New Edition of Health Care USA Addresses Health Reform and Many Other Changes in the Industry

In the foreword of the latest edition of their best-selling text, Health Care USA, authors Harry Sultz and Katherine Young take a brief look at the current state of the U.S. Health Care:

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Health Care USA, 7th Ed. will be available on July 12. Qualified instructors can reserve a complimentary review copy today.In spite of its long history and common use, the U.S. health care system has been a complex puzzle to many Americans. Medical care in the United States is an enormous $2.5 trillion industry. It includes thousands of independent medical practices and partnerships and provider organizations; public and nonprofit institutions such as hospitals, nursing homes, and other specialized care facilities; and major private corporations. In dollar volume, the U.S. health care industry is second only to the manufacturing sector. For personal consumption, Americans spend more only on food and housing than they do on medical care. Furthermore, health care is by far the largest service industry in the country. In fact, the U.S. health care system is the world’s eighth largest economy, second to that of France, and is larger than the total economy of Italy.1

More intimidating than its size, however, is its complexity. Not only is health care labor intensive at all levels, but also the types and functions of its numerous personnel change periodically to adjust to new technology, knowledge, and ways of delivering health care services.

As is frequently associated with progress, medical advances often create new problems while solving old ones. The explosion of medical knowledge that produced narrowly defined medical specialties has compounded a long-standing shortcoming of American medical care. The delivery of sophisticated high-tech health care requires the support of an incredibly complicated infrastructure that allows too many opportunities for patients to fall through the cracks between its narrowly defined services and specialists. In addition, our system has proven to be inept in securing even a modicum of universal coverage. Currently, over 47 million Americans are uninsured.

The size and complexity of health care in the United States contributes to its long-standing problems of limited consumer access, inconsistent quality, and uncontrolled costs. In addition, the U.S. health care system has done little to address the unnecessary and wasteful duplication of certain services in some areas and the absence of essential services in others.

These problems have worried this country’s political and medical leaders for decades and have motivated legislative proposals that are aimed at reform by eight U.S. presidents. President Clinton’s National Health Security Act of 1993 produced an unusually candid and sometimes acrimonious congressional debate. Vested interests advocating change and those defending the status quo both lobbied extensively to influence public and political opinion. In the end, the stakeholders in the traditional system convinced a public—apprehensive about more governmental control over personal health services—that the Clinton plan was too much, too liberal, and too costly, and it was therefore defeated.

President Obama’s 2009 proposal for a major reform of the U.S. health care system produced an even more boisterous response by those with vested interests in the status quo. Led by the lobbyists of the insurance and pharmaceutical industries who envision constraints on their long history of unlimited profits, opponents of expanding the role of government, and supported by folks frightened of change or the scare tactics of reform opponents, the debate has been partisan and vigorous.

As 2009 ended, both houses of Congress had passed landmark, but somewhat different, health care reform bills by the slimmest of margins. In March 2010 the two versions of health care reform legislation were reconciled, signed by President Obama, and the long-awaited health care reform movement is underway. In subsequent chapters the proposed legislative changes are described.

Regardless of the forthcoming governmental intervention, health care is already undergoing a revolution. Health care reform has been occurring as a market-driven, not a policy-driven, phenomenon. In a world of accelerating consolidation to achieve ever higher standards of effectiveness and economy, there has been a surge of health care facility and service mergers and acquisitions, new programs, new names, and new roles that signal the onset of fundamental changes throughout the system. Hospitals are competing for patients, clinics have sprung up in shopping plazas, and physicians are creating larger and larger group practices.

The practice of medicine, long a cottage industry that valued individual entrepreneurship and control, has undergone dramatic change and physicians have been most affected. Physicians who cherished the individual autonomy and privileged position afforded them now face the vexing oversight of case and utilization management, practice guidelines, critical pathways, and clinical report cards. Unfortunately, the loss of professional control has also been accompanied by the loss of control over the allocation of health care dollars. The result has been a substantial decrease in annual physician incomes. Insurers have controlled health costs by arbitrarily refusing reimbursement for certain medical procedures and reducing payments for others.

This book is intended to serve as a text for introductory courses on the organization of health care for students in schools of public health, medicine, nursing, dentistry, and pharmacy and in schools and colleges that prepare physical therapists, occupational therapists, respiratory therapists, medical technologists, health administrators, and a host of other allied health professionals. It provides an introduction to the U.S. health care system and an overview of the professional, political, social, and economic forces that have shaped it and will continue to do so. Because the complex health care system in the United States is in a state of rapid change, this book is updated every 2 years to keep its readers abreast of new developments.

To facilitate its use as a teaching text, this book has been organized into a succession of chapters that both stand alone as balanced discussions of discrete subjects and, when read in sequence, provide incremental additions of information to complete the reader’s understanding of the entire health care system. Although decisions about what subjects and material were essential to the book’s content were relatively easy, decisions about the topics and content to be left out were very difficult. The encyclopedic nature of the subject and the finite length of the final manuscript were in constant conflict.

Thus the authors acknowledge in advance that nurses, dentists, pharmacists, physical and occupational therapists, and others may be disappointed that the text contains so little of the history and the political and professional struggles that characterize the evolution of their important professions. Given the centrality of those historical developments in students’ educational preparation, it was assumed that appropriate attention to those subjects, using books written specifically for that purpose, would be included in courses in those professional curricula. To be consistent with that assumption, the authors tried to include only those elements in the history of public health, medicine, and hospitals that had a significant impact on how health care was delivered.

The authors made a similar set of difficult decisions regarding the depth of information to include about specific subjects. Topics such as epidemiology, history of medicine, program planning and evaluation, quality of care, and the like each have their own libraries of in-depth texts and, in many schools, dedicated courses. Thus it seemed appropriate in a text for an introductory course to provide only enough descriptive and interpretive detail about each topic to put it in the context of the overall subject of the book.

This book was written from a public health or population perspective and reflects the viewpoint of its authors. Both authors have public health and preventive medicine backgrounds and long histories of research into various aspects of the health care system, have planned and evaluated innovative projects for improving the quality and accessibility of care in both the public and voluntary sectors, and have served in key executive positions in the health field.

The authors have used much of the material contained in Health Care USA: Understanding Its Organization and Delivery to provide students, consumers, and neophyte professionals with an understanding of the unique interplay of the technology, workforce, research findings, financing, regulation, and personal and professional behaviors, values, and assumptions that determine what, how, why, where, and at what cost health care is delivered in the United States. In this seventh edition, as in each previous edition, we have included important additions and updates to provide a current perspective on the health care industry’s continuously evolving trends.

The authors hope that as this book’s readers plan and expand their educational horizons and, later, their professional experiences, they will have the advantage of a comprehensive understanding of the complex system in which they practice.

Reference

1. U.S. Bureau of the Census. The 2009 statistical abstract. National health expenditures—summary and projections. Available from
http://www.census.gov/compendia/statab/2009/cats/health_nutrition/health_expenditures.html.
Accessed November 16, 2009.