Understanding Health Policy: A Clinical Approach PDF
Preview Understanding Health Policy: A Clinical Approach
SEVENTH EDITION '. ' .. : ·' ,. l tl DI Hl ffil l (cid:143) II I ! Pl ! W! TPI :P0i'! l ! ' f 11 AC LINICAL APPROACH THOMAS BODENHEIMER KEVIN GRUMBACH LANGE .. i~l: .. a LANGE medical book UN DERSTAN DI NG HEALTH POLICY A Clinical Approach SEVENTH ED IT~O N Thomas Bodenheimer, MD Professor fmeritus Departlrnent of Family & Community Medi:cine LI niversity of Ca lifom ra, San Francisco Kevin Grumbach, MD Professor and Ch al r Departrnent of Family & Community Medicine lJ niversity of Ca lifom ia, San Francisco - - New York Chicago San Fm nal sco lisbon lo:nd on Madrrd Mexico City Milan New Delhi Singapore Sydney Toronto Copyright © 2016 by McGraw-Hill Education. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a data base or retrieval system, without the prior written permission of the publisher. ISBN: 978-1-25-958476-3 MHID: 1-25-958476-3 The material in this eBook also appears in the print version of this title: ISBN: 978-1-25-958475-6, MHID: 1-25-958475-5. eBook conversion by codeMantra Version 1.0 All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this book, they have been printed with initial caps. McGraw-Hill Education eBooks are available at special quantity discounts to use as premiums and sales promotions or for use in corporate training programs. To contact a representative, please visit the Contact Us page at www.mhprofessional.com. Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. 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Neither McGraw-Hill Education nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill Education has no responsibility for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill Education and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise. Contents Preface 1. Introduction: The Paradox of Excess and Deprivation 2. Paying for Health Care 3. Access to Health Care 4. Paying Health Care Providers 5. How Health Care Is Organized—I: Primary, Secondary, and Tertiary Care 6. How Health Care Is Organized—II: Health Delivery Systems 7. The Health Care Workforce and the Education of Health Professionals 8. Painful Versus Painless Cost Control 9. Mechanisms for Controlling Costs 10. Quality of Health Care 11. Prevention of Illness 12. Long-Term Care 13. Medical Ethics and Rationing of Health Care 14. Health Care in Four Nations 15. Health Care Reform and National Health Insurance 16. Conflict and Change in America’s Health Care System 17. Conclusion: Tensions and Challenges 18. Questions and Discussion Topics Index Preface Understanding Health Policy: A Clinical Approach is a book about health policy as well as 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, 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 differences in access to care between families on Medicaid and those with private coverage influences which patients end up seeing one of us in the private sector over the other in a public hospital. 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, social work, public health, and others—who 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 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 intense 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 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. 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
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