Health Care System in Place in Massachusetts Essay

Basics of the U.S. Health Care System Third Edition Nancy J. Niles, PhD, MPH, MS, MBA Associate Professor, Rollins College, Winter Park, Florida World Headquarters Jones & Bartlett Learning 5 Wall Street Burlington, MA 01803 978-443-5000 info@jblearning.com 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 specialsales@jblearning.com. Copyright © 2018 by Jones & Bartlett Learning, LLC, an Ascend Learning Company All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner. The content, statements, views, and opinions herein are the sole expression of the respective authors and not that of Jones & Bartlett Learning, LLC. Reference herein to any specific commercial product, process, or service by trade name, trademark, manufacturer, or otherwise does not constitute or imply its endorsement or recommendation by Jones & Bartlett Learning, LLC and such reference shall not be used for advertising or product endorsement purposes. All trademarks displayed are the trademarks of the parties noted herein. Basics of the U.S. Health Care System, Third 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. Health Care System in Place in Massachusetts Essay

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. 10300-7 Production Credits VP, Executive Publisher: David D. Cella Publisher: Michael Brown Associate Editor: Lindsey Mawhiney Associate Editor: Danielle Bessette Production Manager: Carolyn Rogers Pershouse Senior Vendor Manager: Tracey McCrea Vendor Manager: Juna Abrams Senior Marketing Manager: Sophie Fleck Teague Manufacturing and Inventory Control Supervisor: Amy Bacus Composition and Project Management: Integra Software Services Pvt. Ltd. Cover Design: Kristin Parker Rights & Media Specialist: Merideth Tumasz Media Development Editor: Shannon Sheehan Cover Images: Blood Pressure: © verbaska/Shutterstock; Walker: © Tyler Olson/Shutterstock; Hospital: © Steve Design/ Shutterstock; MRI: © sfam_photo/Shutterstock Printing and Binding: Edwards Brothers Malloy Cover Printing: Edwards Brothers Malloy Library of Congress Cataloging-in-Publication Data Names: Niles, Nancy J., author. Title: Basics of the U.S. health care system / Nancy Niles. Description: Third edition. | Burlington, MA : Jones & Bartlett Learning, [2018] | Includes bibliographical references and index. Identifiers: LCCN 2016045762 | ISBN 9781284102888(pbk.) Subjects: | MESH: Delivery of Health Care | Insurance, Health | National Health Programs | United States Classification: LCC RA445 | NLM W 84 AA1 | DDC 362.1–dc23 LC record available at https://lccn.loc.gov/2016045762 6048 Printed in the United States of America 20 19 18 17 16 10 9 8 7 6 5 4 3 2 1 Hospital: © Steve Design/Shutterstock; Blood Pressure: © verbaska/Shutterstock; MRI: © sfam_photo/Shutterstock Brief Contents About the Author viii Acknowledgmentsix Prefacex Chapter 1 History of the U.S. Healthcare System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Chapter 12 Chapter 13 Chapter 14 Impact of the Affordable Care Act on Healthcare Services . . . . . . . . . . . . . 29 Current Operations of the Healthcare System. . . . . . . . . . . . . . . . . . . . . . . . 57 Government’s Role in U.S. Health Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Public Health’s Role in Health Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Inpatient and Outpatient Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 U. S. Healthcare Workforce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Health Care System in Place in Massachusetts Essay

Healthcare Financing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 Managed Care Impact on Healthcare Delivery. . . . . . . . . . . . . . . . . . . . . . 229 Information Technology Impact on Health Care. . . . . . . . . . . . . . . . . . . . . 251 Healthcare Law. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277 Healthcare Ethics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 308 Mental Health Issues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338 Analysis of the U.S. Healthcare System. . . . . . . . . . . . . . . . . . . . . . . . . . . . 367 Glossary397 Index421 iii Hospital: © Steve Design/Shutterstock; Blood Pressure: © verbaska/Shutterstock; MRI: © sfam_photo/Shutterstock Contents About the Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x Chapter 1 History of the U.S. Healthcare System . . . . . . . . . . . . . . . . . . . . . . . . . 1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Consumer Perspective on Health Care . . . . . . . . . . . . . . 3 Milestones of the Hospital System . . . . . . . . . . . . . . . . . . 8 Milestones of Public Health. . . . . . . . . . . . . . . . . . . . . . . . . 9 Milestones of the Health Insurance System . . . . . . . . 10 Current System Operations . . . . . . . . . . . . . . . . . . . . . . . . 12 Assessing Your Healthcare System Using the Iron Triangle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Vocabulary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Student Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Chapter 2 Impact of the Affordable Care Act on Healthcare Services. . . . . . . . . . . 29 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Legal Issues with the Affordable Care Act . . . . . . . . . . Major Provisions of the Affordable Care Act . . . . . . . . Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Vocabulary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Student Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 30 31 40 41 42 44 45 Chapter 3 Current Operations of the Healthcare System . . . . . . . . . . . . . . 57 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Overview of the Current System Update. . . . . . . . . . . 58 Major Stakeholders in the Healthcare Industry . . . . . 58 iv Stakeholders’ Environment. . . . . . . . . . . . . . . . . . . . . . . . . Healthcare Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Vocabulary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Student Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 62 77 78 78 79 80 Chapter 4 Government’s Role in U.S. Health Care. . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 History of the Role of Government in Health Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 U.S. Government Agencies. . . . . . . . . . . . . . . . . . . . . . . . . 92 Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Vocabulary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Student Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Chapter 5 Public Health’s Role in Health Care . . . . . . . . . . . . . . . . . . . 114 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . What Is Health?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Origins of Public Health. . . . . . . . . . . . . . . . . . . . . . . . . . . What Is Public Health?. . . . . . . . . . . . . . . . . . . . . . . . . . . . The Epidemiology Triangle. . . . . . . . . . . . . . . . . . . . . . . . Epidemiologic Surveillance. . . . . . . . . . . . . . . . . . . . . . . Environmental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . Emergency Preparedness. . . . . . . . . . . . . . . . . . . . . . . . . State and Local Response to Disasters. . . . . . . . . . . . . Bioterrorism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Public Health Functions and Administration. . . . . . . Healthy People Reports. . . . . . . . . . . . . . . . . . . . . . . . . . . Public Health Infrastructure. . . . . . . . . . . . . . . . . . . . . . . Public Health Education and Health Promotion . . . 115 115 117 117 118 118 119 119 121 122 123 124 124 128 Contents Collaboration of Public Health and Private Medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Vocabulary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Student Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 129 130 131 133 134 Chapter 6 Inpatient and Outpatient Services. . . . . . . . . . . . . . . . . . . . . . . 146 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . History of Hospitals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hospital Types by Ownership. . . . . . . . . . . . . . . . . . . . . Hospital Types by Specialty . . . . . . . . . . . . . . . . . . . . . . . Other Hospital Classifications. . . . . . . . . . . . . . . . . . . . . Hospital Governance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hospital Licensure, Certification, and Accreditation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Care System in Place in Massachusetts Essay

Patient Rights. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Current Status of Hospitals. . . . . . . . . . . . . . . . . . . . . . . . Outpatient Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Health Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Vocabulary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Student Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 147 148 148 148 149 150 150 150 152 154 157 157 158 160 161 Chapter 7 U.S. Healthcare Workforce. . . . . . . 173 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Primary, Secondary, and Tertiary Care . . . . . . . . . . . . . Physician Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Generalists and Specialists. . . . . . . . . . . . . . . . . . . . . . . . Differences Between Primary and Specialty Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Types of Healthcare Providers. . . . . . . . . . . . . . . . . . . . . Other Independent Healthcare Professionals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Allied Health Professionals. . . . . . . . . . . . . . . . . . . . . . . . Non-CAAHEP Allied Health Professionals. . . . . . . . . . Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Vocabulary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 174 174 175 175 176 178 180 183 184 185 185 v Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 Student Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188 Chapter 8 Healthcare Financing. . . . . . . . . . . 200 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Healthcare Spending by Service Type. . . . . . . . . . . . . Healthcare Spending by Sources of Funds . . . . . . . . Health Insurance as a Payer for Healthcare Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Types of Health Insurance . . . . . . . . . . . . . . . . . . . . . . . . Cost Sharing of Health Services. . . . . . . . . . . . . . . . . . . Types of Health Insurance Plans. . . . . . . . . . . . . . . . . . . Public Financing of Healthcare Services. . . . . . . . . . . Reimbursement Methods of Private Health Insurance Plans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Governmental Reimbursement Methods for Healthcare Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Healthcare Financial Management. . . . . . . . . . . . . . . . Funds Disbursement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Vocabulary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Student Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 201 202 202 203 203 204 206 209 210 213 213 213 214 214 216 217 Chapter 9 Managed Care Impact on Healthcare Delivery . . . . . . . . . . . . 229 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . History of Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . The Managed Care Organization Payment Plan. . . …