Updates to the Sixth Edition of Health Care USA
Chapter 1: Overview: A Population Perspective
Contents: Problems of Health Care; Understanding Health Care; Why Patients and
Providers Behave the Way They Do; Indices of Health, Disease; Natural Histories of
Disease and the Levels of Prevention; Major Stakeholders; Alternative Therapies;
Managed Care; Other Insurers; Long-Term Care; Mental Health; Voluntary Facilities,
Agencies; Health Professions Education Professional Associations; Other Health
Organizations; Research; Development of Managed Care; Rural Health Networks; Health
Care Priorities; Tyranny of Technology; Social Choices; Aging Population; Access;
Quality; Conflicts of Interest; Ethical Dilemmas
Changes:
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Updated data on size and cost of the U.S. health care system
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Chapter 2: Benchmark Developments
Contents: Great Depression; Birth of Blue Cross; Influence of Government; Medicare
and Medicaid; Planning, Regulation, Consumer Protection; Managed Care; New
Federalism; Evolution of High-Tech Medicine; Medical Education and Specialization;
Interest Groups; Influences of Business and Labor; Public Health Focus on Prevention;
Economic Influences, Rising Costs; The Uninsured; Aging; Values and Assumptions
Guiding Priorities; Oregon Death with Dignity Act; HIPPA; Internet and Health Care;
Basic Issues.
Changes:
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Updated section on Managed Care Organizations and current status of PPOs and
HMOs
Updated discussion of physician supply
New data regarding effect of Oregon Death with Dignity Legislation
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Chapter 3: Hospitals: Origin, Organization, and Performance
Historical Perspective; Forces That Shaped Hospital Industry; Medicare, Medicaid;
Hospital Growth and Decline; Types, Financial Condition; Academic Health Centers,
Medical Education, Specialization; Balanced Budget Act; Hospitals of Department of
Veterans Affairs; Structure and Organization of Hospitals; Complexity of System; Types
and Roles of Patients; Rights and Responsibilities of Patients; Important Decisions,
Informed Consent, Second Opinions; Diagnosis-Related Group Hospital Reimbursement
System; Discharge Planning; Subacute Care; Integrated Health Systems; Quality of
Hospital Care; Landmark Studies of Quality of Hospital Care; Nurse Shortage; Forces of
Reform: Cost, Quality, and Access;
Changes:
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Updates to all data regarding number, types, and services of U.S. hospitals
New discussion of the rapidly increasing number of physician-owned specialty
hospitals and surgical centers and their effects on public and voluntary hospitals
Updated information on the variety of efforts of hospitals to reduce medical
errors, e.g. Institute for Health Care Improvement, 100,000 Lives Initiative
New discussion of the new Medicare website on hospital performance standards
Updated information on the efforts of hospitals to reduce hospital-transmitted
infections
New discussion of the community-wide over-capacity of hospital beds and underutilization costs
New discussion of the advances in non-invasive technology, i.e. MRI/CT/PET in
coronary artery disease diagnosis and implications for hospitals, providers and
patients
New information on the increasing interest in challenging tax-exempt status of
hospitals providing little or no charitable care
Net page change: + 2
Chapter 4: Ambulatory Care
Contents: Overview and Trends; Private Medical Office Practice; Other Ambulatory Care
Practitioners; Ambulatory Care Services of Hospitals: History and Trends; Hospital
Emergency Services; Free Standing Services; Primary Care Centers; Urgent/Emergent
Care Centers; Ambulatory Surgery Centers; Community Health Centers; Public Health
Services; Voluntary Agencies; Continued
Expansion
Changes:
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Updated data on physician practice characteristics
Updated information on hospital ambulatory clinics activity relative to hospital
revenues
New discussion of the increasing hospital competition with privately owned
outpatient facilities
Updated emergency department utilization data and current issues in ED capacity
New discussion of the continuing proliferation of hospital and privately owned
free standing emergent care centers.
Updated data on freestanding surgery centers
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Expanded discussion of and updated data on the role of federally funded
Community Health Centers as community “safety-nets.”
Updated data and expanded discussion of roles of State and local health
departments in emergency preparedness and epidemic control planning and
management
Voluntary Agencies: New discussion about the pressures for consolidation and
collaboration from government and private funders to eliminate duplication of
overhead and services.
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Chapter 5: Medical Education and the Changing Practice of Medicine
Contents: Flexner Report and Medical School Reforms; Academic Medical Centers;
Graduate Medical Education Consortia; Delineation and Growth of Medical Specialties;
Specialty Boards and Residency Performance; Funding of Graduate Medical Education;
Physician Workforce and U.S. Medical Schools; Generalist/Specialist Imbalance;
Primary Care Physicians; Preventive Medicine; Changing Physician/Hospital
Relationships, Cost Containment, Restructuring Medical Practice; Hold Harmless
Clauses; Clinical Practice Guidelines; Physician Report Cards; Escalating costs of
Malpractice Insurance; Growing Concern About Ethical Issues; Physicians and the
Internet; Provider Network Contracting; Management Service Organizations; Future of
Medical Practice.
Changes:
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Updated data on the number and roles of hospitalists; new discussion about
continuity of care
Removed section on now defunct Physician-Hospital Organizations
New section on the significant decline of physician incomes in the last decade in
contrast to rising incomes of other professionals.
New information about how managed care organizations undervaluing of the
services of primary care physicians has led to a decline in availability of general
practitioners and predictions of a dire shortage in primary care services.
New remarks about how the growing concerns of serious physician shortages in
near future has stimulated medical schools to increase class size.
Net page change: -1
Chapter 6: Health Care Personnel
Contents: Health Professions; Health Care Personnel; Health Care Reforms;
Credentialing and Regulating Health Professionals; Health Care Occupations; Alternative
Therapists; Factors Influencing Demand for Health Personnel; Health Care Workforce
Issues;
Changes:
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Updated Department of Labor estimates of number and types of health care
personnel.
Updated information on the factors that influence the demand and utilization of
health care personnel with particular reference to changing hospital and managed
care practices.
Updated information on the influence of technological innovations on the
functions of specific health care professionals.
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Note: Chapters 7 and 8 are now combined. The Chapter 7 title “Financing Health Care”
was retained but now includes the discussion of managed care which was formerly
Chapter 8.
Chapter 7: Financing Health Care (includes former Chapter 8)
Contents: Health Care Expenditures in Perspective; New Diagnostic and Treatment
Technology; Growth of Specialized Medicine; The Uninsured and Underinsured; A
Labor-Intensive Industry; Economic Incentives That Fuel Rising Costs; Components of
Health Care Expenditures; Sources of Health Care Payment; Evolution of Health
Insurance: Third-Party Payment; Self-Funded Insurance Programs; Government as a
Source of Payment; Balanced budget Act of 1997; Other Services Funded by the
Government; The Future: Continuing Change
Contents: Chapter 8: Historical Perspective; Managed Care Fundamentals; HMO Act of
1973; Evolution of Managed Care; Emerging Developments in Managed Care; Medicare
and Medicaid Managed Care; Managed Care Organizations and Quality; The Future of
Managed Care
Changes: (combining former Chapters 7 and 8:)
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Updated National Health Care Expenditures Data through latest available data.
Updated data on the number of un-underinsured Americans with impact to costs
A new historical overview of Medicare and Medicaid programs: definitions and
history
Updated data on the sources of payment and payment recipients
New explanation of the role of Managed Care as the primary mode of US health
insurance coverage
New discussion of the programmatic and cost implications of the Medicare
Prescription Drug Improvement and Modernization Act of 2003.
Shorter discussion of the Balanced Budget Act of 1997 to just an historical
perspective
Updated information on current Medicare and Medicaid program expenditure data
Updated trends in Medicare and Medicaid cost containment strategies
Updated fiscal challenges for employers at the federal, state and local levels
Updated “Consumer Driven” health insurance initiatives
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New discussion of government and private insurer cost savings initiatives through
education and case management. .
Net page change: -20
Chapter 8: Long Term Care (Former Chapter 9)
Contents: Long-Term Care and the Continuum of Care; Development of Long-Term Care
Services; Modes of Delivery of Long-Term Care Services; Skilled Nursing Care;
Assisted Living; Hospice Care; Respite Care; Adult Day Care; Innovations in Long-Term
Care; Long-Term Care Insurance; The Future of Long-Term Care.
Changes:
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Updated long term care industry trends
Updated statistics on needs, use, and costs for:
o Skilled nursing care
o Home Care
o Assisted Living Arrangements
o Hospice
o Respite
o Adult Day Care
o Continuing Care Retirement and Long Term Care Communities
Updated information on Federal Administration on Aging demonstration “Aging
in Place” projects.
Updated report on long term care insurance enrollments: ongoing challenges.
Net page change: -3
Chapter 9: Mental Health Services (Former Chapter 10)
Contents: Historical Overview; Recipients of Mental Health Services; Children and
Adolescents; Older Adults; The Organization and Funding of Mental Health Services;
Health Insurance Coverage and Managed Behavioral Health Care; Barriers to Accessing
Services; Priorities for Mental Health Services; Need for Further Research
Changes:
 Updated profile of affected populations
 New discussion of the prevalence of dementia disorders in older adults; add
discussion of preventive behavioral services.
 New information on pharmacological advances in treatment of dementias
 Updated data on insurance coverage for behavioral health
 Updated information on implementation progress on the NIMH Plan
 Updated developments from the “Freedom Commission on Mental Health”
initiative
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Chapter 10: Public Health and the Role of Government in Health Care (Former
Chapter 11)
Contents: Historical Perspective; Public Health and Government-supported Services;
Decline of the Public Health Service; Responsibilities of the Public Health Sector;
Relationships of Public Health and Private Medicine; Resource Priorities Favoring
Curative Medicine; Health Care Reform and the Public Health/Medicine Relationship;
Hospital-Sponsored Public Health Activities; Public Health Services of Voluntary
Agencies; Changing Roles of Government in Public Health; Public Health in an Era of
Privatization and Managed Care; State Children’s Health Insurance Program; Federal
Support to Address Emerging Health Issues; Future Role of Government in Promoting
the Public’s Health.
Changes:
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Updated budget and description of the U.S. Public Health Service
Updated budget and description of services of the U.S. Veteran Administration’s
Medical Centers
New discussion of the effect of influx of Iraq War casualties on VA services.
Update federal, state and local public health initiatives in emergency preparedness
for terrorist activities and avian influenza
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Chapter 11: Research: How Health Care Advances (Former Chapter 12)
Contents: The Focus of Different Types of Research; Research in Health and Disease;
Epidemiology; Health Services Research; Agency for Health Care Policy and Research;
Health Services Research and Health Policy; Quality Improvement; Medical Errors;
Evidence-Based Medicine; Outcomes Research; Patient Satisfaction; Research Ethics;
Future Challenges
Changes:
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Revise section on “Research Ethics” to reflect growing concerns about financial
ties between pharmaceutical companies and supposedly “independent”
researchers who judge the safety and effectiveness of newly developed drugs.
Update section on Federal Drug Administration to reflect latest administrative and
performance activities.
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Chapter 12: The Future of Health Care (Former Chapter 13)
Contents: The Paradox of U.S. Health Care; Major Challenges; Growing Number of
Uninsured; Demand for Greater Accountability; Technological Growth and Innovation;
Changing Population Composition; New Physician Roles; Academic Health Centers;
Health Professions; Nurses, Nurse Practitioners; Physician Assistants; Increased Scrutiny
of Costs; New Health Insurance Plan; Changing Composition of Health System;
Corporate Growth in Health Care; Corporate Alliances; Information Management; Future
Role of the Federal Government; Conclusion
Changes
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New remarks on the increasing number and changing characteristics of Americans
without health insurance
Condensed section on “Demand for Greater Accountability.”
Updated discussion of future supply and roles of physicians, nurses, physician
assistants and nurse practitioners.
Updated and condensed sections on “Corporate Growth” and “Corporate
Alliances” in health care.
Condensed “Conclusion” section of this chapter.
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