Preface |
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xi | |
About the Authors |
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xv | |
Acknowledgments |
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xvii | |
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1 | |
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2 | |
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The System in the United States Is Unique, But Not Unparalleled |
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4 | |
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5 | |
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Health Policy: What Is It? |
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7 | |
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The Policy Analysis Process |
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7 | |
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Supporting Implementation |
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9 | |
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Health Professionals and the Policy Process |
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9 | |
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Big Issues to Keep Our Eyes On |
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11 | |
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19 | |
Part I The Context |
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23 | |
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Current Outcomes and Costs |
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23 | |
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A More Systematic Evaluation |
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30 | |
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38 | |
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Leadership at the State and Local Level |
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42 | |
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Industrializing Structures for Delivery |
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43 | |
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Medicalization of Society |
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55 | |
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57 | |
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Chapter 3 How Did We Get Here? |
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59 | |
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Contending Visions of a System for Delivering Health Care |
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60 | |
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61 | |
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The Current "Era" Emerges |
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69 | |
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Employers Want Out: Backing for Consumer-Driven Health Care |
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74 | |
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75 | |
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Case 3-1 International Comparisons: Where Else Might We Have Gone? |
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76 | |
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Chapter 4 Where Do We Want to Go? |
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87 | |
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Alignment with the Rest of Society |
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88 | |
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Who Is the "We" in "Where Do We Want to Be"? |
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88 | |
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98 | |
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Case 4-1 National Standards on Culturally and Linguistically Appropriate Services (CLAS) |
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98 | |
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Chapter 5 What Are the Governmental Alternatives? Many Actors, Many Proposals |
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103 | |
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Federal Level Alternatives |
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106 | |
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Access to CareAdministered System |
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106 | |
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Access to Care Oligopolistic Competition |
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108 | |
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Access to CareFree-Market Competition |
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110 | |
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Quality of CareAdministered System |
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111 | |
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Quality of Care Oligopolistic Competition |
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112 | |
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Quality of CareFree-Market Competition |
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113 | |
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Cost of CareAdministered System |
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113 | |
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Cost of Care Oligopolistic Competition |
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114 | |
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Cost of CareFree-Market Competition |
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115 | |
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119 | |
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State and Local Government Options |
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121 | |
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Access to CareAdministered System |
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123 | |
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Access to Care Oligopolistic System |
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125 | |
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Access to CareFree-Market Competition |
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127 | |
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Quality of CareAdministered System |
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128 | |
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Quality of Care Oligopolistic System |
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129 | |
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Quality of CareFree-Market System |
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129 | |
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Cost of CareAdministered System |
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130 | |
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Cost of Care Oligopolistic System |
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131 | |
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Cost of Care Free-Market System |
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133 | |
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134 | |
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136 | |
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Case 5-1 Specialty Hospitals and Community Hospitals |
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136 | |
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Chapter 6 Alternative Responses and Initiatives of Institutions and Professions |
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143 | |
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145 | |
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145 | |
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154 | |
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167 | |
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For-Profit Versus Not-for-Profit |
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168 | |
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The Value-Driven Care Initiative |
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169 | |
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170 | |
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Case 6-1 Global Medical Coverage |
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171 | |
Part II The Policy Analysis Process |
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Chapter 7 The Policy Analysis Process Identification and Definition |
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179 | |
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Getting the Scenario Right |
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181 | |
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186 | |
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Defining What Is a Medical Problem |
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191 | |
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192 | |
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Case 7-1 Small Area Variations |
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193 | |
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Chapter 8 The Policy Analysis Process Evaluation Technology Assessment |
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195 | |
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196 | |
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Technological Forecasting |
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197 | |
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Levels of Technological Forecasting |
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198 | |
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200 | |
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206 | |
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213 | |
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Organizations Devoted to Health Care Technology Assessment |
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213 | |
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218 | |
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Case 8-1 Regional Health Information Organizations (RHIOs): Disruptive Technology or Business As Usual? |
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219 | |
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Chapter 9 The Policy Analysis Process Evaluation Political Feasibility |
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233 | |
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234 | |
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236 | |
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236 | |
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240 | |
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253 | |
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258 | |
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Methods for Analyzing Political Feasibility |
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265 | |
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270 | |
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Case 9-1 Politics of the Clinton Health Plan |
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272 | |
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Chapter 10 The Policy Analysis Process EvaluationEconomic Viability |
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283 | |
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Defining the Health Care Process Involved |
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285 | |
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Agreeing in Detail on the Delivery System Involved |
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287 | |
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Selecting the Analytical Approach |
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287 | |
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288 | |
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Supply and Demand Concepts |
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291 | |
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292 | |
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Agreeing on the Resources Required |
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294 | |
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Determining Relevant Costs |
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295 | |
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Agreeing on the Outcomes Produced |
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296 | |
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Valuing the Outcomes Produced |
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298 | |
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Determining the Present Values of Costs and Outcomes |
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298 | |
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299 | |
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301 | |
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301 | |
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302 | |
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Dealing with Important Uncertainties |
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302 | |
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Identifying Financing Methods |
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304 | |
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Considering Distributional Effects |
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304 | |
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Comparing with Competing Alternatives |
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305 | |
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305 | |
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308 | |
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Case 10-1 Folic Acid Fortification Decision: Before and After |
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308 | |
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Chapter 11 The Policy Process Analysis of Values Last But Not Least |
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321 | |
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322 | |
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322 | |
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Patient Privacy and Confidentiality |
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323 | |
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323 | |
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323 | |
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326 | |
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326 | |
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327 | |
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327 | |
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329 | |
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335 | |
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Influence on Society: A Broader Question |
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335 | |
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337 | |
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338 | |
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Case 11-1 The 100K Lives Campaign: A Voluntary Code In Action |
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338 | |
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Chapter 12 Implementation Strategy and Planning |
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351 | |
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Levels of Implementation Failure |
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352 | |
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353 | |
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358 | |
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361 | |
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Providing for Periodic Reviews |
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362 | |
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Implementing Policies That Affect Clinical Decision Making |
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362 | |
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364 | |
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365 | |
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Case 12-1 Introducing Evidence-Based Practice in Mental Health in North Carolina (B) |
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366 | |
Part III The Professional as a Participant |
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Chapter 13 What Is Likely to Work |
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375 | |
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Working Out Your Own Scenarios |
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380 | |
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Chapter Exercise: Working Out Your Own Scenarios |
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384 | |
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So, What Is Likely to Work? |
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384 | |
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388 | |
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Chapter 14 Health Professional Leadership |
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389 | |
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390 | |
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Informational Credibility |
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390 | |
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To Influence Globally, Start Locally |
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391 | |
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392 | |
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Health Policy Analysis: A Relevant School for Leadership |
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392 | |
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393 | |
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394 | |
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394 | |
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Enhancing the Professional's Role |
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395 | |
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Chapter Exercise: Gender Discrimination Issues in Health Care |
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397 | |
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398 | |
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Chapter 15 ConclusionAll Those Levers and No Fulcrum |
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399 | |
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400 | |
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402 | |
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403 | |
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Chapter Exercise: Tradeoffs |
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404 | |
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404 | |
References |
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407 | |
Index |
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425 | |