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The distinctive mixing and continuous remixing of public and private roles is a defining feature of health care in the United States. The Public-Private Health Care State explores the interweaving of public and private enterprise in health care in the United States as a basis for thinking about health care in terms of its history and its continuing evolution today. Historian and policy analyst Rosemary Stevens has selected and edited seventeen essays from both her published and unpublished work to illustrate continuing themes, such as: the flexible meanings of the terms "public" and "private," and how useful their ambiguity has been and is; the role of ideology as ratifying rather than preordaining change; and the common behavior of public leaders and corporate entities in the face of fiscal opportunity. The topics--covering the period of 1870 through the twenty-first century--represent Stevens' research interests in hospital history and policy, the medical profession, government policy, and paying for health care. The volume also considers her involvement with policy questions, which include health services research, health maintenance organizations, and physician workforce policy. Section I demonstrates the long history of state government involvement with private not-for-profit hospitals from the 1870s through the 1930s. Section II examines the federal role in health care from the 1920s through the 1970s, including the establishment of veterans' hospitals and the implementation of Medicaid. Section III shows how shifting governmental roles require constantly changing organizing rhetoric, whether for inventing a federal role for health services research and HMOs, "regionalization" in the 1970s, or defining civil rights and "equity" as mobilizing vehicles in the 1980s. Section IV examines growing concerns from the 1970s through the present about the traditional "public" role of the largely "private" medical profession. Section V returns to the ambiguous public-private status of not-for profit hospitals, buffeted in the 1980s and 1990s by assumptions about the efficiency of the market.
This dissertation focuses on examining the impact of public spending in health insurance and health care markets. Health care subsidies account for a fast-growing share of public expenditures in many developed and developing countries, making them an ever more important component of fiscal policy discussions. Two principle projects constitute my dissertation research. In the first project, I examine the heterogeneity in the impact of subsidized health insurance coverage on individual welfare, in the context of a Chinese public health insurance program. In the course of this research, I have also developed new econometric methods to address the empirical challenges of studying the effects of health insurance. These methods have broad applications beyond topics in health economics. In the second project, I look at the role of tax subsidies in the supply of health care. In particular, I exploit variations in state and federal level tax policies in the U.S to estimate the impact of government subsidies on ownership choice, provision of public services and the quality of hospitals. The first chapter of the dissertation mainly assesses the effect of public health insurance on program beneficiaries' welfare, by evaluating a new national public medical insurance program in China, Urban Resident Basic Insurance (URBMI). This program, introduced in 2007 and having an annual fiscal expenditure of 30 billion RMB, aims to provide coverage to more than 200 million urban residents including elderly, children, college students and unemployed adults. I exploit the city-variation in policy generosity as an exogenous determinant of URBMI enrollment. Using data from the Chinese Health and Nutrition Survey (CHNS), I find that URBMI increases welfare on several margins. Having insurance coverage increases health care spending while decreasing the out-of-pocket payments, providing protection from the financial risk. It also increases efficiency in medical spending by inducing the use of preventative care and reducing the probability of hospitalization. In terms of health outcomes, insurance coverage has a significant impact on subjective self-ratings in health and happiness. I also extend my examination to consider the labor market effects of URBMI. Since this program provides insurance coverage outside of employment status, it will potentially increase an individual's mobility between jobs and impact the retirement decision. In Chapter 2, building on the results of the first chapter, I explore the heterogeneity in the impact of health insurance through a semiparametric model. Since URBMI is a national program covering a wide range of subpopulations, observed and unobserved individual characteristics may play an important role in determining the response of an individual to insurance coverage. This chapter builds a panel data model with endogenous treatment, which incorporates unobserved individual heterogeneity non-additively into the outcome. The model is estimated in the context of a semiparametric setting. I first propose a two-stage semiparametric least square (SLS) method to consistently estimate the model parameters and then conduct a localized 2SLS procedure to recover the quantile treatment effect. Identification, consistency, and root-N asymptotic normality of estimators for parameters and marginal effects are proved. The estimation results reveal substantial variation in the impact of URBMI by age, income and gender. Children, the elderly above the age of 70, and females ages 25-40 benefit the most from the program. Adult males and individuals with incomes below the median level do not respond significantly to insurance coverage. The findings of heterogeneous insurance effects have important policy implications for the cost-effectiveness of URBMI across population groups, suggesting the need for differentiated insurance programs. In the third chapter, another form of subsidy in health care markets is studied. This chapter focuses on assessing the effect of government subsidies on the supply side of the health care market in the U.S. An important form of government subsidies to health care providers is the tax exemption for non-profit organizations. The validity and efficiency of such practice has long been under debate. Recently, many state and federal laws have been enacted that mandate the reporting of benefits provided to the community by non-profit providers. This chapter studies the hospital sector. Given the preferential tax treatment for nonprofit hospitals, the tax rate, in conjunction with community benefit reporting requirement (CRR), determine the net subsidy provided to a nonprofit hospital compared to its for-profit counterpart. I exploit the variation in tax policy across states and over time to identify the effect of tax subsidy on the ownership choice of hospitals. I further differentiate behavior between nonprofit versus for-profit hospitals, including cost, provision of undercompensated care as well as quality. Using Center for Medicare and Medicaid Services(CMS) hospital cost report data from 1996 to 2015, I estimate a 4-6 percent increase in the probability of non-profit conversion into for-profit hospitals due to the enactment of CRR. Moreover, the effect of CRR diminishes with the tax rate. My results further show that hospitals divert community benefit spending to teaching to meet the requirement of CRR, rather than increasing provision of uncompensated care.
**** The third edition (1990) is cited in Brandon-Hill. A text that focuses on the decision-making process which precedes and governs the selection of treatment of various pediatric orthopedic conditions. Each author provides the basic science that relates to the condition under discussion and the scientific basis for treatment decisions. This revised and updated edition is also completely reorganized, adding a second editor and 16 new authors. New chapters deal with orthopedic genetics, history taking and examination of the pediatric patient, syndromes and localized disorders affecting bone, neuromuscular disorders, and fracture treatment, a major portion of pediatric orthopedic practice. Thoroughly illustrated in bandw. Annotation copyright by Book News, Inc., Portland, OR
Featuring analysis of cutting-edge healthcare issues and first-person stories, Policy & Politics in Nursing and Health Care, 7th Edition is the leader in helping students develop skills in influencing policy in today’s changing health care environment. Approximately 150 expert contributors present a wide range of topics in this classic text, providing a more complete background than can be found in any other policy textbook on the market. Discussions include the latest updates on conflict management, health economics, lobbying, the use of media, and working with communities for change. With these insights and strategies, you'll be prepared to play a leadership role in the four spheres in which nurses are politically active: the workplace, government, professional organizations, and the community. Comprehensive coverage of healthcare policies and politics provides a broader understanding of nursing leadership and political activism, as well as complex business and financial issues. Taking Action essays include personal accounts of how nurses have participated in politics and what they have accomplished. Expert authors make up a virtual Nursing Who's Who in healthcare policy, sharing information and personal perspectives gained in the crafting of healthcare policy. Winner of several American Journal of Nursing "Book of the Year" awards! NEW! Nine new chapters ensure you have the most up-to-date information on key topics such as ethical dimensions of policy and politics, patient engagement, public health, women's reproductive health, emergency preparedness, new health insurance exchanges, and much more. NEW! The latest information and perspectives are provided by nursing leaders who influenced health care reform, including the Affordable Care Act. NEW! Emphasis on evidence-based policy throughout the text. NEW! A list of web links is included in most chapters for further study.
This issues-based reference work (available in both print and electronic formats) shines a spotlight on health care policy and practice in the United States. Impassioned debates about the best solutions to health care in America have perennially erupted among politicians, scholars of public policy, medical professionals, and the general public. The fight over the Health Care Reform Act of 2010 brought to light a multitude of fears, challenges, obstacles, and passions that often had the effect of complicating rather than clarifying the debate. The discourse has never been more heated. The complex issues that animate the health care debate have forced the American public to grapple with the exigencies of the present system with regard to economic, fiscal, and monetary policy, especially as they relate to philosophical, often ideologically driven approaches to the problem. Americans have also had to examine their ideas about the relationship of the individual to and interaction with the state and the varied social and cultural beliefs about what an American solution to the problem of health care looks like. In light of the need to keep students, researchers, and other interested readers informed and up-to-date on the issues surrounding health care in the U.S., this volume uses introductory essays followed by point/counterpoint articles to explore prominent and perennially important debates, providing readers with views on multiple sides of this complex issue. Features & Benefits: The volume is divided into three sections, each with its own Section Editor: Quality of Care Debates (Dr. Jennie Kronenfeld), Economic & Fiscal Debates (Dr. Mark Zezza), and Political, Philosophical, & Legal Debates (Prof. Wendy Parmet). Sections open with a Preface by the Section Editor to introduce the broad theme at hand and provide historical underpinnings. Each Section holds 12 chapters addressing varied aspects of the broad theme of the section. Chapters open with an objective, lead-in piece (or "headnote") followed by a point article and a counterpoint article. All pieces (headnote, point article, counterpoint article) are signed. For each chapter, students are referred to further readings, data sources, and other resources as a jumping-off spot for further research and more in-depth exploration. Finally, the volume concludes with a comprehensive index, and the electronic version of the book includes search-and-browse features, as well as the ability to link to further readings cited within chapters should they be available to the library in electronic format.
**Selected for Doody's Core Titles® 2024 with "Essential Purchase" designation in Health Policy/Reform** Learn how to influence policy and become a leader in today's changing health care environment. Featuring analysis of cutting-edge healthcare issues and first-person insights, Policy & Politics in Nursing and Health Care, 8th Edition continues to be the leading text on nursing action and activism. Approximately 150 expert contributors present a wide range of topics in policies and politics, providing a more complete background than can be found in any other policy textbook on the market. This expanded 8th edition helps you develop a global understanding of nursing leadership and political activism, as well as the complex business and financial issues that drive many actions in the health system. Discussions include the latest updates on conflict management, health economics, lobbying, the use of media, and working with communities for change. With these innovative insights and strategies, you will be prepared to play a leadership role in the four spheres in which nurses are politically active: the workplace, government, professional organizations, and the community. - Comprehensive coverage of healthcare policies and politics provides a broader understanding of nursing leadership and political activism, as well as complex business and financial issues. - Key Points at the end of chapters helps you review important, need-to-know lesson content. - Taking Action essays include personal accounts of how nurses have participated in politics and what they have accomplished. - Expert authors make up a virtual Nursing Who's Who in healthcare policy, sharing information and personal perspectives gained in the crafting of healthcare policy. - NEW! The latest information and perspectives are provided by nursing leaders who influenced health care reform, including the Affordable Care Act. - NEW! Added information on medical marijuana presents both sides of this ongoing debate. - NEW! More information on health care policy and the aging population covers the most up-do-date information on this growing population. - NEW! Expanded information on the Globalization of Nursing explores international policies and procedures related to nursing around the world. - NEW! Expanded focus on media strategies details proper etiquette when speaking with the press. - NEW! Expanded coverage of primary care models and issues throughout text. - NEW! APRN and additional Taking Action chapters reflect the most recent industry changes. - NEW! Perspectives on issues and challenges in the government sphere showcase recent strategies and complications.
Featuring analysis of healthcare issues and first-person stories, Policy & Politics in Nursing and Health Care helps you develop skills in influencing policy in today’s changing health care environment. 145 expert contributors present a wide range of topics in policies and politics, providing a more complete background than can be found in any other policy textbook on the market. Discussions include the latest updates on conflict management, health economics, lobbying, the use of media, and working with communities for change. The revised reprint includes a new appendix with coverage of the new Affordable Care Act. With these insights and strategies, you’ll be prepared to play a leadership role in the four spheres in which nurses are politically active: the workplace, government, professional organizations, and the community. Up-to-date coverage on the Affordable Care Act in an Appendix new to the revised reprint. Comprehensive coverage of healthcare policies and politics provides a broader understanding of nursing leadership and political activism, as well as complex business and financial issues. Expert authors make up a virtual Nursing Who's Who in healthcare policy, sharing information and personal perspectives gained in the crafting of healthcare policy. Taking Action essays include personal accounts of how nurses have participated in politics and what they have accomplished. Winner of several American Journal of Nursing "Book of the Year" awards! A new Appendix on the Affordable Care Act, its implementation as of mid-2013, and the implications for nursing, is included in the revised reprint. 18 new chapters ensure that you have the most up-to-date information on policy and politics. The latest information and perspectives are provided by nursing leaders who influenced health care reform with the Patient Protection and Affordable Care Act of 2010.
"The Nation has lost sight of its public health goals and has allowed the system of public health to fall into 'disarray'," from The Future of Public Health. This startling book contains proposals for ensuring that public health service programs are efficient and effective enough to deal not only with the topics of today, but also with those of tomorrow. In addition, the authors make recommendations for core functions in public health assessment, policy development, and service assurances, and identify the level of government--federal, state, and local--at which these functions would best be handled.
Present-day health care policies in the United States are moving toward a system in which patients will be treated like industrial objects by doctors forced to work mechanically, says the distinguished medical sociologist Eliot Freidson in Medical Work in America. He offers a number of controversial proposals designed both to reduce costs and to avoid such dehumanization. In a series of essays that includes some of his classic work as well as significant new material, Freidson discusses the doctor-patient relationship, relations between physicians in various forms of medical practice, and the forces now reorganizing medical work. He shows how increasingly restrictive health insurance contracts insert a new, problematic element into both doctor-patient and colleague relations, and how bureaucratic methods of controlling medical decisions affect those relations. Finally, Freidson advances some basic principles to guide health care policy. He emphasizes that the physician's freedom to exercise discretion is essential if patients are to be treated as individuals rather than as administratively defined diagnostic categories. His recommendations include eliminating fee-for-service compensation, controlling health industry profits, and limiting the external administrative regulation of medical decisions while organizing medical work in such a way as to maximize effective and responsible self-governance.