Health Systems in Transition: USA, Second Edition

By Thomas Rice, Pauline Rosenau, Lynn Y. Unruh, and Andrew J. Barnes

© 2021

This analysis of the United States health care system reviews developments in organization and governance, health financing, health care provision, health reforms, and health system performance. The U.S. system has both considerable strengths and notable weaknesses. It has a large and well-trained health workforce, a wide range of high-quality medical specialists as well as secondary and tertiary institutions, a robust health sector research program, and, for selected services, among the best medical outcomes in the world. But it also suffers from incomplete coverage of its citizenry, health expenditure levels per person far exceeding all other countries, poor objective and subjective indicators of quality and outcomes, and an unequal distribution of resources and outcomes across the country and among different population groups. Because of the adoption of the Affordable Care Act in 2010, and subsequent revisions to it, the U.S. is facing a period of enormous change. There is a great need to improve coverage and improve equity, better ensure quality outcomes, and find ways to better control expenditures. Health Systems in Transition: United States provides an in-depth discussion of these issues and a thorough review of the U.S. health care system.

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Product Details

  • North American Rights
  • Page Count: 512 pages
  • Dimensions: 6.0in x 0.0in x 9.0in
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Quick Overview

The book provides a thorough review of the U.S. health care system, including its organization and financing, care delivery, recent reforms, and an evaluation of the system’s performance.

Health Systems in Transition: USA, Second Edition

By Thomas Rice, Pauline Rosenau, Lynn Y. Unruh, and Andrew J. Barnes

© 2021

This analysis of the United States health care system reviews developments in organization and governance, health financing, health care provision, health reforms, and health system performance. The U.S. system has both considerable strengths and notable weaknesses. It has a large and well-trained health workforce, a wide range of high-quality medical specialists as well as secondary and tertiary institutions, a robust health sector research program, and, for selected services, among the best medical outcomes in the world. But it also suffers from incomplete coverage of its citizenry, health expenditure levels per person far exceeding all other countries, poor objective and subjective indicators of quality and outcomes, and an unequal distribution of resources and outcomes across the country and among different population groups. Because of the adoption of the Affordable Care Act in 2010, and subsequent revisions to it, the U.S. is facing a period of enormous change. There is a great need to improve coverage and improve equity, better ensure quality outcomes, and find ways to better control expenditures. Health Systems in Transition: United States provides an in-depth discussion of these issues and a thorough review of the U.S. health care system.

Continue Reading Read Less

Product Details

  • North American Rights
  • Page Count: 512 pages
  • Dimensions: 6.0in x 0.0in x 9.0in
  • Reviews

    “Among the many commentaries on American health care, Health Systems in Transition: USA stands apart as the most comprehensive, objective, and contemporary overview.  The data -driven book focuses on the United States, but interprets the performance of the US system in relation to other wealthy countries. This book will be an essential resource for health policy scholars and a valuable text for health services research students.”

    Robert M. Kaplan,  Clinical Excellence Research Center (CERC), Stanford University School of Medicine

  • Author Information

    Thomas Rice is an economist and a Distinguished Professor in the Department of Health Policy and Management at the UCLA Fielding School of Public Health.


    Pauline Rosenau is a Professor Emerita of Management and Policy Sciences in the School of Public Health at the University of Texas.


    Lynn Y. Unruh is a professor of Health Services Administration in the Department of Health Management and Informatics at the University of Central Florida.


    Andrew J. Barnes is an associate professor of Health Behavior and Policy at Virginia Commonwealth University.
  • Table of contents

    Preface
    Acknowledgements
    List of abbreviations
    List of tables, figures and boxes
    Abstract
    Executive summary

    1 Introduction
    1.1 Geography and sociodemography
    1.2 Economic context
    1.3 Political context
    1.4 Health status

    2 Organization and governance
    2.1 Historical background
    2.2 Organization of the healthcare system
    2.3 Decentralization and centralization
    2.4 Planning
    2.5 Intersectorality
    2.6 Patient empowerment
    2.7 Regulation

    3 Financing
    3.1 Health expenditure
    3.2 Sources of revenue, financing and financial flows
    3.3 Medicare
    3.4 Medicaid
    3.5 Private health insurance
    3.6 Out-of-pocket payments
    3.7 Payment mechanisms

    4 Physical and human resources
    4.1 Physical resources
    4.2 Human resources

    5 Provision of services
    5.1 Patient pathways
    5.2 Public health
    5.3 Outpatient services: primary care
    5.4 Outpatient services: specialty care
    5.5 Other outpatient services: ambulatory surgical, emergency and urgent care
    5.6 Acute inpatient care
    5.7 Dental care
    5.8 Behavioural healthcare
    5.9 Pharmaceutical care
    5.10 Post-acute care: rehabilitation, intermittent home care and subacute care
    5.11 Long-term care
    5.12 Palliative care
    5.13 Services from informal care-givers
    5.14 Racial and ethnic minorities, low-income individuals, the uninsured and other vulnerable populations

    6 Principal health reforms
    6.1 History of US health reforms
    6.2 The Affordable Care Act
    6.3 The future of the ACA

    7 Assessment of the health system
    7.1 Health system governance
    7.2 Accessibility
    7.3 Financial protection
    7.4 Healthcare quality
    7.5 Health outcomes
    7.6 Health system efficiency

    8 Conclusions
    9 Appendices
    9.1 References
    9.2 Useful websites
    9.3 HiT methodology and production process
    9.4 About the authors

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