Healthcare in the United States: Navigating the Basics of a Complex System

297 Pages·2022·20.994 MB·English

by  Deanna L. Howe, Andrea L. Dozier, Sheree O. Dickenson

Healthcare in the
United States
Navigating the Basics of a Complex System
Deanna L. Howe | Andrea L. Dozier | Sheree O. Dickenson
Blue Ridge | Cumming | Dahlonega | Gainesville | Oconee
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ISBN: 978-1-940771-91-5
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T C
ABLE OF ONTENT S
Acknowledgements ix
PrefAce xi
introduction 1
1.1 Learning Objectives......................................1
1.2 Key Terms..............................................1
1.3 Healthcare System Defined .............................. 2
1.4 History of the U.S. Healthcare System..................... 5
1.5 Timeline of Important Healthcare Events................. 16
1.6 Summary............................................. 16
1.7 Review Questions...................................... 16
References ...............................................17
overview of HeAltH 20
2.1 Learning Objectives.................................... 20
2.2 Key Terms............................................ 20
2.3 Introduction.......................................... 21
2.4 How is Health Defined? ................................ 21
2.5 How is Health Status Measured? ........................ 29
2.6 How Can We Improve Health in the U.S.?................. 39
2.7 Summary ............................................ 40
2.8 Review Questions ..................................... 41
2.9 References ........................................... 41
HeAltHcAre workforce 46
3.1 Learning Objectives.................................... 46
3.2 Key Terms............................................ 46
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3.3 Introduction.......................................... 47
3.4 Physicians............................................ 47
3.5 Advanced Practice Providers............................ 49
3.6 Registered Nurses..................................... 54
3.7 Licensed Practical/Vocational Nurses (LPN/LVN) ......... 57
3.8 Other Assistant Healthcare Workers..................... 58
3.9 Allied Health Professionals............................. 58
3.10 Other Doctoral Level Providers ........................ 64
3.11 Other Healthcare Occupations...........................71
3.12 Gender Pay Gap ...................................... 72
3.13 Impact of COVID-19 on the Healthcare Workforce ........ 72
3.14 Summary ........................................... 74
3.15 Review Questions .................................... 74
3.16 References .......................................... 74
HeAltHcAre settings 80
4.1 Learning Objectives.................................... 80
4.2 Key Terms ........................................... 80
4.3 Introduction.......................................... 81
4.4 Defining Healthcare Services ........................... 81
4.5 Inpatient Healthcare .................................. 82
4.6 Outpatient Healthcare ................................. 91
4.7 Summary ........................................... 100
4.8 Review Questions .................................... 101
4.9 References .......................................... 101
federAl And stAte funded HeAltHcAre 104
5.1 Learning Objectives................................... 104
5.2 Key Terms........................................... 104
5.3 Introduction......................................... 105
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5.4 Federally-Funded Healthcare .......................... 105
5.5 Joint Federal/State Funded Healthcare.................. 109
5.6 Federally Funded Organizations for the Promotion of Health 115
5.7 Summary............................................ 120
5.8 Review Questions .................................... 120
5.9 References ...........................................121
PrivAte insurAnce 124
6.1 Learning Objectives................................... 124
6.2 Key Terms .......................................... 124
6.3 Introduction......................................... 125
6.4 Fee-for-Service ...................................... 125
6.5 Private Insurance .................................... 125
6.6 Managed Care Background ............................ 126
6.7 Managed Care Organizations .......................... 126
6.8 Types of Managed Care Organizations................... 127
6.9 Which Type of Healthcare Plan is Right for You? ..........131
6.10 Workers’ Compensation Insurance .................... 132
6.11 Summary........................................... 135
6.12 Review Questions ................................... 136
6.13 References ......................................... 136
sPeciAl PoPulAtions 138
7.1 Learning Objectives................................... 138
7.2 Key Terms........................................... 138
7.3 Introduction......................................... 138
7.4 American Indians and Alaska Natives ................... 139
7.5 Military Veterans......................................141
7.6 Persons with Disabilities .............................. 145
7.7 Elderly.............................................. 150
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7.8 Incarcerated......................................... 152
7.9 COVID-19 Virus and Special Populations ................ 153
7.10 Summary .......................................... 155
7.11 Review Questions.................................... 155
7.12 References ......................................... 156
Access issues in HeAltHcAre 160
8.1 Learning Objectives................................... 160
8.2 Key Terms .......................................... 160
8.3 Introduction......................................... 160
8.4 Access to Healthcare...................................161
8.5 Barriers to Healthcare ................................ 166
8.6 Consequences of Inadequate Access to Healthcare........ 174
8.7 Emerging Issues and Possible Improvements in the Healthcare
System................................................. 174
8.8 Summary ........................................... 176
8.9 Review Questions .....................................177
8.10 References ..........................................177
cost of HeAltHcAre 180
9.1 Learning Objectives................................... 180
9.2 Key Terms .......................................... 180
9.3 Introduction......................................... 180
9.4 Gross Domestic Product and Healthcare .................181
9.5 National Health Expenditure Accounts.................. 182
9.6 U.S. Healthcare Spending ............................. 182
9.7 Population Growth ................................... 183
9.8 Population Aging..................................... 183
9.9 Impact of COVID-19 on Healthcare Costs ................ 194
9.10 Summary .......................................... 194
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9.11 Review Questions.................................... 194
9.12 References ......................................... 194
QuAlity in HeAltHcAre 199
10.1 Learning Objectives.................................. 199
10.2 Key Terms.......................................... 199
10.3 Introduction........................................ 199
10.4 Quality in Healthcare ................................200
10.5 Regulatory Agencies for Healthcare.................... 201
10.6 Comparing the U.S. with Other Countries............... 202
10.7 Value-Based Care.................................... 205
10.8 Accreditation.......................................206
10.9 Medicare Access and Children’s Health Insurance Program
Reauthorization Act of 2015 (MACRA)......................208
10.10 Quality Improvement Programs...................... 210
10.11 Quality Improvement Examples ...................... 212
10.12 Healthcare Workers and Quality ..................... 214
10.13 Health Disparities .................................. 214
10.14 Summary ......................................... 214
10.15 Review Questions................................... 215
10.16 References ........................................ 215
tecHnology use in HeAltHcAre 218
11.1 Learning Objectives .................................. 218
11.2 Key Terms.......................................... 218
11.3 Introduction ........................................ 219
11.4 Health Information Technology Support................ 219
11.5 Electronic Health Record/Digitalization of Health Records 222
11.6 Emerging Technologies............................... 228
11.7 Data Analytics....................................... 236
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11.8 Summary........................................... 237
11.9 Review Questions.................................... 237
11.10 References......................................... 237
nAtionAl HeAltHcAre systems 241
12.1 Learning Objectives.................................. 241
12.2 Key Terms.......................................... 241
12.3 Introduction........................................ 241
12.3 Basic Models of Healthcare Systems ................... 242
12.3.1 Germany.......................................... 243
12.4 Issues Surrounding the U.S. Healthcare System ......... 255
12.5 Current U.S. Legislation..............................260
12.6 Time for Change .................................... 263
12.7 The Impact of COVID-19 on the U.S. Healthcare System... 266
12.8 Summary .......................................... 267
12.9 Review Questions ................................... 268
12.10 References ........................................ 268
glossAry 273
contributors 280
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Acknowledgements
Contributors
Thanks goes to the individuals who provided a first-person perspective on
specific topics throughout the book: Dr. Joan Darden, Dr. Michael Daugherty,
Misty A. Spanberger, Deb Hairr, James Brooks, Sheila Graddy-Bennett, Brandy
Bass, Samantha Wells, Terri M. Mitchell, Nicholas K. Johnson, Cynthia Chaney,
Sarah Schrader and Josh Lipkowitz.
Thanks to our administrators for supporting us throughout this writing
process: Dr. Sarah Brinson, Dean, Darton College of Health Professions; Dr. Cathy
Williams, Department Chair, Nursing.
Thanks to the administrators from Affordable Learning Georgia, in particular
Mr. Jeff Gallant, for initiating this project which serves students through no cost
textbooks.
Our Team
We wish to extend a special thanks to eCampus Administrative Services,
especially Dr. Sarah Kuck and Ms. Christy Talley Smith, for providing faculty
authors, guidance, and support throughout the development process. We also
want to acknowledge Ms. Yinning Zhang, the project manager, who guided us from
the beginning to the end, and Kristy Gamble, the graphic designer, who promoted
the aesthetics of this book. The peer reviewers who took the time to read all of the
chapters and provide us with constructive feedback. To all the UNG Press staff, in
particular Dr. Bonnie Robinson and Ms. Corey Parson, who worked diligently to
ensure this book is published and in the hands of students.
Dr. Howe would like to personally thank: my supportive and thoughtful
husband for being a sounding board, reading content, and giving feedback; for
supporting me through the many long nights and long months of the researching
and writing process; to my children Courtney and Bailey (and their partners)
for being such great people who I can call my own! You both inspire me! To my
mother who has and probably always will brag about my accomplishments.
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