Sultz & Young’s Health Care USA: Understanding Its Organization and Delivery

449 Pages·2017·5.626 MB·English

by  Kristina M. Young, Philip J. Kroth

NINTH EDITION
Sultz & Young’s
Health
Care USA
Understanding Its Organization and Delivery
Kristina M. Young, MS
Clinical Assistant Professor Emerita
School of Public Health and Health Professions
State University of New York at Buffalo
Buffalo, New York
President
Kristina M. Young & Associates, Inc.
Buffalo, New York
Philip J. Kroth, MD, MS
Director, Biomedical Informatics Research, Training and Scholarship
Health Sciences Library and Informatics Center
Associate Professor and Section Chief for Clinical Informatics
Divisions of Translation Informatics and General Internal Medicine
University of New Mexico School of Medicine
Albuquerque, New Mexico
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Library of Congress Cataloging-in-Publication Data
Names: Young, Kristina M., author. | Kroth, Philip J., author. | Preceded by
(work): Sultz, Harry A. Health care USA.
Title: Health care USA : understanding its organization and delivery / Kristina M. Young, Philip J. Kroth.
Description: Ninth edition. | Burlington, MA : Jones & Bartlett Learning, [2018] | Preceded by Health care USA : understanding its
organization and delivery / Harry A. Sultz, Kristina M. Young. 8th ed. c2014. | Includes bibliographical references and index.
Identifiers: LCCN 2016044745 | ISBN 9781284114676 (paperback)
Subjects: | MESH: Delivery of Health Care | Health Policy | United States
Classification: LCC RA395.A3 | NLM W 84 AA1 | DDC 362.10973--dc23 LC record available at https://lccn.loc.gov/2016044745
6048
Printed in the United States of America
21 20 19 18 17 10 9 8 7 6 5 4 3 2 1
This book is dedicated to our parents,
Jacob Jay and Marie Young, and Joseph R. Kroth and
Nathalie Baszczynski-Kroth. We owe each of them our
untold gratitude for the values they instilled and the
examples they provided.

Contents
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Rural Health Networks . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Priorities of Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Tyranny of Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . xiv
Social Choices of Health Care . . . . . . . . . . . . . . . . . . . . 16
About the Contributor . . . . . . . . . . . . . . . . . . . . . . . . . xv
Aging Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvi
Access to Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
New to the Ninth Edition . . . . . . . . . . . . . . . . . . . . . . xxi
Quality of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Conflicts of Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Chapter 1 Overview of Health Care:
Health Care’s Ethical Dilemmas . . . . . . . . . . . . . . . . . . .19
A Population Perspective . . . . . . 1
Continuing Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Problems of Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Chapter 2 Benchmark Developments
Understanding Health Care . . . . . . . . . . . . . . . . . . . . . . . 3
in U .S . Health Care . . . . . . . . . . 23
Why Patients and Providers Behave the
Way They Do . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
The Great Depression and the Birth of
Indexes of Health and Disease . . . . . . . . . . . . . . . 3 Blue Cross . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Natural Histories of Disease and the Levels
Dominant Influence of Government . . . . . . . . . . . . . 25
of Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Three Major Health Care Concerns . . . . . . . . . . . . . . . 26
Major Stakeholders in U .S . Healthcare
Efforts at Planning and Quality Control . . . . . . . . . . . 27
Industry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Managed Care Organizations . . . . . . . . . . . . . . . . . . . . 28
The Public . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Employers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 The Reagan Administration: Cost Containment
and Prospective Hospital Reimbursement . . . . . 28
Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Hospitals and Other Healthcare Biomedical Advances: Evolution of
Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 High-Technology Medicine . . . . . . . . . . . . . . . . . . . . 29
Governments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Technical Advances Bring New
Complementary and Alternative Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Therapists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Roles of Medical Education and
Health Insurers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Specialization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Long-Term Care Industry . . . . . . . . . . . . . . . . . . . 12 Influence of Interest Groups . . . . . . . . . . . . . . . . . . . . . 31
Voluntary Facilities and Agencies . . . . . . . . . . . 12 The American Medical Association . . . . . . . . . . 31
Health Professions Education and Training Insurance Companies . . . . . . . . . . . . . . . . . . . . . . 31
Institutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Consumer Groups . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Professional Associations . . . . . . . . . . . . . . . . . . . 13 Business and Labor . . . . . . . . . . . . . . . . . . . . . . . . . 32
Other Health Industry Organizations . . . . . . . . 13 Pharmaceutical Industry . . . . . . . . . . . . . . . . . . . . 32
Research Communities . . . . . . . . . . . . . . . . . . . . . 13 Public Health Focus on Prevention . . . . . . . . . . 33
v
vi Contents
Health Insurance Portability and Health Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Accountability Act . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Medicare and Medicaid . . . . . . . . . . . . . . . . . . . . . 73
The Balanced Budget Act of 1997 . . . . . . . . . . . . . . . . 34 Growth and Decline in Numbers of Hospitals . . . . 74
Oregon Death with Dignity Act and Other Types of Hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
End-of-Life Legislation . . . . . . . . . . . . . . . . . . . . . . . . 34
Financial Condition of Hospitals . . . . . . . . . . . . . . . . . . 76
Health Information and Technology for
Academic Health Centers, Medical Education,
Economic and Clinical Health Act . . . . . . . . . . . . . 35
and Specialization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
The Internet and Health Care . . . . . . . . . . . . . . . . . . . . 36
Hospital System of the Department of
The Patient Protection and Affordable Care Veterans Affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Act of 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Structure and Organization of Hospitals . . . . . . . . . . 78
Judicial Challenges to the Affordable
Medical Division . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Care Act . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Nursing Division . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
The Affordable Care Act Implementation
Allied Health Professionals . . . . . . . . . . . . . . . . . . 80
Provisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Diagnostic Services . . . . . . . . . . . . . . . . . . . . . . . . . 80
New Consumer Protections . . . . . . . . . . . . . . . . . 38
Rehabilitation Services . . . . . . . . . . . . . . . . . . . . . . 81
Improving Quality and Lowering Costs . . . . . .38
Other Patient Support Services . . . . . . . . . . . . . 81
Increasing Access to Affordable Care . . . . . . . . 39
Nutritional Services . . . . . . . . . . . . . . . . . . . . . . . . . 81
Holding Insurance Companies
Administrative Departments . . . . . . . . . . . . . . . . 82
Accountable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Hotel Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Information Technology’s Impact on
Chapter 3 Health Information
Hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Technology . . . . . . . . . . . . . . . . . 45
Complexity of the System . . . . . . . . . . . . . . . . . . . . . . . .83
Historical Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Types and Roles of Patients . . . . . . . . . . . . . . . . . . . . . . 83
Historical Challenges in Implementing Health Rights and Responsibilities of
Information Technology . . . . . . . . . . . . . . . . . . . . . . . 46 Hospitalized Patients . . . . . . . . . . . . . . . . . . . . . 84
The Federal Government’s Response to Health Informed Consent and Second
Information Technology Implementation Opinions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Diagnosis-Related Group Hospital
HIT Opportunities: Improving Healthcare Reimbursement System . . . . . . . . . . . . . . . . . . . . . . . 86
Delivery Quality, Effectiveness, and Discharge Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Efficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Post-Diagnosis-Related Group and Managed
Health Information Exchanges . . . . . . . . . . . . . . . . . . . 56 Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
The Veterans Administration Health Early Market Reforms . . . . . . . . . . . . . . . . . . . . . . . 87
Information System . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Horizontal Integration . . . . . . . . . . . . . . . . . . . . . . 88
Electronic Health Record Adoption Progress Vertical Integration . . . . . . . . . . . . . . . . . . . . . . . . . 89
in the United States . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Quality of Hospital Care . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Future Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Hazards of Hospitalization . . . . . . . . . . . . . . . . . . 89
Variations in Medical Care . . . . . . . . . . . . . . . . . . .92
Chapter 4 Hospitals: Origin, Organization, Nurse Shortage Staffing Crisis . . . . . . . . . . . . . . . 92
and Performance . . . . . . . . . . . .71 Research Efforts in Quality
Improvement . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Historical Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Responsibility of Governing Boards for
Effects of Insurance on the Hospital Industry . . . . . 73 Quality of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Contents vii
Hospitalists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Delineation and Growth of Medical
Forces of Reform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
The Affordable Care Act . . . . . . . . . . . . . . . . . . . . 96 Deficient Training of Medical
Specialists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Population Focus . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Certification of Physicians with Board
Market Consolidations: Hospital Mergers
Examinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
and Acquisitions . . . . . . . . . . . . . . . . . . . . . . . . . 97
Accountable Care Organizations . . . . . . . . . . . . 97 Accreditation of Graduate Physician Training . . . 150
Reimbursement and Payment Revisions . . . . 98 Physician Workforce Supply and Distribution . . . 151
Medicare Access & CHIP Reauthorization Ratios of Generalist to Specialist Physicians
Act of 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 and the Changing Demand . . . . . . . . . . . . . . . . . 152
Continuing Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Preventive Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Changing Physician–Hospital Relationships . . . . 155
Chapter 5 Ambulatory Care . . . . . . . . . . . 109
Evidence-Based Clinical Practice
Overview and Trends . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Private Medical Office Practice . . . . . . . . . . . . . . . . . 111 Physician Report Cards and “Physician
Compare” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Integrated Ambulatory Care Models . . . . . . . . . . . 114
Health Information Technology and Physician
Patient-Centered Medical Homes . . . . . . . . . 115
Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Accountable Care Organizations . . . . . . . . . . 119
Escalating Costs of Malpractice Insurance . . . . . . 160
Other Ambulatory Care Practitioners . . . . . . . . . . . 120
Ethical Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Ambulatory Care Services of Hospitals:
History and Trends . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Physicians and the Internet . . . . . . . . . . . . . . . . . . . . 161
Hospital Emergency Services . . . . . . . . . . . . . . . . . . 122 Future Perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Non-hospital-Based (Freestanding) Facilities . . . 124
Urgent Care Centers . . . . . . . . . . . . . . . . . . . . . . 124 Chapter 7 The Healthcare Workforce . . . 169
Retail Clinics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Health Professions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Ambulatory Surgery Centers . . . . . . . . . . . . . . 127
Credentialing and Regulating Health
Federally Qualified Health Centers . . . . . . . . 128
Professionals . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
Public Health Ambulatory Services . . . . . . . . 130
Healthcare Occupations . . . . . . . . . . . . . . . . . . . . . . . 172
Not-for-Profit Agency Ambulatory Services 132
Physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
Telehealth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Continued Future Expansion and
Registered Nurses . . . . . . . . . . . . . . . . . . . . . . . . 174
Experimentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Licensed Practical Nurses . . . . . . . . . . . . . . . . . 177
Chapter 6 Medical Education and the Nurse Practitioners . . . . . . . . . . . . . . . . . . . . . . . 178
Changing Practice of Physician Assistants . . . . . . . . . . . . . . . . . . . . . . . 179
Clinical Nurse Specialists . . . . . . . . . . . . . . . . . . 180
Medicine . . . . . . . . . . . . . . . . . . 141
Dentistry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
Medical Education: Colonial America to the Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
1800s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Podiatric Medicine . . . . . . . . . . . . . . . . . . . . . . . . 182
Flexner Report and Medical School Reforms . . . 143 Chiropractors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Transition from Academic Medical Centers to Optometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Academic Health Centers . . . . . . . . . . . . . . . . . . . 144 Healthcare Administrators . . . . . . . . . . . . . . . . 184
Graduate Medical Education . . . . . . . . . . . . . . . . . . . 145 Allied Health Personnel . . . . . . . . . . . . . . . . . . . 184
viii Contents
Technicians and Technologists . . . . . . . . . . . . . . . . . 185 Private Health Insurance Cost Trends . . . . . . . . . . . 216
Laboratory Technologists and Self-Funded Insurance Programs . . . . . . . . . . . . . . . 217
Technicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Government as a Source of Payment:
Radiologic and Magnetic Resonance A System in Name Only . . . . . . . . . . . . . . . . . . . . . 217
Imaging Technologists . . . . . . . . . . . . . . . . . 185
Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
Nuclear Medicine Technology . . . . . . . . . . . . 186
Medicaid and the Children’s Health Insurance
Therapeutic Science Practitioners . . . . . . . . . . . . . . 186 Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
Physical Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . 186 Children’s Health Insurance Program . . . . . . 229
Occupational Therapy . . . . . . . . . . . . . . . . . . . . 187
Medicaid Managed Care . . . . . . . . . . . . . . . . . . . . . . . 230
Speech-Language Pathology . . . . . . . . . . . . . 187
Medicaid Quality Initiatives . . . . . . . . . . . . . . . . . . . . 230
Behavioral Scientists . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Medicaid Expansion Under the Affordable
Social Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
Care Act . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Rehabilitation Counselor . . . . . . . . . . . . . . . . . . 188
Disproportionate Share Hospital Payments . . . . . 232
Support Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
Healthcare-Financing Mandates of the
Health Information Administrators . . . . . . . . 189
Affordable Care Act for Individuals
Complementary and Integrative and Employers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
Medicine Practitioners . . . . . . . . . . . . . . . . . 189
The Individual Mandate and Health
Medical Assistant . . . . . . . . . . . . . . . . . . . . . . . . . 190 Insurance Marketplaces . . . . . . . . . . . . . . . . 233
Factors That Influence Demand for Health The Employer Mandate . . . . . . . . . . . . . . . . . . . 234
Personnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
The Affordable Care Act: Insurance Coverage
Changing Nature of Disease, Disability, Progress and Costs . . . . . . . . . . . . . . . . . . . . . . . . . . 234
and Treatment . . . . . . . . . . . . . . . . . . . . . . . . . 191
Continuing Challenges and Innovations . . . . . . . 235
Physician Supply . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Chapter 9 Long-Term Care . . . . . . . . . . . . 245
Expansion of Home Care . . . . . . . . . . . . . . . . . . 191
Corporatization of Health Care . . . . . . . . . . . . 192
Development of Long-Term Care Services . . . . . 246
Healthcare Workforce Issues and the Patient
Modes of Long-Term Care Service
Protection and Affordable Care Act . . . . . . . . . . 192
Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250
The Future: Complexities of National Healthcare
Skilled Nursing Care . . . . . . . . . . . . . . . . . . . . . . 250
Workforce Planning . . . . . . . . . . . . . . . . . . . . . . . . . 193
Assisted-Living Facilities . . . . . . . . . . . . . . . . . . 252
Home Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
Chapter 8 Financing Health Care . . . . . . 201 Hospice Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
Respite Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Healthcare Expenditures in Perspective . . . . . . . . 202
Adult Day Care . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
Waste, Fraud, and Abuse . . . . . . . . . . . . . . . . . . 207
Innovations in Long-Term Care . . . . . . . . . . . . . . . . . 264
Drivers of Healthcare Expenditures . . . . . . . . . . . . . 208
Aging in Place . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Evolution of Private Health Insurance . . . . . . . . . . 209
Continuing Care Retirement and Life
The Rise of Blue Cross and Blue Shield Care Communities . . . . . . . . . . . . . . . . . . . . . 265
and Commercial Health Insurance . . . . . 209 Naturally Occurring Retirement
Transformation of Health Insurance: Communities . . . . . . . . . . . . . . . . . . . . . . . . . . 267
Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 High-Technology Home Care: Hospitals
Managed Care Backlash . . . . . . . . . . . . . . . . . . 213 Without Walls . . . . . . . . . . . . . . . . . . . . . . . . . . 267
Managed Care Today . . . . . . . . . . . . . . . . . . . . . . . . . . 214 Long-Term Care Insurance . . . . . . . . . . . . . . . . . . . . . 267
MCOs and Quality . . . . . . . . . . . . . . . . . . . . . . . . 214 Future of Long-Term Care . . . . . . . . . . . . . . . . . . . . . . 268
Contents ix
Chapter 10 Behavioral Health Voluntary National Public Health Department
Services . . . . . . . . . . . . . . . . . 277 Accreditation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320
Public Health Organization Challenges
Historical Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278 and Responses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
Recipients of Psychiatric and Behavioral Public Health Accomplishments and
Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281 Resource Challenges of the 20th and
Treatment Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285 21st Centuries . . . . . . . . . . . . . . . . . . . . . . . . . 323
Barriers to Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285 Public Health Services of Voluntary
Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Children and Adolescents . . . . . . . . . . . . . . . . 285
Older Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286 Relationships of Public Health and Clinical
Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
The Organization of Psychiatric and Behavioral
Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287 Public Health Ethics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330
Paradigm Shifts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289 The ACA and Public Health . . . . . . . . . . . . . . . . . . . . 331
Recovery Oriented Systems of Care . . . . . . . 289 National Prevention, Health Promotion
and Public Health Council . . . . . . . . . . . . . . 331
Integration of Primary Care and
Behavioral Health Services . . . . . . . . . . . . . 289 Health Care Workforce Development . . . . . 331
Financing Psychiatric and Behavioral Health Current and Future: Enduring and Emerging
Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291 Public Health Challenges . . . . . . . . . . . . . . . . . . . . 332
Public Funding of Behavioral Enduring Public Health Issues . . . . . . . . . . . . . 332
Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292 Emergent Domestic Public Health
Cost Containment Mechanisms . . . . . . . . . . . 293 Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334
The Future of Psychiatric and Behavioral Emergent Global Public Health
Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295 Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
The Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
Chapter 11 Public Health and the Role
Chapter 12 Research: How Health Care
of Government in Health
Advances . . . . . . . . . . . . . . . . 351
Care . . . . . . . . . . . . . . . . . . . . . 301
Focus of Different Types of Research . . . . . . . . . . . 352
Public Health Defined . . . . . . . . . . . . . . . . . . . . . . . . . 301
Types of Research . . . . . . . . . . . . . . . . . . . . . . . . 352
Early History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302
Agency for Healthcare Research and
Public Health in England . . . . . . . . . . . . . . . . . . 303
Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355
Development of U .S . Public Health and
Health Services Research and Health
Government-Supported Services . . . . . . . 304
Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 356
Government Responsibilities for Health and
Quality Improvement . . . . . . . . . . . . . . . . . . . . . 357
Public Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306
Medical Errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359
Federal Responsibilities . . . . . . . . . . . . . . . . . . . 306
Evidence-Based Medicine . . . . . . . . . . . . . . . . . . . . . . 360
Veterans Health Administration . . . . . . . . . . . 309
Outcomes Research and the Patient-Centered
Department of Defense Military Health
Outcomes Research Institute . . . . . . . . . . . . . . . . 363
System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
State and Local Government The Patient-Centered Outcomes Research
Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . 310 Institute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364
State Roles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310 Patient Satisfaction Surveys . . . . . . . . . . . . . . . 365
Local Roles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315 Research Ethics and Conflicts of
Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366
State and Local Health Department
Relationships . . . . . . . . . . . . . . . . . . . . . . . . . . 319 Future Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367