Jonas and kovner 11th edition pdf

Health Care Delivery in the United States

James R. Knickman Anthony R. Kovner Editors

Jonas & Kovner’s

11th Edition

Health Care Delivery in the United States James R. Knickman, PhD · Anthony R. Kovner, PhD Editors

Steven Jonas, MD, MPH, MS, FNYAS, Founding Editor

Knickm an

Kovner

Jonas & Kovner’s 11th Edition

11th Edition

9 780826 125279

ISBN 978-0-8261-2527-9

11 W. 42nd Street New York, NY 10036-8002 www.springerpub.com

“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

Brief Contents

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

Glossary 363

Index 379

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

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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 textbook@springerpub.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

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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

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v

Contents

LIST OF TABLES AND FIGURES xi

FOREWORD Sherry Glied xiii

ACKNOWLEDGMENTS xv

ORGANIZATION OF THIS BOOK xvii

CONTRIBUTORS xix

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

Contentsvi

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

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Contents vii

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

Understanding Vulnerable Populations and Th eir Context 150 Th e Growing Number of Vulnerable Populations 153 Organization and Financing of Health Care and Other Services for Vulnerable Populations 158 Social Service Needs 162 Federal and State Financing of Care for Vulnerable Populations 164 Challenges for Service Delivery and Payment 165 Emerging and Tested Ideas for Better Health Delivery 167 Conclusion 174 Discussion Questions 175 Case Study 176 References 176

PART III: MEDICAL CARE: TREATING AMERICANS’ MEDICAL PROBLEMS

CHAPTER 9 ORGANIZATION OF CARE 183 Amy Yarbrough Landry and Cathleen O. Erwin

Description of the Current Care Delivery System 184 Th e Future of the Delivery System 202 Best Practices 207 Looking Forward 208 Discussion Questions 209 Case Study 209 References 210

CHAPTER 10 THE HEALTH WORKFORCE 213 Joanne Spetz and Susan A. Chapman

Who Is Part of the Health Workforce? 214 Traditional Approaches to Health Workforce Planning 215 Health Workforce Education 216 Critical Issues for the Health Workforce 218 Conclusion: Building the Future Health Care Workforce 224

Contentsviii

Discussion Questions 224 Case Study 225 References 225

CHAPTER 11 HEALTH CARE FINANCING 231 James R. Knickman

General Overview of Health Care Financing 232 What the Money Buys and Where It Comes From 234 How Health Insurance Works 235 How Providers Are Paid for the Health Services Th ey Deliver 240 Specialized Payment Approaches Used by Payers 241 Issues Shaping the Future of Health Care Financing 244 Conclusion 249 Discussion Questions 250 Case Study 251 References 251

CHAPTER 12 HEALTH CARE COSTS AND VALUE 253 Thad Calabrese and Keith F. Safi an

Th e Issue of Health Care Spending Growth 254 Conclusion 269 Discussion Questions 269 Case Study 270 References 270

CHAPTER 13 HIGH-QUALITY HEALTH CARE 273 Carolyn M. Clancy and Irene Fraser

Defi ning Quality 274 How Are We Doing? 274 How Do We Improve Quality? 275 How Do We Incentivize Quality Care? 281 What Are Major Recent Developments Aff ecting Quality? 289 Core Competencies for Health Administrators 292 Conclusion 293 Discussion Questions 294 Case Study 294 References 295

CHAPTER 14 MANAGING AND GOVERNING HEALTH CARE ORGANIZATIONS 297 Anthony R. Kovner and Christy Harris Lemak

Governing Boards and Owners 298 Management Work 301 Conclusion 308 Discussion Questions 308 Case Study 309 References 309

Contents ix

CHAPTER 15 HEALTH INFORMATION TECHNOLOGY 311 Nirav R. Shah

HIT Defi ned 312 Th e Backing of Government 315 Transformative Powers of HIT 316 HIT at the VA 321 Th e New York Experience 322 Implementing HIT 323 Challenges and Shortcomings of HIT 324 Toward the Future 325 Discussion Questions 326 Case Study 327 References 327

PART IV: FUTURES

CHAPTER 16 THE FUTURE OF HEALTH CARE DELIVERY AND HEALTH POLICY 333 James R. Knickman and Anthony R. Kovner

Dynamics Infl uencing Change 334 Aspects of the Health System Th at Are Set to Change by 2020 335 Future Prospects for Diff erent Stakeholders in the Health Enterprise 339 Conclusion 341 Discussion Questions 341 Case Study 342 Bibliography 342

APPENDIX Major Provisions of the Patient Protection and Aff ordable Care Act of 2010 343

GLOSSARY 363

INDEX 379

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