Health Care in the United States

Organization, Management, and Policy

Howard P. Greenwald

• Publisher: Jossey-Bass
• Year: 2022
• Print ISBN:
  9781119812210
• eBook ISBN:
  9781119812227
• Edition: 2
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

A one-stop resource covering American health care and the challenges it faces 

In the newly revised Second Edition of Health Care in the United States: Organization, Management, and Policy, distinguished health and organizational researcher Dr. Howard P. Greenwald delivers a comprehensive exploration of the US health care system and the challenges its practitioners, professionals, and consumers face. 

From organization to management, financing, and evaluation, this book discusses the critical concepts, trends, and features of this sprawling set of interlocking systems. It also examines the historical origins of modern health care and how it delivers services to over 300 million Americans. Readers will discover: 

• Modern controversies in American health care that animate political debate and discussion, including the Affordable Care Act. 
• Discussions of the health care labor force, as well as its history, background, and crucial challenges. 
• Possible future directions for US health care, including preventive medicine, new policy initiatives, and proposals for reform. 

Written for students and professionals working in or studying health care management, health policy, public health, medical sociology, or anthropology, social work, or political science, this latest edition of Health Care in the United States is also a fascinating read for members of the general public curious about one of the most important services they'll ever interact with. 

PART 1
The System and Its Tasks

Health care serves a basic human need and for this reason is one of the oldest specialized human functions. Perhaps even before the recording of history, specialized personnel in the human group acquired some degree of healing art. Imperfect understanding, and even magic and mystery, characterizes healing from the layperson’s point of view. Still today, the layperson views health care with varying degrees of awe, uncertainty, and suspicion. As experienced by many in the modern world, the outcomes of health care are uncertain, the cost unjustifiable, and the practitioners aloof.

The U.S. health care system shares many of the essential characteristics of health care throughout history and across the globe. But the U.S. system is unusual in the degree to which it is privately owned and operated and lacking in direction by a central authority or agency. Values central to the American mind such as belief in the private sector have helped maintain these characteristics. Beliefs among Americans in meritocracy, the right to unrestricted choice, and maximization of personal advantages also help maintain the system as it is. Values such as these led many Americans to oppose the Affordable Care Act (ACA), the first major health care reform to be enacted in generations.

The health care system’s basic tasks are to prevent and remedy illness and injury. Chronic, noninfectious disease represents today’s principal threat to health and survival. Diseases of this nature tend to have multiple causes, both behavioral and environmental. They require close collaboration between clinician and client for control. Because of the need for repeated treatment, such diseases tend to be expensive to care for.

Until recently, infectious diseases were relegated to historical accounts of epidemics and plagues. But the COVID-19 pandemic reminded the world of the continuing importance of infectious disease. COVID-19 was not the first pandemic of modern times. It followed, for example, the human immunodeficiency virus (HIV), which, by early in the twenty-first century, killed over 30 million people worldwide. Fatalities of this magnitude are reminders of the continuing importance of public health institutions from the local to the international community.

Health is often an outcome of human behavior. Individuals vary significantly in the taking of health risks. Similarly, people differ in their perceptions and acceptance of illness. Demographic factors strongly influence the tendency of people to seek health care even when they perceive the need.

Major disparities in race and class now exist in both health and longevity. The degree to which health care itself contributes to these disparities is uncertain. Broader social forces, such as systemic racism, contribute to these disparities and must be addressed both along with and separate from health care. In the realm of health care, development of cultural competence among providers and health literacy among consumers constitutes immediate challenges.

CHAPTER 1
Understanding Health Care

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Learning Objectives

To obtain an overview of health care as a concern in the U.S. and worldwide

• To appreciate the challenges experienced by health care consumers and providers
• To identify objectives and goals for health care
• To highlight the importance of public trust and professional ethics
• To frame health care issues within three perspectives: a systems approach, critical thinking, and the public interest

Health Care as a National Concern

Health and health care are subjects in which everyone has an interest. When young mothers get together, talk soon turns to the health of their children. In search of health, men and women of all ages work out at the gym. Among elders, conversation inevitably involves aches, pains, and the merits and shortcomings of their physicians. Health and health care are major election issues. Acute concerns for health, health care, and associated costs are only a step away from each individual, who, if he or she has no direct involvement, almost always has a friend, relative, or neighbor in need of care. The COVID-19 pandemic raised health concerns to the top of the news and made once-arcane terms such as “virus variant” and “herd immunity” into household words.

In times of both crisis and normality, health care in the United States is arguably the best in the world. By some measures the hopes of Americans for long and healthy lives are brighter than they have ever been. Children with leukemia, whose illness amounted to a death sentence only a generation ago, now often survive to live normal lives. Elders who at one time would have been confined to wheelchairs and nursing homes now live active, independent lives thanks to procedures such as cataract surgery and hip replacement. Effective drugs and widely available surgery are chipping away at heart disease, for generations America’s leading cause of death. Acquired immunodeficiency syndrome (AIDS) is now often controllable, whereas at a time still well remembered it invariably led to a miserable death. Life expectancy in the United States increased from 69.7 years in 1960 to 78.7 in 2018.¹

Health care, however, has become a major source of dissatisfaction and controversy in the United States. A challenge affecting the United States as a whole, and Americans as individuals, is that of cost. Figure 1.1, which includes a projection to 2028, demonstrates how markedly the cost of health care has increased in recent decades. National health expenditures grew by 4.6% between 2018 and 2019 alone, to 17.7% of the United States gross domestic product (GDP). National health spending is projected to reach $6.2 trillion by 2028.²

FIGURE 1.1 Growth in Per Capita Health Care Costs, United States, 1960–2028.

Sources: Data to 2010: National Center for Health Statistics, Health United States 2019. Estimates 2020 and 2028: NHE Fact Sheet, https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet.

Figure 1.1 takes on added significance when viewed alongside changes in the health insurance upon which nearly all Americans depend. Most of the dollars paid for health care come from health insurance of some kind. As recently as the late 1970s, a large number of Americans paid nothing out of pocket for their health care. Hardly anyone today enjoys such generosity. Now, both private and public insurers continuously seek ways to reduce the extent of coverage. Not only are health care costs higher to...

Table of contents

• Cover
• Title page
• Copyright
• Dedication
• Table of Contents
• Tables and Figures
• Preface to the Second Edition
• The Author
• Acknowledgments
• About the Companion Website
• Part 1 The System and Its Tasks
• Part 2 Means of Delivery
• Part 3 Paths Forward
• Glossary
• Abbreviations
• Index
• End User License Agreement