Foreword |
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v | |
Four Notes on How to Read This Book |
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vii | |
Introduction: The Lay of the Land |
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ix | |
Acknowledgments |
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xiii | |
A Note on the Inflation Reduction Act |
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xv | |
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Chapter 1 Health Care Delivery and Systems |
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1 | (36) |
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Getting to the Hospital (Emergency Services and Emergency Departments) |
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2 | (2) |
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Hospital or Inpatient Care (Types of Hospitals, Hospital Networks, and Hospital Operations) |
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4 | (6) |
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10 | (2) |
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Outpatient or "Ambulatory" Care (types of Clinks, Ambulatory Surgery Centers, Dialysis Centers, Non-Physician Services, Pharmacies, Telemedicine and Telehealth) |
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12 | (6) |
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Home Health and Home-Based Care |
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18 | (1) |
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All 1,000 People in the Ecology of Care (Public Health System, the "Safety Net," and Population Health and Delivery Innovations) |
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19 | (5) |
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24 | (13) |
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24 | (1) |
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25 | (1) |
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26 | (2) |
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28 | (9) |
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37 | (28) |
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Basics and Background of Insurance (What Is Insurance and Why Have It? How Do You Get Insurance? Insurance Terms and Concepts, Cost-Sharing, Utilization Management, Trade-Offs, Insurance Churn, and What Did the ACA Change About Insurance Coverage) |
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37 | (6) |
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Insurance: Types and Options |
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43 | (14) |
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43 | (1) |
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44 | (3) |
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47 | (4) |
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Veterans Health Administration |
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51 | (1) |
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51 | (1) |
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52 | (1) |
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Employer-Sponsored Insurance |
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53 | (2) |
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55 | (1) |
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Spotlight on Kaiser Permanente |
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56 | (1) |
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Short-Term Limited Duration Insurance Plans |
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56 | (1) |
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Does Insurance Even Accomplish What We Want? The Oregon Medicaid Experiment |
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57 | (2) |
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59 | (6) |
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Chapter 3 Health Care Economics and Financing |
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65 | (44) |
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The Big Picture (How Much Does US Health Care Cost, Where Does the Money Come From and Where Does It Go, How Is the Spending Distributed, and How Are Costs Trending?) |
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66 | (3) |
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Health Economics Concepts (Information Asymmetry, Moral Hazard, Adverse Selection, Cost vs Charge vs Reimbursement, Rationing) |
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69 | (3) |
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Health Care Is Not a Normal Market |
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72 | (2) |
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Understanding Reimbursement |
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74 | (14) |
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Fee-for-Service (CPT, ICD-10, DRGs, RVUs, Variation, and the Importance of Medicare) |
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75 | (6) |
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Alternative Payment Models and Value-Based Payment (Risk Adjustment, Accountable Care Organizations, Medicare Advantage) |
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81 | (6) |
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Reimbursement for All Other Care Services |
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87 | (1) |
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The (Big) Business of Medicine (Networks and Consolidation, Pharmacy Benefits Managers) |
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88 | (4) |
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Why Does U.S. Health Care Cost So Much? |
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92 | (17) |
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Chapter 4 Quality and Technology |
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109 | (33) |
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109 | (13) |
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Definitions (Safety, Quality, Value, Systems Improvement) |
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110 | (3) |
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Measurement and Action (Donabedian Triad, Measuring Safety, Connection With Technology, Quality Metrics) |
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113 | (4) |
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Some Major Areas of Focus in Quality |
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117 | (1) |
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117 | (1) |
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Health Care-Associated Infections |
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117 | (1) |
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118 | (1) |
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119 | (1) |
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Chronic Disease Management: Spotlight on Hypertension |
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119 | (1) |
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120 | (2) |
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Health Information Technology and Digital Health |
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122 | (8) |
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Electronic Health Records/Electronic Medical Records |
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122 | (2) |
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124 | (1) |
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Interoperability and Health Information Exchange |
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125 | (1) |
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Patient Access and Portals |
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126 | (1) |
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127 | (1) |
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128 | (1) |
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129 | (1) |
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Where Are We Headed with Health IT? |
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129 | (1) |
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Issues in Quality and Technology |
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130 | (12) |
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Choosing the Right Metrics |
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131 | (1) |
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EHRs, Measurement, and Burnout |
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132 | (1) |
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Safety and Medical Malpractice |
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133 | (9) |
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Chapter 5 Research, Pharmaceuticals, and Medical Devices |
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142 | (34) |
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Biomedical and Health Research |
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142 | (7) |
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What Are the Types of Research and Who Does It? |
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143 | (1) |
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144 | (2) |
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146 | (1) |
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What Have We Gotten for All This Research? |
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147 | (2) |
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Pharmaceuticals and Devices |
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149 | (12) |
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Growth of the Pharmaceutical Industry |
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149 | (1) |
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150 | (2) |
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152 | (1) |
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What About Medical Devices? |
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153 | (1) |
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How Are the Pharmaceutical and Device Industries Regulated? |
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153 | (5) |
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Paying for Prescription Drugs |
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158 | (3) |
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Issues in Research and Industry |
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161 | (15) |
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161 | (1) |
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162 | (2) |
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Drug Pricing Controversies |
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164 | (12) |
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176 | (29) |
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Timeline of Major Public Health and Health Policy Developments |
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176 | (2) |
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Policy Making in America (Congress and Legislatures, Executive Branch and the Federal Health Administration, State and Local Administration, Interest Groups) |
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178 | (4) |
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Government Spending: Focus on CMS |
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182 | (7) |
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The RVU Update Committee (RUC) |
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184 | (1) |
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MACRA and the Quality Payment Program |
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185 | (1) |
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Federal Medical Assistance Program (FMAP) |
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186 | (1) |
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Medicare Advantage and Managed Medicaid |
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187 | (1) |
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187 | (2) |
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189 | (9) |
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189 | (2) |
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Legacy of the ACA at 10 Years |
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191 | (2) |
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Understanding Reform Options |
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193 | (2) |
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195 | (3) |
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198 | (7) |
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198 | (1) |
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199 | (1) |
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200 | (5) |
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Chapter 7 Health Care Workforce |
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205 | (28) |
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205 | (4) |
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Education, Licensing, and Certification |
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205 | (3) |
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Graduate Medical Education |
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208 | (1) |
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209 | (2) |
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Scope of Practice and "Top of License" |
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209 | (1) |
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Interprofessional Care Teams |
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210 | (1) |
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"Clinicians" and Scope of Practice |
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211 | (3) |
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Health Care Workforce Growth and Shortage |
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214 | (2) |
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216 | (1) |
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Health Care Workforce Quick Reference Guide |
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217 | (16) |
Readmissions Case Study |
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233 | (4) |
References |
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237 | (2) |
Suggested Reading |
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239 | (2) |
Index |
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241 | (8) |
About the Authors |
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249 | |