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Understand how the healthcare system works – and how you can succeed in it A Doody's Core Title for 2017! The Seventh Edition of Understanding Health Policy: A Clinical Approach remains the most trusted and comprehensive guide to healthcare available and provides everything you need to build a solid foundation on the field’s most critical issues. This concise and engaging textbook clearly explains the all major aspects of healthcare, including finance, organization, and reimbursement. It will help you develop a clearer, more systematic way of thinking about health care in the United States, its problems, and the alternatives for managing and solving these problems. The book features a unique approach, using clinical vignettes to highlight key policy issues, clarify difficult concepts, and demonstrate how they apply to real-world situations, affecting both patients and professionals alike. Expert practitioners in both the public and private healthcare sectors, the authors cover the entire scope of our healthcare system. They carefully weave key principles, descriptions, and concrete examples into chapters that make important health policy issues interesting and understandable. Understanding Health Policy makes otherwise difficult concepts easy to understand—so you can make better decisions, improve outcomes, and enact positive change on a daily basis. The Seventh Edition features: Updated throughout to reflect the latest changes and events, including additional content on value-based care, Choosing Wisely®, etc. Expanded coverage of the impact of the Affordable Care Act, including Accountable Care Organizations and their impact, and global issues in health policy End-of-chapter summaries and comprehensive lists of review questions to reinforce what you have learned Includes "Questions and Discussion Topics" for classroom or individual study
Market: M2 and M4; FP and IM residents; NP and public health educators; nurse practitioners; physician assistants; PA students New two-color design Includes questions for review and discussion
"This highly readable text gives a broad but detailed picture of how health care is organized and dispensed in the United States." -Annals of Internal Medicine, on the First Edition The #1 text on health policy, this well-known book provides a short introduction to U.S. health care policy by two leading experts who are themselves practicing physicians. The Fourth Edition features the latest information on cost containment, health insurance, managed care, hospital payment, and the new two-tier model of physician reimbursement.
An engaging and clinically applicable work on the principles and structure of the U.S. healthcare system A Doody's Core Title for 2011! "Eminently readable...Anyone wanting to gain insight into the forces that shaping health policy and the future of health care will appreciate this book."--Critical Care Nurse Magazine Understanding Health Policy is the best-written, most informative book available on the subject--and it's the #1 choice for healthcare students and professionals alike. The authors carefully weave key principles, descriptions, and concrete examples into chapters that make important health policy issues both interesting and understandable. Fully updated to reflect current issues in the ever-changing world of healthcare, the newest edition addresses all the topics that affect you most, from the structure and organization of the industry to issues regarding government and private insurance, to access to healthcare. Everything you need to understand how the healthcare system works - and your role in it: Clinical vignettes in every chapter illustrate key points Detailed treatment of both U.S. and international issues A complete chapter of review questions NEW Expanded coverage of healthcare workers other than physicians NEW Closer scrutiny of the pharmaceutical industry NEW Brand-new chapter on the medical education system
Understand how the healthcare system works – and how you can succeed in it Covers the 2010 Affordable Care Act The most trusted and comprehensive guide to healthcare available, Understanding Health Policy provides everything students and professionals need to build a solid foundation on the field’s most critical issues. Expert practitioners in both the public and private healthcare sectors, the authors cover the entire scope of our healthcare system—from the concepts behind policy decisions to concrete examples of how they affect patients and professionals alike. Understanding Health Policy, 6e makes otherwise difficult concepts easy to understand—so you can make better decisions, improve outcomes, and enact positive change on a daily basis. Features: Coverage of structure, organization, and financing of the health care system Key principles, descriptions, and concrete examples are skillfully interwoven in each chapter to make important issues interesting and understandable Clinical vignettes clarify difficult concepts and demonstrate how they apply to real-world situations Comprehensive list of review questions reinforce what you have learned Understanding Health Policy, 6e will help you develop a clearer, more systematic way of thinking about health care in the United States, its problems, and the alternatives for managing and solving these problems.
Understanding Health Policy: A Clinical Approach is a book about health policy as well as about individual patients and caregivers and how they interact with each other and with the overall health system.We, the authors, are practicing primary care physicians—one in a public hospital and clinic and the other, for many years, in a private practice. We are also analysts of our nation’s health care system. In one sense, these two sides of our lives seem quite separate.When treating a patient’s illness, it seems that health expenditures as a percentage of gross domestic product or variations in surgical rates between one city and another seem remote if not irrelevant—but they are neither remote nor irrelevant.Health policy affects the patients we see on a daily basis.Managed care referral patterns determine to which specialist we can send a patient, the coverage gaps for outpatient medications in the Medicare benefit package affects how we prescribe medications for our elderly patients, and the failure of our nation to legislate universal health insurance influences which patients ended up seeing one of us (in the private sector) and which the other (in a public setting). In Understanding Health Policy, we hope to bridge the gap separating the microworld of individual patient visits and the macrouniverse of health policy. THE AUDIENCE The book is primarily written for health science students—medical, nursing, nurse practitioner, physician assistant, pharmacy, public health, and others—who we feel will benefit from understanding the complex environment in which they will work. Physicians feature prominently in the text, but in the actual world of clinical medicine, patients’ encounters with nurses, physician assistants, nurse practitioners, pharmacists, and other health care givers are an essential part of their health care experience. Physicians would be unable to function without the many other members of the health care team. Patients seldom appreciate the contributions made to their well-being by public health personnel, research scientists, educators, and many other health-related professionals.We hope that the many nonphysician members of the clinical care, public health, and health science education teams as well as students aspiring to join these teams will find the book useful. Nothing can be accomplished without the combined efforts of everyone working in the health care field. THE GOAL OF THE BOOK Understanding Health Policy attempts to explain how the health care system works.We focus on basic principles of health policy in hopes that the reader will come away with a clearer, more systematic way of thinking about health care in the United States, its problems, and the alternatives for managing these problems. Most of the principles also apply to understanding health care systems in other nations. Given the public’s concerns about health care in the United States, the book concentrates on the failures of the system.We spend less time on the successful features because they need less attention. Only by recognizing the difficulties of the system can we begin to fix its problems. The goal of this book, then, is to help all of us understand the health care system so that we can better work in the system, use the system, and change what needs to be changed. CLINICAL VIGNETTES In our attempt to unify the overlapping spheres of health policy and health care encounters by individuals, we use clinical vignettes as a central feature of the book. These short descriptions of patients, physicians, and other caregivers interacting with the health care system are based on our own experiences as physicians, the experiences of colleagues, or cases reported in the medical literature or popular press. Most of the people and institutions presented in the vignettes have been given fictitious names to protect privacy. Some names used are emblematic of the occupations, health problems, or attitudes portrayed in the vignettes; most do not have special significance. Copyright © 2009 by The McGraw-Hill Companies, Inc. Click here for terms of use. OUR OPINIONS In exploring the many controversial issues of health policy, our own opinions as authors inevitably color and shade the words we use and the conclusions we reach.We present several of our most fundamental values and perspectives here. THE RIGHT TO HEALTH CARE We believe that health care should be a right enjoyed equally by everyone. Certain things in life are considered essential. No one gets excited if someone is turned away from a movie or concert because he or she cannot afford a ticket. But sick people who are turned away from an emergency department can make headlines, and rightly so. Legally, health care is not a right in the United States, though many public opinion polls reveal that the great majority of the public believes that health care should be a right. In all other industrialized nations of the world, health care is a right. This right is difficult to translate into reality; it requires the establishment of a network of health care institutions accessible to everyone and a method of financing those institutions that allows everyone to obtain needed services without regard for ability to pay. The right to health care means universal access to health care. Naturally, this right has limits (see Chapter 13).Were everyone to receive yearly total-body magnetic resonance imaging (MRI) scans, health care costs would go through the roof. A simple statement of the right to health care reads something like this: All people should have equal access to a reasonable level of appropriate health services, regardless of ability to pay. THE IMPERATIVE TO CONTAIN COSTS We believe that limits must be placed on the costs of health care. Cost controls can be imposed in a manner that does relatively little harm to the health of the public. The rapidly rising costs of health care are in part created by scientific advances that spawn new, expensive technologies. Some of these technologies truly improve health care, some are of little value or harmful, and others are of benefit to some patients but are inappropriately used for patients whom they do not benefit. Eliminating medical services that produce no benefit is one path to “painless” cost control (see Chapter 8). Reduction in the rapidly rising cost of administering the health care system is another route to painless cost containment. Administrative excess wastes money that could be spent for useful purposes, either within or outside the health care sector.While large bureaucracies do have the advantage of creating jobs, the nation and the health care system have a great need for more socially rewarding and productive jobs (e.g., home health aides, drug rehabilitation counselors, childcare workers, and many more) that could be financed from funds currently used for needless administrative tasks. There is a growing consensus that health care cost increases are bad for the economy. Employers complain that the high cost of health insurance for employees reduces international competitiveness. If government health expenditures continue their rapid rise, other publicly financed programs essential to the nation’s economy (e.g., education and transportation) will be curtailed because government budgets are limited by the public’s willingness to pay taxes. Rising costs are harmful to everyone because they make health services and health insurance unaffordable. Many companies are shifting more health care costs onto their employees. As government health budgets balloon, cutbacks are inevitable, generally hurting the elderly and the poor. Individuals with no health insurance or inadequate coverage have a far harder time paying for care as costs go up. As a general rule, when costs go up, access goes down. For these reasons, we believe that health care costs should be contained, using strategies that are as painless as possible (i.e., that do the least harm to the health of the population). THE NEED FOR POPULATION-BASED MEDICINE Most physicians, nurses, and other health professionals are trained to provide clinical care to individuals. Yet clinical care is not the only determinant of health status; standard of living and public health measures may have an even greater influence on the health of a population (see Chapter 3). Health care, then, should have another dimension: concern for the population as a whole. Individual physicians may be first-rate in caring for their patients’ heart attacks, but may not worry enough about the prevalence of hypertension, smoking, elevated cholesterol levels, uncontrolled diabetes, and lack of exercise in their city, in their neighborhood, or among the group of patients enrolled in their practices. For years, clinical medicine has divorced itself from the public health community, which does concern itself with the health of the population. We believe that health caregivers should be trained to add a population orientation to their current role of caring for individuals. ACKNOWLEDGMENTS We could not have written this book by ourselves. The circumstances encountered by hundreds of our patients provided the insights we needed to understand and describe the health care system. Moreover, numerous health care professionals and academics read parts of our manuscript, made wise and helpful suggestions, and encouraged us to proceed. La Phengrasamy provided major assistance in updating materials for this 5th Edition. Any inaccuracies in the book are entirely our responsibility. Our warmest thanks go to our families, who provided both encouragement and patience. Finally, earlier versions of Chapters 2, 4, 5, 8, 9, and 16 were published serially as articles in the Journal of the American Medical Association (1994;272:634–639, 1994;272:971–977, 1994;272:1458–1464, 1995;273:160–167, 1995;274:85–90, and 1996;276:1025–1031) and are published here with permission (copyright, 1994, 1995, and 1996, American Medical Association). CONCLUSION This is a book about health policy. As such, we will cite technical studies and will make cross-national generalizations. We will take matters of profound personal meaning—sickness, health, providing of care to individuals in need—and discuss them using the detached language of “inputs and outcomes,” “providers and consumers,” and “cost-effectiveness analysis.” As practicing physicians, however, we are daily reminded of the human realities of health policy. Understanding Health Policy: A Clinical Approach is fundamentally about the people we care for: the uninsured janitor enduring the pain of a gallbladder attack because surgery might leave him in financial ruin, or the retired university professor who sustains a stroke and whose life savings are disappearing in nursing home bills uncovered by her Medicare or private insurance plans. Almost every person, whether a mother on public assistance, a working father, a well-to-do physician, or a millionaire insurance executive, will someday become ill, and all of us will die. Everyone stands to benefit from a system in which health care for all people is accessible, affordable, appropriate in its use of resources, and of high quality. Thomas S. Bodenheimer Kevin Grumbach San Francisco, California June 2008
This fully updated edition of a bestselling book explores the processes and institutions that make health policy, examining what constitutes health policy, where power lies, and what changes could be made to improve the quality of health policy making.

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