Changing the U.S. Health Care System: Key Issues in Health Services Policy and Management by Ronald M. Andersen, Thomas H. Rice, Gerald F. Kominski, Abdelmonem A. Afifi (Foreword by), Linda Rosenstock (Foreword by)

From the Publisher

The third edition of Changing the U.S. Health Care System is a thoroughly revised and updated compendium of the most current thought on three key components of health care policy—improving access, ensuring quality, and controlling costs. Written by a panel of health care policy experts, this third edition highlights the most recent research relevant to health policy and management issues. New chapters address topics such as the disparities in health and in health care, information systems, and performance in the area of nursing. Revisions to chapters from the previous edition emphasize the most recent developments in the field.

Doody Review Services

Reviewer:Carole A. Kenner, RNC, DNS, FAAN (University of Oklahoma College of Nursing)
Description:This comprehensive book addresses issues in healthcare from a policy and management perspective. Each chapter is written by experts in the field who were charged with integration of evidence to support the current condition and projected needed change. The previous edition was published in 2001.
Purpose:The book is intended to present current issues in health policy and management within the context of evidence. It is intended to be a "one stop shop" for health issues facing the U.S. populace. The book lives up to its objective, being comprehensive and contemporary in its approach to a very old topic.
Audience:The intended audience is interdisciplinary students, health service researchers and analysts, healthcare managers, practitioners, and healthcare providers.
Features:Starting off with access to healthcare, cost, quality, special populations, and culminating in directions for change, the book provides a comprehensive review of current issues. The tie to the Institute of Medicine (IOM) reports about quality is excellent. The coverage of healthcare reform and the impact on special populations such as women and children is very good.
Assessment:This is the most comprehensive healthcare policy book around. Its emphasis on the current research and evidence to support each chapter's content gives it a unique spin. This edition includes contemporary topics such as disparities in health and in access to care, use of information systems, and nursing performance indicators as they impact quality. Thislast chapter highlights the contribution nursing has made to quality care and patient safety, something that is lacking in many healthcare policy books.

Booknews

Researchers working in health policy from a wide range of perspectives summarize existing empirical research on their specialties and discuss research and management strategies that can be used to address current problems. Those whose chapter were carried over from the first edition (no date noted) were asked to emphasize developments since then. The 20 studies cover access, costs, quality, special populations, and directions for change. Annotation c. Book News, Inc., Portland, OR (booknews.com)

Fatbrain

"The authoritative book on the U.S. health care system. Any student, scholar, executive, or policymaker who wants to understand a particular phenomenon should consult it."
--Deborah A. Freund, vice chancellor and provost, professor of public administration, Syracuse University

"Under one cover can be found the basic data and research relevant to virtually all important health policy issues, as well sophisticated analytic material on current problems and their range of possible solutions."
--Steven A. Schroeder, M.D., president and CEO, The Robert Wood Johnson Foundation

Rating

4 Stars! from Doody

Product Details

• Table of Contents
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Table of Contents

Read an Excerpt

Chapter 1: Improving Access To Care In America

Ronald M. Andersen and Pamela L. Davidson

The purpose of this chapter is to present basic trends as well as research and policy issues related to health care access. We define access as actual use of personal health services and everything that facilitates or impedes their use. It is the link between health services systems and the populations they serve. Access means not only getting to service but also getting to the right services at the right time to promote improved health outcomes.

Conceptualizing and measuring access is the key to understanding and making health policy in a number of ways: (1) predicting use of health services, (2) promoting sociaI justice, and (3) improving effectiveness and efficiency of health service delivery.

The chapter presents a conceptual framework for understanding the multiple dimensions of access to medical care. The various types of access are considered and related to their policy purposes. Examples of key access measures are given and trend data are used to track changes that have occurred over time in these access indicators. The chapter addresses the questions, Is access improving or declining in the United States? For whom? According to what measures? It concludes by discussing future access indicators and research directions.

Understanding Access to Health Care

This section proposes a conceptual framework based on a behavioral model of health services use that emphasizes contextual as well as individual determinants of access to medical care. Also reviewed are the dimensions of access defined according to components of the framework and how access might be improved for each dimension.

Conceptual Framework

Compared to the framework presented in the first edition of this volume, the version shown in Figure 1.1 stresses that improving access to care is best accomplished by focusing on contextual as well as individual determinants.' By contextual we point to the circumstances and environment of health care access. Context includes health organization and provider-related factors as well as community characteristics.2 Contextual factors are measured at some aggregate rather than at the individual level. These aggregate levels range from units as small as the family to those as large as a national health care system. In between are workgroups, provider organizations, health plans, local communities, and metropolitan statistical areas. Individuals are related to these aggregate units through either membership (family, workgroup, provider institutions, health plan) or residence (community, metropolitan area, national health system).

The model shown in Figure 1.1 suggests that the major components of contextual characteristics are divided in the same way as individual characteristics determining access: (1) existing conditions that predispose people to use or not use services even though these conditions are not directly responsible for use, (2) enabling conditions that facilitate or impede the use of services, and (3) need or conditions recognized by laypeople or health care providers as requiring medical treatment.3 The model shown in Figure 1.1 emphasizes contextual factors in recognition of the importance of community, the structure and process of providing care,4 and the realities of a managed care environment.5 Still, the ultimate focus of the model remains on health behaviors of individuals (especially their use of health services) and resulting outcomes regarding their health and satisfaction with services. We now turn to brief consideration of each major component of the model shown in Figure 1.1.

Contextual Predisposing Characteristics. Demographic characteristics include the age, gender, and marital status composition of a community. Thus, a community populated primarily by older persons might well have a different mix of available health services and facilities than one in which the majority are younger parents and children.

,Social characteristics at the contextual level describe how supportive or detrimental the communities where people live and work might be to their health and access to health services. Relevant measures include educational levels, ethnic and racial composition, proportion of recent immigrants, employment levels, and crime rates.

Beliefs refer to underlying community or organizational values and cultural norms and prevailing political perspectives regarding how health services should be organized, financed, and made accessible to the population.

Contextual Enabling Characteristics. Health policies are authoritative decisions made pertaining to health or influencing the pursuit of health. They can be public policies made in the legislative, executive, or judicial branches of government, at all levels from local to national. They can also be policies made in the private sector by such decision makers as executives of managed care organizations concerning product lines, pricing, or marketing, or by accrediting agencies such as the Joint Commission on Accreditation of Health Care Organizations JCAHO) or quality assessment organizations such as the National Committee for Quality Assurance (NCQA).

Financing characteristics are described by an array of contextual measures that suggest resources potentially available to pay for health services, including per capita community income, and wealth. Other financial characteristics are incentives to purchase or provide services such as rate of health insurance coverage, relative price of medical care and other goods and services, and method of compensating providers. Also included here are per capita expenditures for health services.

Organization at the contextual level includes the amount and distribution of health services facilities and personnel as well as how they are structured to offer services. Structure includes supply of services in the community such as the ratios of physicians and hospital beds to population. Structure also includes how medical care is organized in a particular institution or delivery system where people receive care, such as office hours and location of service, provider mix, utilization and quality control oversight, and outreach and education programs.

Contextual Need Characteristics. Environmental need characteristics include healthrelated measures of the physical environment, among them the quality of housing, water, and air (for example, residing in counties that met national ambient air quality standards throughout the year).? Other measures suggesting how healthy the environment might be are injury and death rates, such as rate of occupational injury and disease and related deaths as well as death rates from motor vehicle injuries, homicides, and firearms...