Basics of the U.S. Health Care System, 2nd Edition
Niles
Transition Guide
Introduction
This 2nd edition of the Basics of the U.S. Healthcare system was sorely needed because of the
monumental change in the U.S. healthcare system: the passage of the Affordable Care Act in
2010. Although the first edition included a standalone chapter devoted to the Affordable Care
Act, since that publication, the ACA has evolved. The ACA continues to be very controversial.
There have been several lawsuits and constant discussions in Congress about repealing several
different mandates. As of this writing, there are many mandates that have already been
implemented that will impact healthcare consumers, which are discussed in the textbook.
Because of the ACA impact, each chapter has been updated as it relates to ACA changes and as
the healthcare industry has evolved over the past few years. I also placed the ACA chapter,
which was originally an add-on to the first edition, as the second chapter of this edition. That
way the student can become familiar with the mandates in the early learning process of the
course and the textbook.
The 2nd edition allows the instructor to utilize the textbook for an onground class, a distant
learning class or a hybrid class. As teaching methods have evolved, textbook development has
also evolved to ensure that all delivery modes are included.
I truly hope this new edition will continue to provide a foundation for additional learning
about the U.S. healthcare system. I also hope it encourages students to have careers in health
care. The healthcare system’s growth will continue due to the aging of the U.S. population and
the increased focus of providing quality health care to healthcare consumers.
CHANGES TO CHAPTERS
I have included discussion boards for each chapter that can be used for both online and on-
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Basics of the U.S. Health Care System, 2nd Edition
Niles
Transition Guide
ground classes. I also wrote each chapter as a standalone chapter that can be included in other
courses. I have also included more tables and figures to illustrate important concepts in the
textbook.
Changes to Chapter Student Activities:
The crossword puzzles are now online and can be used for both onground and distant learning
classes. I now have four case studies for each chapter that allows the students to develop critical
thinking for the chapter materials. All of the vocabulary and internet exercises have been
updated.
Recognizing how education delivery has changed, I have modified the crossword puzzles
so they can be done online or on-ground. I have also included three additional case studies per
chapter that can be done on-ground or online. I have also included 5 discussion questions that
can be used for a distant learning discussion board or in class activity.
CHANGES TO ANCILLARY MATERIALS
Development of Student Companion website:
I have developed a student companion website that provides tips on how to study, videos for
each chapter, practice quizzes, and vocabulary exercises. A glossary was developed that can be
used for matching exercises and additional crossword puzzles. There are practice quizzes for
each chapter which consists of 10 true or false questions. I have also included websites for
several chapters that students can access for additional research. I have also included YouTube
videos for several of the chapters that both students and instructors can utilize for class and
online discussion. I have also included tips on how to develop time management skills to
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Basics of the U.S. Health Care System, 2nd Edition
Niles
Transition Guide
improve study habits.
Changes to the Instructor Manual:
There is a summary of each chapter for instructor review. The instructor manual now includes a
section on the updates of the Affordable Care Act. The author will periodically provide an
update as the ACA continues to evolve. This will be done with a narrated PowerPoint slide
presentation.
Test Bank update:
Each chapter now has 30 True/False and fill in the blank questions and 10 multiple choice
questions, and four or more short answer/essay questions.
The following is a summary of each chapter:
Chapter 1 History of the U.S. Healthcare System
Chapter 1 is a summary of the different components of the healthcare system that are discussed
in each chapter of the textbook. The four tables that highlighted the milestones of the four major
components of the U.S. healthcare system- medicine and medical education, hospitals and
healthcare systems, public health and health insurance were updated to include any new
development thru 2014. I also included a figure of the Iron Triangle, a tool that is frequently
used to assess the U.S. healthcare system.
Chapter 2- Impact of the Affordable Care Act on Healthcare Services
Chapter two discusses the impact of the Affordable Care Act on healthcare services. This is a
very complicated act with many initiatives. I have included a table that outlines the different
initiatives by year thru 2015. I also have updated all of the progress of the ACA since the first
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Basics of the U.S. Health Care System, 2nd Edition
Niles
Transition Guide
edition of this textbook was published. I also felt it was important to discuss the political
divisiveness the ACA has created.
Chapter 3 Current Operations of the Healthcare System
In the first edition, I selected data from the Organization for Economic Cooperation and
Development (OECD) because it was the most current data I could retrieve for the data I wanted
to utilize for country comparisons. I used the same data source again with updated data from
2005-2010. Although the data is still dated, it is the most current data available for my purposes.
In addition to physician resources, I included data on nurse resources who are such an important
team member of patient care. In this edition, I included data on obesity rates of both males and
females and tobacco and alcohol consumption. Although these data were less reported than the
other data, I felt it was important to include these data because they represent risk factors for
many diseases.
Chapter 4 Government’s Role in U.S. Healthcare
The government agencies have been updated to include the Administration for Community
Living which merges the efforts of the Administration on Aging, The Administration on
Intellectual and Developmental Disabilities and the HHS Office on Disability. The Office of the
Assistant Secretary for Preparedness and Response which was created to focus on emergency
preparedness and planning is also discussed.
Chapter 5 Public Health
Because public health is an integral component of the U.S. healthcare system, it is one of the
longest chapters of the textbook. I have included an updated figure of the determinants of health
with the Dahlgren and Whitehead model (1991). I have also included a table which depicts the
differences between primary, secondary and tertiary prevention activities. There are two tables
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Basics of the U.S. Health Care System, 2nd Edition
Niles
Transition Guide
that outline the essential public health and environmental health activities in public health as well
as a figure that depicts the many participants of the public health system. I have also included a
table that outlines what public health departments do for their communities.
Chapter 6 Inpatient and Outpatient Services
The hospital section has been updated to include their continued expansion into outpatient
services such as urgent care and ambulatory surgery centers. They are also focusing on
practicing cost containment methods such as lean, Six Sigma and Plan Do Study Act.
The outpatient services section has been updated to include recent data on urgent care centers,
adult daycare centers, and senior centers. Included in this chapter is the increased use of
telemedicine as an effective way of providing outpatient care.
Chapter 7 U.S. Healthcare Workforce
All of the labor statistics (2010) have been updated in this chapter for each type of healthcare
employment. The data includes average wages, required education and employment growth.
Chapter 8 Healthcare Financing
All data has been updated in this chapter to reflect spending by service type and by state. This
chapter includes the the Affordable Care Act initiatives which focus on patient centered quality
care. There is a discussion of the newly established Center for Medicare and Medicaid
Innovation and its goals including the Accountable Care Organizations. There is also a table
that outlines that four Bundled Payments Models initiatives.
Chapter 9 Managed Care Impact on Healthcare Delivery
There is an updated discussion on Medicaid Managed Care’s Managed Long Term Services and
Sponsors as a way to expand community and home based services as well as the requirement for
states to now submit a strategy to CMS to improve their programs. I have condensed the NCQA
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Basics of the U.S. Health Care System, 2nd Edition
Niles
Transition Guide
and HEDIS section but included a section on managed care accreditation. I have also included a
discussion on the American Medical Association’s National Managed Care Contract which
provides information to physicians regarding their relationships with managed care
organizations.
Chapter 10 Information Technology Impact on Health Care
Data regarding computerized physician order entry and e-prescribing use has been updated. All
data regarding electronic health record implementation has been updated. I have also updated the
section on electronic health records to include ‘meaningful use’. The case study of the Primary
Care Information Project in NYC has been updated. The section on applied health information
technology has also been updated to include technological advances in healthcare treatment.
Chapter 11 Healthcare Law
I replaced the section on the legal structures of healthcare organizations with a section on
employment related legislation which is important to future healthcare employees and
employers. I also updated any recent amendments to legislation as well as a brief discussion of
the Affordable Care Act
Chapter 12 Healthcare Ethics
I have included a section on how to develop a code of ethics for a healthcare organization. I also
have included a section on workplace bullying which has become an issue in the healthcare
industry. Many healthcare professional organizations and accreditation organizations require a
code of conduct that targets this negative behavior. In many instances, it is legal but certainly
unethical so I felt it should be included in this chapter.
I have also included a section on how to apply a decision making model when a healthcare
dilemma presents itself. Having taught business ethics for many years and have introduced this
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Basics of the U.S. Health Care System, 2nd Edition
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Transition Guide
type of model to business students, has helped them when they transition to their careers.
Chapter 13 Mental Health Issues
All data regarding mental health disorders has been updated. I have included a section on the
National Institute for Mental Health's Strategic Plan (2013). I also included a discussion of the
National Institutes of Health refusal to endorse the 2013 Diagnostic and Statistical Manual of
Mental Disorders because NIH believes their method of categorizing mental health disorders is
not science based.
Chapter 14 Analysis of the U.S. Healthcare system
I have included a figure that depicts the healthcare industry stakeholders. I have updated the trends
in healthcare and included the accountable care organizations, drugstore clinics, care managers, and
an example of a patient centered health care system in Florida. I also have updated the status of the
country comparison data as well as the two state universal type programs from Massachusetts and
San Francisco.
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