instructors is an Instructor’s Manual, PowerPoint slides, Syllabus, Test Bank, Image Bank, Supplemental e-chapter on the ACA, and a transition guide bridging the 10th and 11th editions.
Key Features: • Integration of the ACA throughout the text, including
a supplementary e-chapter devoted to this major health care policy innovation
• The implementation of Obamacare • Combines acute and chronic care into organizations
of medical care • Nursing workforce challenges • Health disparities, vulnerable populations, and
immigrant health • Strategies to achieve the Triple Aim (better health and
better care at lower cost)
• New models of care including accountable care organizations (ACOs), patient homes, health exchanges, and integrated health systems
• Emerging societal efforts toward creating healthy environments and illness prevention
• Increasing incentives for efficiency and better quality of care
• Expanded discussion of information technology • A new 5-year trend forecast
Jonas & Kovner’s Health Care Delivery in the United States
Jonas & Kovner’s
Health Care Delivery in the United States
PART I: HEALTH POLICY
Chapter 1 The Challenge of Health Care Delivery and Health Policy 3
Chapter 2 A Visual Overview of Health Care Delivery in the United States 13
Chapter 3 Government and Health Insurance: The Policy Process 29
Chapter 4 Comparative Health Systems 53
PART II: KEEPING AMERICANS HEALTHY
Chapter 5 Population Health 79
Chapter 6 Public Health: A Transformation for the 21st Century 99
Chapter 7 Health and Behavior 119
Chapter 8 Vulnerable Populations: A Tale of Two Nations 149
PART III: MEDICAL CARE: TREATING AMERICANS’ MEDICAL PROBLEMS
Chapter 9 Organization of Care 183
Chapter 10 The Health Workforce 213
Chapter 11 Health Care Financing 231
Chapter 12 Health Care Costs and Value 253
Chapter 13 High-Quality Health Care 273
Chapter 14 Managing and Governing Health Care Organizations 297
Chapter 15 Health Information Technology 311
PART IV: FUTURES
Chapter 16 The Future of Health Care Delivery and Health Policy 333
Appendix Major Provisions of the Patient Protection and Affordable Care Act of 2010 343
James R. Knickman, PhD, is president and chief executive offi cer of the New York State Health Foundation (NYSHealth), a private foundation dedicated to improving the health of all New Yorkers, especially the most vulnerable. Under Dr. Knickman’s leadership, NYSHealth has invested more than $90 million since 2006 in initiatives to improve health care and the public health system in New York state. Central to the foundation’s mission is a commitment to sharing the results and lessons of its grantmaking; informing policy and practice through timely, credible analysis and commentary; and serving as a neutral convener of health care leaders and stakeholders throughout New York. Before joining NYSHealth, Dr. Knickman was vice president of research and evaluation, Robert Wood Johnson Foundation, and served on the faculty of New York University’s Robert F. Wagner Graduate School of Public Service. He serves on numerous boards, including the National Council on Aging and Philanthropy New York.
Anthony R. Kovner, PhD, is professor of management at New York University’s Robert F. Wagner Graduate School of Public Service. He has directed the executive MPA in manage- ment, the concentration for nurse leaders, the program in health policy and management, and the advanced management program for clinicians at NYU/Wagner. He was a senior program consultant to the Robert Wood Johnson Foundation’s rural hospital program and was senior health consultant to the United Autoworkers Union. He served as a manager for 12 years in all, in a large community health center, a nursing home, an academic faculty practice, and as CEO at a community hospital. Professor Kovner is the author or editor, with others, of 11 books, 48 peer-reviewed articles, and 33 published case studies. He was the fourth recipient, in 1999, of the Filerman Prize for Educational Leadership from the Association of University Programs in Health Administration.
Jonas & Kovner’s
Health Care Delivery in the United States 11th Edition
James R. Knickman, PhD Anthony R. Kovner, PhD Editors
Steven Jonas, MD, MPH, MS, FNYAS Founding Editor
Copyright © 2015 Springer Publishing Company, LLC
All rights reserved.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, elec- tronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, LLC, or authorization through payment of the appropriate fees to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, firstname.lastname@example.org or on the Web at www.copyright.com.
Springer Publishing Company, LLC 11 West 42nd Street New York, NY 10036 www.springerpub.com
Acquisitions Editor: Sheri W. Sussman Composition: Exeter Premedia Services Private Ltd.
ISBN: 978-0-8261-2527-9 e-book ISBN: 978-0-8261-2529-3
For Professors: Instructors’ Manual: ISBN 978-0-8261-7155-9 Transition Guide for the 11th Edition: ISBN 978-0-8261-2628-3 Test Bank: ISBN 978-0-8261-7159-7 PowerPoints: ISBN 978-0-8261-7157-3 Syllabus: ISBN 978-0-8261-7158-0 Please email email@example.com to request these fi les.
For Students: Visit ushealthcaredelivery.com for additional materials including an update on the Aff ordable Care Act.
15 16 17 18 / 5 4 3 2 1
Th e author and the publisher of this Work have made every eff ort to use sources believed to be reliable to provide information that is accurate and compatible with the standards generally accepted at the time of publication. Th e author and publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reli- ance on, the information contained in this book. Th e publisher has no responsibility for the persistence or accuracy of URLs for external or third-party Internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.
Library of Congress Cataloging-in-Publication Data
Jonas and Kovner’s health care delivery in the United States / [edited by] James R. Knickman, Anthony R. Kovner.—11th edition. p. ; cm. Health care delivery in the United States Editors’ names reversed on the previous edition. Preceded by: Jonas & Kovner’s health care delivery in the United States. Includes bibliographical references and index. ISBN 978-0-8261-2527-9—ISBN 978-0-8261-2529-3 (e-book) I. Knickman, James, editor. II. Kovner, Anthony R., editor. III. Title: Health care delivery in the United States. [DNLM: 1. Delivery of Health Care—United States. 2. Health Policy—United States. 3. Health Services—United States. 4. Quality of Health Care—United States. W 84 AA1] RA395.A3 362.10973—dc23 2014045558
Special discounts on bulk quantities of our books are available to corporations, professional associations, pharmaceutical companies, health care organizations, and other qualifying groups. If you are interested in a custom book, including chapters from more than one of our titles, we can provide that service as well.
For details, please contact: Special Sales Department, Springer Publishing Company, LLC 11 West 42nd Street, 15th Floor, New York, NY 10036-8002 Phone: 877-687-7476 or 212-431-4370; Fax: 212-941-7842 E-mail: firstname.lastname@example.org
Printed in the United States of America by Bradford and Bigelow.
LIST OF TABLES AND FIGURES xi
FOREWORD Sherry Glied xiii
ORGANIZATION OF THIS BOOK xvii
PART I: HEALTH POLICY
CHAPTER 1 THE CHALLENGE OF HEALTH CARE DELIVERY AND HEALTH POLICY 3 James R. Knickman and Anthony R. Kovner
Context 3 Th e Importance of Good Health to American Life 4 Defi ning Characteristics of the U.S. Health System 5 Major Issues and Concerns 6 Key Stakeholders Infl uencing the Health System 8 Organization of Th is Book 11 Discussion Questions 12 Case Study 12 Bibliography 12
CHAPTER 2 A VISUAL OVERVIEW OF HEALTH CARE DELIVERY IN THE UNITED STATES 13 Catherine K. Dangremond
Th e U.S. Health Care System: A Period of Change 13 Th e Shared Responsibility for Health Care 14 Where the Money Comes From, and How It Is Used 16 A Comparative Perspective 16 Population Health: Beyond Health Care 17 Access to Care and Variation in Health Outcomes 19 Health and Behavior 20 Th e Health Care Workforce 21 Variations in Health Care Delivery 22 Health Care Quality 23 Health Care Cost and Value 24 Th e Future of Health Care Delivery 26 References 27
SHARE JONAS & KOVNER ’S HEALTH CARE DELIVERY IN THE UNITED STATES: 11th EDITION
CHAPTER 3 GOVERNMENT AND HEALTH INSURANCE: THE POLICY PROCESS 29 Michael S. Sparer and Frank J. Thompson
Context 29 Th e Government as Payer: Th e Health Insurance Safety Net 30 Government and Health Insurance: Th e Policy Process 41 Conclusion 49 Discussion Questions 49 Case Study 50 References 50
CHAPTER 4 COMPARATIVE HEALTH SYSTEMS 53 Michael K. Gusmano and Victor G. Rodwin
Overview 53 Health System Models 55 NHS and NHI Systems Compared With the United States 57 Th e Health Systems in England, Canada, France, and China 58 Lessons 70 Discussion Questions 71 Case Study 72 References 72
PART II: KEEPING AMERICANS HEALTHY
CHAPTER 5 POPULATION HEALTH 79 Pamela G. Russo
Context 79 Th e Population Health Model 80 Th e Medical Model 82 Comparing the Medical and Population Health Models 83 Th e Infl uence of Social Determinants on Health Behavior and Outcomes 85 Leading Determinants of Health: Weighting the Diff erent Domains 89 Health Policy and Returns on Investment 90 Conclusion 94 Discussion Questions 95 Case Study 96 References 97
CHAPTER 6 PUBLIC HEALTH: A TRANSFORMATION FOR THE 21ST CENTURY 99 Laura C. Leviton, Paul L. Kuehnert, and Kathryn E. Wehr
Who s in Charge of Public Health? 99 A Healthy Population Is in the Public Interest 102 Core Functions of Public Health 106 Governmental Authority and Services 108 Rethinking Public Health for the 21st Century 112 Discussion Questions 116 Case Study 117 References 117
CHAPTER 7 HEALTH AND BEHAVIOR 119 Elaine F. Cassidy, Matthew D. Trujillo, and C. Tracy Orleans
Behavioral Risk Factors: Overview and National Goals 120 Changing Health Behavior: Closing the Gap Between Recommended and Actual Health Lifestyle Practices 126 Changing Provider Behavior: Closing the Gap Between Best Practice and Usual Care 137 Conclusion 142 Discussion Questions 143 Case Study 144 References 144
CHAPTER 8 VULNERABLE POPULATIONS: A TALE OF TWO NATIONS 149 Jacqueline Martinez Garcel, Elizabeth A. Ward, and Lourdes J. Rodríguez