The Fragmentation of U.S. Health Care

Causes and Solutions

Author: Einer Elhauge

Publisher: Oxford University Press on Demand

ISBN: 019539013X

Category: Law

Page: 388

View: 2315

Why is the American health care system so fragmented in the care it gives patients? This title approaches this question and more with a highly interdisciplinary approach. The articles included in the work address legal and regulatory issues, including laws that mandate separate payments for each provider.

The Fragmentation of U.S. Health Care

Causes and Solutions

Author: Einer Elhauge

Publisher: Oxford University Press

ISBN: 019974940X

Category: Law

Page: 396

View: 9446

Why is our health care system so fragmented in the care it gives patients? Why is there little coordination amongst the many doctors who treat individual patients, who often even lack access to a common set of medical records? Why is fragmentation a problem even within a single hospital, where errors or miscommunications often seem to result from poor coordination amongst the myriad of professionals treating any one individual patient? Why is health care fragmented both over time, so that too little is spent on preventive care, and across patients, so that resources are often misallocated to the patients who need it least? The Fragmentation of U.S. Health Care: Causes and Solutions approaches these broad questions with a highly interdisciplinary approach. The articles included in the work address legal and regulatory issues, including laws that mandate separate payments for each provider, restrict hospitals or others from controlling or rewarding the set of providers treating a patient to assure coordinated care, and provide affirmative disincentives for coordinating care by paying more for uncoordinated care that requires more services. Business reasons for the current form of hospital organization are considered, and efficiency and design are examined and compared to other industries. The economics of current hospital organization are also taken into account. The authors examine and propose various reforms that make our health care system less fragmented, more efficient, and more medically effective.

The Learning Healthcare System

Workshop Summary

Author: Institute of Medicine,Roundtable on Evidence-Based Medicine

Publisher: National Academies Press

ISBN: 9780309133937

Category: Medical

Page: 374

View: 4652

As our nation enters a new era of medical science that offers the real prospect of personalized health care, we will be confronted by an increasingly complex array of health care options and decisions. The Learning Healthcare System considers how health care is structured to develop and to apply evidence--from health profession training and infrastructure development to advances in research methodology, patient engagement, payment schemes, and measurement--and highlights opportunities for the creation of a sustainable learning health care system that gets the right care to people when they need it and then captures the results for improvement. This book will be of primary interest to hospital and insurance industry administrators, health care providers, those who train and educate health workers, researchers, and policymakers. The Learning Healthcare System is the first in a series that will focus on issues important to improving the development and application of evidence in health care decision making. The Roundtable on Evidence-Based Medicine serves as a neutral venue for cooperative work among key stakeholders on several dimensions: to help transform the availability and use of the best evidence for the collaborative health care choices of each patient and provider; to drive the process of discovery as a natural outgrowth of patient care; and, ultimately, to ensure innovation, quality, safety, and value in health care.

The Healthcare Imperative:

Lowering Costs and Improving Outcomes: Workshop Series Summary

Author: Roundtable on Evidence-Based Medicine,LeighAnne Olsen,Pierre L. Young,Roundtable on Value & Science-Driven Health Care,Institute of Medicine

Publisher: National Academies Press

ISBN: 0309144337

Category: Medical

Page: 852

View: 7944

The United States has the highest per capita spending on health care of any industrialized nation but continually lags behind other nations in health care outcomes including life expectancy and infant mortality. National health expenditures are projected to exceed $2.5 trillion in 2009. Given healthcare's direct impact on the economy, there is a critical need to control health care spending. According to The Health Imperative: Lowering Costs and Improving Outcomes, the costs of health care have strained the federal budget, and negatively affected state governments, the private sector and individuals. Healthcare expenditures have restricted the ability of state and local governments to fund other priorities and have contributed to slowing growth in wages and jobs in the private sector. Moreover, the number of uninsured has risen from 45.7 million in 2007 to 46.3 million in 2008. The Health Imperative: Lowering Costs and Improving Outcomes identifies a number of factors driving expenditure growth including scientific uncertainty, perverse economic and practice incentives, system fragmentation, lack of patient involvement, and under-investment in population health. Experts discussed key levers for catalyzing transformation of the delivery system. A few included streamlined health insurance regulation, administrative simplification and clarification and quality and consistency in treatment. The book is an excellent guide for policymakers at all levels of government, as well as private sector healthcare workers.

The Oxford Handbook of U.S. Healthcare Law

Author: I. Glenn Cohen

Publisher: Oxford University Press

ISBN: 0199366527

Category: Medical care

Page: 1216

View: 9599

The Oxford Handbook of U.S. Health Law covers the breadth and depth of health law, with contributions from the most eminent scholars in the field. The Handbook paints with broad thematic strokes the major features of American healthcare law and policy, its recent reforms including the Affordable Care Act, its relationship to medical ethics and constitutional principles, and how it compares to the experience of other countries. It explores the legal framework for the patient experience, from access through treatment, to recourse (if treatment fails), and examines emerging issues involving healthcare information, the changing nature of healthcare regulation, immigration, globalization, aging, and the social determinants of health. This Handbook provides valuable content, accessible to readers new to the subject, as well as to those who write, teach, practice, or make policy in health law.

Engineering a Learning Healthcare System:

A Look at the Future: Workshop Summary

Author: Institute of Medicine,National Academy of Engineering

Publisher: National Academies Press

ISBN: 0309120640

Category: Medical

Page: 340

View: 7760

Improving our nation's healthcare system is a challenge which, because of its scale and complexity, requires a creative approach and input from many different fields of expertise. Lessons from engineering have the potential to improve both the efficiency and quality of healthcare delivery. The fundamental notion of a high-performing healthcare system--one that increasingly is more effective, more efficient, safer, and higher quality--is rooted in continuous improvement principles that medicine shares with engineering. As part of its Learning Health System series of workshops, the Institute of Medicine's Roundtable on Value and Science-Driven Health Care and the National Academy of Engineering, hosted a workshop on lessons from systems and operations engineering that could be applied to health care. Building on previous work done in this area the workshop convened leading engineering practitioners, health professionals, and scholars to explore how the field might learn from and apply systems engineering principles in the design of a learning healthcare system. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary focuses on current major healthcare system challenges and what the field of engineering has to offer in the redesign of the system toward a learning healthcare system.

Integrated Health Care Delivery

Author: Leonie A. Klein,Emily L. Neumann

Publisher: Nova Science Pub Incorporated

ISBN: 9781604568516

Category: Business & Economics

Page: 171

View: 3767

In an integrated health network, various types of organisations are connected along a continuum of care through horizontal and vertical integration. Integrated health network has several interchangeable terms such as integrated health system, integrated delivery system (network), integrated care system (network), organised delivery system, community care network, integrated health care organisation, integrated service network, population-based integrated delivery system, and so on, which all emphasise as a multi-organisation form characterised by serving a defined population across multi-disciplines, including professionals, units, or service-lines of primary care, acute care and long term care. This book provides leading-edge issues on this field from around the globe.

A Call to be Whole

The Fundamentals of Health Care Reform

Author: Barbara J. Sowada

Publisher: Greenwood Publishing Group

ISBN: 9780275978853

Category: Health & Fitness

Page: 222

View: 2304

Examines the basic assumptions that underlie the organization of the modern health care system and illuminates the layers of systemic dysfunction that result in today's cost, quality, and access problems.

Crossing the Quality Chasm:

A New Health System for the 21st Century

Author: Committee on Quality of Health Care in America,Institute of Medicine

Publisher: National Academies Press

ISBN: 0309072808

Category: Medical

Page: 360

View: 8518

Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.

Ensuring America's Health

The Public Creation of the Corporate Health Care System

Author: Christy Ford Chapin

Publisher: Cambridge University Press

ISBN: 110704488X

Category: History

Page: 369

View: 8164

This book provides an in-depth evaluation of the U.S. health care system's development in the twentieth century. It shows how a unique economic design - the insurance company model - came to dominate health care, bringing with it high costs; corporate medicine; and fragmented, poorly distributed care.

Oxymorons

The Myth of a U.S. Health Care System

Author: J. D. Kleinke

Publisher: Jossey-Bass

ISBN: 9780787959708

Category: Medical

Page: 256

View: 6713

In this impassioned and often vitriolic book - a follow-up to the author's bestselling Bleeding Edge: The Business of Health Care in the New Century - U.S. health care industry expert J.D. Kleinke offers an unflinching look at our broken health care system. Throughout the book, Kleinke - who was once a vocal advocate of the managed health care system - explains what went wrong and attempts to answer such perplexing questions as: Who's in charge of the American health care system? How does managed care work . . . or not work? Why have hospitals become so complex? What are the prospects for reform? Does the Internet change anything? Can we solve the growing problem of the uninsured?

The Fragmentation of Being

Author: Kris McDaniel

Publisher: Oxford University Press

ISBN: 0191030384

Category: Philosophy

Page: 304

View: 6552

The Fragmentation of Being offers answers to some of the most fundamental questions in ontology. There are many kinds of beings but are there also many kinds of being? The world contains a variety of objects, each of which, let us provisionally assume, exists, but do some objects exist in different ways? Do some objects enjoy more being or existence than other objects? Are there different ways in which one object might enjoy more being than another? Most contemporary metaphysicians would answer "no" to each of these questions. So widespread is this consensus that the questions this book addressed are rarely even raised let alone explicitly answered. But Kris McDaniel carefully examines a wide range of reasons for answering each of these questions with a "yes". In doing so, he connects these questions with many important metaphysical topics, including substance and accident, time and persistence, the nature of ontological categories, possibility and necessity, presence and absence, persons and value, ground and consequence, and essence and accident. In addition to discussing contemporary problems and theories, McDaniel also discusses the ontological views of many important figures in the history of philosophy, including Aquinas, Aristotle, Descartes, Heidegger, Husserl, Kant, Leibniz, Meinong, and many more.

The Truth About Big Medicine

Righting the Wrongs for Better Health Care

Author: Cheryl L. Brown,John T. James

Publisher: Rowman & Littlefield

ISBN: 1442231610

Category: Health & Fitness

Page: 280

View: 1364

This title drills deeply into the broken American health care industry—demonstrating how the medical industry’s self-serving interests have run afoul of safe care. Written by passionate experts in multiple relevant fields, this book shows readers how the system works, why it works this way, how it harms and often kills people and how we can fix it.

Out of Practice

Fighting for Primary Care Medicine in America

Author: Frederick M. Barken

Publisher: Cornell University Press

ISBN: 9780801461088

Category: Medical

Page: 244

View: 454

Primary care medicine, as we know and remember it, is in crisis. While policymakers, government administrators, and the health insurance industry pay lip service to the personal relationship between physician and patient, dissatisfaction and disaffection run rampant among primary care doctors, and medical students steer clear in order to pursue more lucrative specialties. Patients feel helpless, well aware that they are losing a valued close connection as health care steadily becomes more transactional than relational. The thin-margin efficiency, rapid pace, and high volume demanded by the new health care economics do not work for primary care, an inherently slower, more personal, and uniquely tailored service. In Out of Practice, Dr. Frederick Barken juxtaposes his personal experience with the latest research on the transformations in the medical field. He offers a cool critique of the "market model of medicine" while vividly illustrating how the seemingly inexorable trend toward specialization in the last few decades has shifted emphasis away from what was once the foundation of medical practice. Dr. Barken addresses the complexities of modern practice-overuse of diagnostic studies, fragmentation of care, increasing reliance on an array of prescription drugs, and the practice of defensive medicine. He shows how changes in medicine, the family, and society have left physicians to deal with a wide range of geriatric issues, from limited mobility to dementia, that are not addressed by health care policy and are not entirely amenable to a physician's prescription. Indeed, Dr. Barken contends, the very survival of primary care is in jeopardy at a time when its practitioners are needed more than ever. Illustrated with case studies gleaned from more than twenty years in private practice and data from a wide range of sources, Out of Practice is more than a jeremiad about a broken system. Throughout, Dr. Barken offers cogent suggestions for policymakers and practitioners alike, making clear that as valuable as the latest drug or medical device may be, a successful health care system depends just as much on the doctor-patient relationship embodied by primary care medicine.

Understanding Teamwork in Health Care

Author: Gordon Mosser,James W. Begun

Publisher: McGraw Hill Professional

ISBN: 0071791965

Category: Medical

Page: 256

View: 7633

A complete introductory guide to the principles and clinical application of teamwork in health care Understanding Teamwork in Health Care emphasizes the essential competencies necessary to implement teamwork in health care in a complex hospital or primary care setting. Unlike similar books on the subject which are theoretical or policy-oriented, this text offers practical, real-world coverage. Valuable for health care professionals seeking a thorough explanation of teamwork and for trainers working in hospitals or primary care settings; could also be used as a textbook. Mini-cases throughout the text help readers appreciate real-world application of principles Written to a level suited for the non-specialist

Assuring the Quality of Health Care in the European Union

A Case for Action

Author: Helena Legido-Quigley

Publisher: World Health Organization

ISBN: 9289071931

Category: Medical

Page: 210

View: 7671

People have always travelled within Europe for work and leisure, although never before with the current intensity. Now, however, they are travelling for many other reasons, including the quest for key services such as health care. Whatever the reason for travelling, one question they ask is "If I fall ill, will the health care I receive be of a high standard?". This book examines, for the first time, the systems that have been put in place in all of the European Union's 27 Member States. The picture it paints is mixed. Some have well developed systems, setting standards based on the best available evidence, monitoring the care provided, and taking action where it falls short. Others need to overcome significant obstacles.

Power, Politics and the Fragmentation of Evangelicalism

From the Scopes Trial to the Obama Administration

Author: Kenneth J. Collins

Publisher: InterVarsity Press

ISBN: 0830863397

Category: Religion

Page: 299

View: 8797

Kenneth J. Collins tells the narrative history of the political and cultural fortunes of American evangelicalism from the late nineteenth century through the contemporary era. He traces the establishment of the evangelical enterprise in American culture and its influences on the political and social values of the American landscape throughout the twentieth century, as well as its fragmentation into competing ideological camps. Underlining how both sides of the liberal-conservative divide have diluted their message through political idioms, Collins suggests a way forward for evangelical political identity that avoids the pitfalls of fundamentalism and liberalism. Will American evangelicalism outlive its partisan history? As Kenneth Collins tells the story, there is reason to think so.

Moving Toward Universal Coverage of Social Health Insurance in Vietnam

Assessment and Options

Author: Aparnaa Somanathan,Ajay Tandon,Huong Lan Dao,Kari L. Hurt,Hernan L. Fuenzalida-Puelma

Publisher: World Bank Publications

ISBN: 1464802610

Category: Business & Economics

Page: 176

View: 2244

Over the past two decades Vietnam has made enormous progress to expand health insurance coverage to its population. Further progress will require significant additional public financing, as well as efforts improve efficiency and strengthen insurance organization and management. It contains recommendations and next steps for Vietnam to follow.

High Performance Healthcare: Using the Power of Relationships to Achieve Quality, Efficiency and Resilience

Author: Jody Hoffer Gittell

Publisher: McGraw Hill Professional

ISBN: 0071621814

Category: Business & Economics

Page: 288

View: 346

In her groundbreaking book The Southwest Airlines Way, Jody Hoffer Gittell revealed the management secrets of the company Fortune magazine called “the most successful airline in history.” Now, the bestselling business author explains how to apply those same principles in one of our nation’s largest, most important, and increasingly complex industries. High Performance Healthcare explains the critical concept of “relational coordination”—coordinating work through shared goals, shared knowledge, and mutual respect. Because of the way healthcare is organized, weak links exist throughout the chain of communication. Gittell clearly demonstrates that relational coordination strengthens those weak links, enabling providers to deliver high quality, efficient care to their patients. Using Gittell’s innovative management methods, you will improve quality, maximize efficiency, and compete more effectively. High Performance Healthcare walks you step by step through the process of: Identifying weak areas of relational coordination within your organization Transforming work practices that are creating barriers to relational coordination Building a high performance work system to foster consistent relational coordination across all disciplines The book includes case studies illustrating how some healthcare organizations are already transforming themselves using Gittell’s proven tools. It concludes by identifying industry-level obstacles to high performance healthcare and showing how individual organizations and their leaders can support sweeping change at the highest levels. Policy changes and increased access to care will not alone answer the healthcare industry’s problems. Timely, accurate, problem-solving communication that crosses all organizational boundaries is a powerful response to business as usual. High Performance Healthcare explains exactly how to achieve this crucial dynamic, providing a long-awaited cure to an industry in crisis.

Partners in Health

How Physicians and Hospitals can be Accountable Together

Author: Kaiser Permanente Institute for Health Policy

Publisher: John Wiley & Sons

ISBN: 0470626593

Category: Medical

Page: 336

View: 448

Praise for Partners in Health "The combination of visionary leadership, knowledge, and superb timing makes this book a winner. Health care is evolving toward collaboration and integration, and this book is essential reading for anyone wishing to change the relationships between hospitals and physicians." —Donald W. Fisher, PhD, president and CEO, the American Medical Group Association "This book is a must-read for anyone committed to a high-performance health system. It spells out the practical steps that will move us toward an accessible, coordinated, patient-centered system of care. Its recommendations for payment and regulatory reform underscore the urgency of comprehensive health reform if the current misaligned incentives are to be changed to support those on the frontlines in providing the best care with prudent stewardship of resources." —Karen Davis, PhD, president, The Commonwealth Fund "Closer physician-hospital integration would lead to higher quality care at lower cost. Partners in Health is a masterful guide to past integration efforts, current models of success, and thoughtful recommendations for future progress." —Victor R. Fuchs, PhD, Henry J. Kaiser Jr. Professor Emeritus, Stanford University "The working relationship of hospitals and physicians must be restructured for the United States to achieve more efficient, accountable care. But addressing our urgent challenges can't wait for all hospitals and physicians to join highly structured systems. Thankfully, the authors offer steps that all the major stakeholders can take today to spur new models and start the flywheel of trust spinning at new speeds." —Richard Umbdenstock, president and CEO of the American Hospital Association "Transitioning U.S. health care from fragmentation to integration, in the context of a more rational payment system, is sure to be a long and tortuous journey. Partners in Health is a kind of Fodor's Guide to the voyage. No one committed to health reform should travel without it." —Susan Dentzer, editor-in-chief, Health Affairs