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Making novel use of the sociology of organizations and pragmatic philosophy, Irwin Miller sheds new light on the nature and evolution of both the Blues and American health care voluntarism and reform. He shows how Walter McNerney, one of the primary health policy shapers over the past forty years, used ideological and utopian rhetoric to help move Blue Cross into HMO development. This case study of institutional and leadership behavior uses firsthand interviews, archival documents, oral histories, and other materials to present an unusually concrete and readable narrative account as to how health care leaders engage in creative institution building, or health care reform.
Reinventing American Health Care by Ezekiel J. Emanuel Pdf
The definitive story of American health care today -- its causes, consequences, and confusions. In March 2010, the Affordable Care Act was signed into law. It was the most extensive reform of America's health care system since at least the creation of Medicare in 1965, and maybe ever. The ACA was controversial and highly political, and the law faced legal challenges reaching all the way to the Supreme Court; it even precipitated a government shutdown. It was a signature piece of legislation for President Obama's first term, and also a ball and chain for his second. Ezekiel J. Emanuel, a professor of medical ethics and health policy at the University of Pennsylvania who also served as a special adviser to the White House on health care reform, has written a brilliant diagnostic explanation of why health care in America has become such a divisive social issue, how money and medicine have their own -- quite distinct -- American story, and why reform has bedeviled presidents of the left and right for more than one hundred years. Emanuel also explains exactly how the ACA reforms are reshaping the health care system now. He forecasts the future, identifying six mega trends in health that will determine the market for health care to 2020 and beyond. His predictions are bold, provocative, and uniquely well-informed. Health care -- one of America's largest employment sectors, with an economy the size of the GDP of France -- has never had a more comprehensive or authoritative interpreter.
The Economic Evolution of American Health Care by David Dranove Pdf
The American health care industry has undergone such dizzying transformations since the 1960s that many patients have lost confidence in a system they find too impersonal and ineffectual. Is their distrust justified and can confidence be restored? David Dranove, a leading health care economist, tackles these and other key questions in the first major economic and historical investigation of the field. Focusing on the doctor-patient relationship, he begins with the era of the independently practicing physician--epitomized by Marcus Welby, the beloved father figure/doctor in the 1960s television show of the same name--who disappeared with the growth of managed care. Dranove guides consumers in understanding the rapid developments of the health care industry and offers timely policy recommendations for reforming managed care as well as advice for patients making health care decisions. The book covers everything from start-up troubles with the first managed care organizations to attempts at government regulation to the mergers and quality control issues facing MCOs today. It also reflects on how difficult it is for patients to shop for medical care. Up until the 1970s, patients looked to autonomous physicians for recommendations on procedures and hospitals--a process that relied more on the patient's trust of the physician than on facts, and resulted in skyrocketing medical costs. Newly emerging MCOs have tried to solve the shopping problem by tracking the performance of care providers while obtaining discounts for their clients. Many observers accuse MCOs of caring more about cost than quality, and argue for government regulation. Dranove, however, believes that market forces can eventually achieve quality care and cost control. But first, MCOs must improve their ways of measuring provider performance, medical records must be made more complete and accessible (a task that need not compromise patient confidentiality), and patients must be willing to seek and act on information about the best care available. Dranove argues that patients can regain confidence in the medical system, and even come to trust MCOs, but they will need to rely on both their individual doctors and their own consumer awareness.
A comprehensive history of sickness, health, and medicine in America from Colonial times to the present. In Health Care in America, historian John C. Burnham describes changes over four centuries of medicine and public health in America. Beginning with seventeenth-century concerns over personal and neighborhood illnesses, Burnham concludes with the arrival of a new epoch in American medicine and health care at the turn of the twenty-first century. From the 1600s through the 1990s, Americans turned to a variety of healers, practices, and institutions in their efforts to prevent and survive epidemics of smallpox, yellow fever, cholera, influenza, polio, and AIDS. Health care workers in all periods attended births and deaths and cared for people who had injuries, disabilities, and chronic diseases. Drawing on primary sources, classic scholarship, and a vast body of recent literature in the history of medicine and public health, Burnham finds that traditional healing, care, and medicine dominated the United States until the late nineteenth century, when antiseptic/aseptic surgery and germ theory initiated an intellectual, social, and technical transformation. He divides the age of modern medicine into several eras: physiological medicine (1910s–1930s), antibiotics (1930s–1950s), technology (1950s–1960s), environmental medicine (1970s–1980s), and, beginning around 1990, genetic medicine. The cumulating developments in each era led to today's radically altered doctor-patient relationship and the insistent questions that swirl around the financial cost of health care. Burnham's sweeping narrative makes sense of medical practice, medical research, and human frailties and foibles, opening the door to a new understanding of our current concerns.
Ensuring America's Health by Christy Ford Chapin Pdf
This book provides an in-depth evaluation of the U.S. health care system's development in the twentieth century. It shows how a unique economic design - the insurance company model - came to dominate health care, bringing with it high costs; corporate medicine; and fragmented, poorly distributed care.
A history of the Blue Cross and Blue Shield system, America's largest and oldest health insurer, from its beginnings to the 1990s. It draws on company archives and shows how its management has pursued the goal of health care coverage over seven decades of social and economic change.
The Private Regulation of American Health Care by Betty Leyerle Pdf
I will begin this book by analyzing the historical and political context for the emergence of managed competition (chapter 1). The chapters that follow will list the corporate initiatives that were launched during the 1970s (chapter 2); describe the evolutionary changes and expansions they went through during the 1980s and early 1990s in the process of becoming "managed competition" (chapter 3); describe the ways in which managed care systems attempt to regulate the cost of health care services and discuss why they fail to do so (chapter 4); describe managed care attempts to control the quality of services and discuss why they fail to do so (chapter 5); and conclude with a summary of the book's major points as well as descriptions of some alternative approaches to getting our nation's health care needs met (chapter 6).
Medicare Prospective Payment and the Shaping of U.S. Health Care by Rick Mayes,Robert A. Berenson Pdf
This is the definitive work on Medicare’s prospective payment system (PPS), which had its origins in the 1972 Social Security Amendments, was first applied to hospitals in 1983, and came to fruition with the Balanced Budget Act of 1997. Here, Rick Mayes and Robert A. Berenson, M.D., explain how Medicare’s innovative payment system triggered shifts in power away from the providers (hospitals and doctors) to the payers (government insurers and employers) and how providers have responded to encroachments on their professional and financial autonomy. They conclude with a discussion of the problems with the Medicare Modernization Act of 2003 and offer prescriptions for how policy makers can use Medicare payment policy to drive improvements in the U.S. health care system. Mayes and Berenson draw from interviews with more than sixty-five major policy makers—including former Treasury secretary Robert Rubin, U.S. Representatives Pete Stark and Henry Waxman, former White House chief of staff Leon Panetta, and former administrators of the Health Care Financing Administration Gail Wilensky, Bruce Vladeck, Nancy-Ann DeParle, and Tom Scully—to explore how this payment system worked and its significant effects on the U.S. medical landscape in the past twenty years. They argue that, although managed care was an important agent of change in the 1990s, the private sector has not been the major health care innovator in the United States; rather, Medicare’s transition to PPS both initiated and repeatedly intensified the economic restructuring of the U.S. health care system.
Encyclopedia of Health Services Research by Ross M. Mullner Pdf
Today, as never before, healthcare has the ability to enhance the quality and duration of life. At the same time, healthcare has become so costly that it can easily bankrupt governments and impoverish individuals and families. Health services research is a highly multidisciplinary field, including such areas as health administration, health economics, medical sociology, medicine, , political science, public health, and public policy. The Encyclopedia of Health Services Research is the first single reference source to capture the diversity and complexity of the field. With more than 400 entries, these two volumes investigate the relationship between the factors of cost, quality, and access to healthcare and their impact upon medical outcomes such as death, disability, disease, discomfort, and dissatisfaction with care. Key Features Examines the growing healthcare crisis facing the United States Encompasses the structure, process, and outcomes of healthcare Aims to improve the equity, efficiency, effectiveness, and safety of healthcare by influencing and developing public policies Describes healthcare systems and issues from around the globe Key Themes Access to Care Accreditation, Associations, Foundations, and Research Organizations Biographies of Current and Past Leaders Cost of Care, Economics, Finance, and Payment Mechanisms Disease, Disability, Health, and Health Behavior Government and International Healthcare Organizations Health Insurance Health Professionals and Healthcare Organizations Health Services Research Laws, Regulations, and Ethics Measurement; Data Sources and Coding; and Research Methods Outcomes of Care Policy Issues, Healthcare Reform, and International Comparisons Public Health Quality and Safety of Care Special and Vulnerable Groups The Encyclopedia is designed to be an introduction to the various topics of health services research for an audience including undergraduate students, graduate students, andgeneral readers seeking non-technical descriptions of the field and its practices. It is also useful for healthcare practitioners wishing to stay abreast of the changes and updates in the field.
Health Care Policy and Politics A to Z by Julie Rovner Pdf
Drawing on over two decades of experience covering health policy on Capitol Hill, National Public Radio journalist Julie Rovner has written explanations for over 300 key concepts to demystify the world of health care policy in the United States. The third edition of Health Care Policy and Politics A to Z has been completely updated and now includes many new entries. Readers will find updated information on long term health care spending, abortion, Medicaid and Medicare, health insurance and the uninsured, and the State Childrens Health Insurance Program (SCHIP). New entries reflect important changes in recent years and include the Medicare Modernization Act, abstinence education, electronic health records, health savings accounts, Plan B, the Presidents Emergency Plan for AIDS Relief (PEPFAR), and Project BioShield.
"Drawing upon a wealth of research, Coombs compares HMOs throughout the nation with the one in Marshfield, which came as close as any HMO to realizing the ideal of early advocates. This book is a resource for specialists in the fields of health policy research and analysis, health care management, health law and politics, public health, and social and organizational history of medicine. It will also appeal to many readers who are disturbed by the current stae of America's health care system and are curious about its future."--BOOK JACKET.
Guide to U.S. Health and Health Care Policy by Thomas R. Oliver Pdf
Guide to U.S. Health and Health Care Policy provides the analytical connections showing students how issues and actions are translated into public policies and institutions for resolving or managing health care issues and crises, such as the recent attempt to reform the national health care system. The Guide highlights the decision-making cycle that requires the cooperation of government, business, and an informed citizenry in order to achieve a comprehensive approach to advancing the nation’s health care policies. Through 30 topical, operational, and relational essays, the book addresses the development of the U.S. health care system and policies, the federal agencies and public and private organizations that frame and administer those policies, and the challenges of balancing the nation’s health care needs with the rising costs of medical research, cost-effective treatment, and adequate health insurance. Key Features: The 30 topical essays investigate the fundamental political, social, economic, and procedural initiatives that drive health and health care policy decisions affecting Americans at the local, regional, and national levels Essential themes traced throughout the chapters include providing access to health care, national and international intervention, nutrition and health, human and financial resource allocation, freedom of religion versus public policy, discrimination and health care policy, universal health care coverage, private health care versus publicly funded health care, and the immediate and long-term costs associated with disease prevention, treatment, and health maintenance A Glossary of Key Health Care Policy Terms and Events, a selected Master Bibliography, and a thorough Index are included. This must-have reference for political science and public policy students who seek to understand the issues affecting health care policy in the U.S. is suitable for academic, public, high school, government, and professional libraries.
The Law and American Health Care by Kenneth R. Wing,Michael S. Jacobs,Patricia C. Kuszler Pdf
This casebook concentrates on the main issue dominating the health care industry today -- finance. Authors Wing, Jacobs, and Kuszler keep their discussion lively and relevant by introducing topics other books ignore, such as bioethics, antitrust, fraud and abuse, white collar crime in health law, and health care reform. By treating health care as a regulated industry with strong social policy implications, "The Law and American Health Care" effectively conveys the necessary legal knowledge as well as the distinct professional character and tortuous history of the field. After an introductory chapter sets the stage, the authors confront today's hottest topics: -- Health Care Financing: Who Pays for Health Care? -- Health Care Facilities: Regulation, Reimbursement, and Cost Containment -- Regulation and Reimbursement of Physicians and Other Individual Health Care Providers -- Individual and Institutional Liability for Malpractice -- Antitrust -- Fraud and Abuse -- White Collar Crime in Health Care -- Integrating Financing, Delivery, and Management of Health Care -- Health Care Reform in the 1990s A well-balanced mix of cases, problems, questions, and notes lead students through the material: -- A generous selection of recent cases demonstrate the real-life consequences of issues under discussion -- Problems stimulate class debate and can also be used on exams Throughout the book, the authors highlight issues of underlying policy and actual practice in the field. The accompanying Teacher's Manual helps instructors choose material to meet individual course needs.
Dying in the City of the Blues by Keith Wailoo Pdf
This groundbreaking book chronicles the history of sickle cell anemia in the United States, tracing its transformation from an "invisible" malady to a powerful, yet contested, cultural symbol of African American pain and suffering. Set in Memphis, home of one of the nation's first sickle cell clinics, Dying in the City of the Blues reveals how the recognition, treatment, social understanding, and symbolism of the disease evolved in the twentieth century, shaped by the politics of race, region, health care, and biomedicine. Using medical journals, patients' accounts, black newspapers, blues lyrics, and many other sources, Keith Wailoo follows the disease and its sufferers from the early days of obscurity before sickle cell's "discovery" by Western medicine; through its rise to clinical, scientific, and social prominence in the 1950s; to its politicization in the 1970s and 1980s. Looking forward, he considers the consequences of managed care on the politics of disease in the twenty-first century. A rich and multilayered narrative, Dying in the City of the Blues offers valuable new insight into the African American experience, the impact of race relations and ideologies on health care, and the politics of science, medicine, and disease.