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CHANGING THEU.S. HEALTH CARE SYSTEM
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CHANGING THEU.S. HEALTH CARE SYSTEM
Key Issues in Health ServicesPolicy and Management
4TH EDITION
Gerald F. KominskiEditor
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Cover design by Wiley
Cover image: C Stephanie Dalton Cowan/Getty Images
Copyright C 2014 by John Wiley & Sons, Inc. All rights reserved.
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Library of Congress Cataloging-in-Publication DataChanging the U.S. health care system : key issues in health services policy and management /
Gerald F. Kominski, editor. —4th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-118-12891-6 (cloth)—ISBN 978-1-118-41890-1 (pdf)—
ISBN 978-1-118-41640-2 (epub)
I. Kominski, Gerald F.
[DNLM: 1. Health Care Reform—United States. 2. Delivery of Health Care—United States.
3. Health Policy—United States. WA 540 AA1]
RA395.A3
362.10973—dc23
2013013537
Printed in the United States of America
FOURTH EDITION
HB Printing 10 9 8 7 6 5 4 3 2 1
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CONTENTS
Figures and Tables xv
Foreword to the Third Edition xix
Foreword to the Fourth Edition xxi
The Editor xxv
The Authors xxvii
Introduction and Overview xliii
Acknowledgments lvii
PART ONE: ACCESS TO HEALTH CARE 1
1 The Patient Protection and Affordable Care Act of 2010 3
Gerald F. Kominski
Learning Objectives 3
Events Leading to the Enactment of the ACA 4
Major Provisions of the ACA 7
Future Directions 20
v
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vi Contents
Summary 25
Key Terms 26
Discussion Questions 28
2 Improving Access to Care 33
Ronald M. Andersen, Pamela L. Davidson, Sebastian E. Baumeister
Learning Objectives 33
Understanding Access to Health Care 34
Future Directions 60
Summary 63
Key Terms 63
Discussion Questions 64
3 Racial and Ethnic Disparities in Health Status 71
Antronette K. Yancey, Roshan Bastani, Beth A. Glenn
Learning Objectives 71
Epidemiology of Health Disparities 73
Factors Underlying Chronic Disease-Related Disparities 82
Future Directions 92
Summary 94
Key Terms 94
Discussion Questions 95
4 Racial and Ethnic Disparities in Health Care 103
Arturo Vargas Bustamante, Leo S. Morales, Alexander N. Ortega
Learning Objectives 103
Definition of Disparity in Health Care 105
Historical Overview of Disparities in Medical Care 109
Scientific Evidence of Disparities in Health Care 115
Future Directions 122
Summary 125
Key Terms 126
Discussion Questions 126
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Contents vii
5 Multilevel Social Determinants of Health 135
Ninez A. Ponce, Michelle Ko
Learning Objectives 135
Policy Frameworks for Social Determinants of Health 137
Mechanisms by Which Social Context Affects Health Care 142
Future Directions 147
Summary 148
Key Terms 149
Discussion Questions 150
6 Public Health Insurance 157
Shana Alex Lavarreda, E. Richard Brown
Learning Objectives 157
Medicare, Medicaid, and CHIP 159
Who is Left Out of Public Coverage? 169
Enactment of the Affordable Care Act of 2010: A Political Success Story 179
Future Directions 183
Summary 183
Key Terms 184
Discussion Questions 185
7 Private Health Insurance 191
Nadereh Pourat, Gerald F. Kominski
Learning Objectives 191
Evolution of Private Health Insurance 192
Concepts in Private Health Insurance 194
Employment-Based Health Insurance 200
Individually Purchased Health Insurance 207
Significant Trends in Private Health Insurance 208
Future Directions 213
Summary 216
Key Terms 216
Discussion Questions 218
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viii Contents
PART TWO: COST OF HEALTH CARE 223
8 Measuring Health Care Expenditures and Trends 225
Thomas H. Rice
Learning Objectives 225
Measuring Health Care Expenditures 226
Trends in Health Care Expenditures 233
Future Directions 239
Summary 239
Key Terms 242
Discussion Questions 243
9 Containing Health Care Costs 245
Thomas H. Rice, Gerald F. Kominski
Learning Objectives 245
Framework 246
Future Directions 263
Summary 264
Key Terms 264
Discussion Questions 265
10 Promoting Pharmaceutical Access While Controlling Prices andExpenditures 269
Stuart O. Schweitzer, William S. Comanor
Learning Objectives 269
The Problem of Drug Expenditures 271
Interpreting Pharmaceutical Price Data 275
International Price Comparisons 279
Determining Drug Prices 281
Approaches for Containing Pharmaceutical Costs 289
The Link Between Pharmaceutical Expenditures and Research 293
Recent Events Surrounding Pharmaceutical Costs and Access 294
Future Directions 298
Summary 298
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Contents ix
Note 299
Key Terms 299
Discussion Questions 300
PART THREE: QUALITY OF HEALTH CARE 305
11 Measuring Health-Related Quality of Life and Other Outcomes 307
Patricia A. Ganz, Ron D. Hays, Robert M. Kaplan, Mark S. Litwin
Learning Objectives 307
Definition, Conceptualization, and Measurement of Quality of Life 310
Contributions From the Literature 318
Comparative Effectiveness Research 328
Future Directions 331
Summary 332
Key Terms 333
Discussion Questions 334
12 Evaluating the Quality of Care 343
Elizabeth A. McGlynn
Learning Objectives 343
The Multiple Dimensions of Quality 344
Criteria for Evaluating Quality Measures 345
A Conceptual Framework for Quality Assessment 347
Structure 348
Process 355
Outcomes 365
Future Directions 371
Summary 372
Key Terms 373
Discussion Questions 374
13 Public Release of Information on Quality 381
Elizabeth A. McGlynn, John L. Adams
Learning Objectives 381
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x Contents
Public Information on Quality 383
Some Methodological Issues in Performance Reporting 391
What is Known About the Impact of Public Reporting? 402
Future Directions 406
Summary 406
Key Terms 407
Discussion Questions 408
14 Health Care Information Systems 413
Jeff Luck, Leah J. Vriesman, Paul Fu Jr.
Learning Objectives 413
Information Systems and Informatics 414
Benefits, Implementation Barriers, and Federal Policy Responses 414
Applications of Information Systems by Health Care Providers 417
Public Health Informatics 434
Applications of Information Systems by Health Plans and Payers 438
Future Directions 441
Summary 445
Key Terms 445
Discussion Questions 446
15 Performance Measurement of Nursing Care 455
Jack Needleman, Ellen T. Kurtzman, Kenneth W. Kizer
Learning Objectives 455
Why Measure Nursing Performance? 455
The Scope of Nursing’s Contribution to Inpatient Hospital Care 457
Issues in Constructing Nursing-Sensitive Performance Measures 461
Measuring Nursing Performance 463
Measuring Nursing Performance: The State of the Science 478
Future Directions 485
Summary 486
Key Terms 487
Discussion Questions 487
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Contents xi
PART FOUR: SPECIAL POPULATIONS 493
16 Long-Term Services and Supports for the Elderly Population 495
Steven P. Wallace, Nadereh Pourat, Linda Delp, Kathryn G. Kietzman
Learning Objectives 495
Institutional Care 497
Community-Based Services 502
Informal Care 507
Workers in the Long-Term Care System 509
Future Directions 516
Summary 517
Note 517
Key Terms 517
Discussion Questions 518
17 HIV and AIDS in the Twenty-First Century 523
Erin G. Grinshteyn, William E. Cunningham
Learning Objectives 523
The Changing Epidemiology and Clinical Treatment of HIV/AIDS 525
Prevention and Education 538
Policy Implications and Research Needs for Management, Planning, and AIDSPolicy 543
Future Directions 546
Summary 547
Key Terms 548
Discussion Questions 550
18 Children’s Health 559
Moira Inkelas, Neal Halfon, David Lee Wood
Learning Objectives 559
Special Health Needs of Children 561
Health Service Delivery for U.S. Children 564
Financing Children’s Health Care 569
Improving the Child Health System 576
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xii Contents
Future Directions 585
Summary 585
Key Terms 586
Discussion Questions 587
19 Homeless Persons 593
Lisa Arangua, Lillian Gelberg
Learning Objectives 593
A Profile of the Homeless 594
Health Status 597
Mental Illness and Substance Abuse 604
Use of Physical Health Services 606
Use of Mental Health and Substance Abuse Services 608
Barriers to Health Care 609
Future Directions 610
Summary 612
Key Terms 612
Discussion Questions 613
PART FIVE: DIRECTIONS FOR CHANGE 621
20 Changing the Health Care Delivery System 623
Nadereh Pourat, Hector P. Rodriguez
Learning Objectives 623
Conceptual Framework: Intervention and Innovations to Correct SystemFailures 625
Future Directions 641
Summary 642
Key Terms 642
Discussion Questions 644
21 Medicare Reform 651
Gerald F. Kominski, Jeanne T. Black, Thomas H. Rice
Learning Objectives 651
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Contents xiii
Origin and Philosophy of Medicare 652
Evolution of Medicare 656
Is Medicare Facing a Crisis? 663
Future Directions 670
Summary 673
Key Terms 674
Discussion Questions 675
22 Public Health and Clinical Care 681
Jonathan E. Fielding, Lester Breslow, Steven M. Teutsch
Learning Objectives 681
Public Health’s Mission and Scope 682
Prevention In Clinical Care Services 685
Public Health and Provision of Clinical Care Services 689
Direct Medical Service Delivery by Government 691
Future Directions 692
Summary 699
Key Terms 700
Discussion Questions 700
23 Strengthening the Safety Net 703
Dylan H. Roby
Learning Objectives 703
Defining the Safety Net 704
Ensuring Access to Care for the Poor, Uninsured, and Underserved 705
Financing the Safety Net 706
Size and Scope of the Safety Net 707
Reducing Costs 715
Improving Quality 716
Future Directions 719
Summary 719
Key Terms 720
Discussion Questions 721
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xiv Contents
24 Ethical Issues in Public Health and Health Services 727
Pauline Vaillancourt Rosenau, Ruth Roemer, Frederick J. Zimmerman
Learning Objectives 727
Overarching Public Health Principles: Our Assumptions 730
Ethical Issues in the Allocation of Resources 730
Ethical Issues in Research 737
Ethical Issues in Economic Support 738
Ethical Issues in Management of Health Services 740
Ethical Issues in Delivery of Care 741
Future Directions 744
Summary 745
Key Terms 746
Discussion Questions 747
Index 753
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FIGURES AND TABLES
Figures
2.1 A Behavioral Model of Health Services Use—6th Revision 35
2.2 The Policy Purposes of Access Measures 43
3.1 U.S. Population (2000 Census) and Projections For 2100 72
3.2 Life Expectancy by Race, Ethnicity, and Gender 74
3.3 Years of Potential Life Lost by Race and Ethnicity
(per 100,000) 77
3.4 Limitation of Activity Caused by Chronic Conditions, United
States, 2006. 78
3.5 Theoretical Framework 83
4.1 Institute of Medicine Model of Disparities in Health Care 106
4.2 Factors Related to Health Care Use and their Synergies 106
5.1 WHO CSDH Conceptual Framework 138
5.2 RWJ Commission to Build a Healthier America Framework 140
5.3 Poor or Fair Health by Family Income and Race or Ethnicity 141
6.1 Family Work Status of Uninsured Nonelderly Persons, United
STates, 2010 171
6.2 Family Income of Uninsured Nonelderly Persons, United States,
2010 172
xv
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xvi Figures and Tables
6.3 Family Income of Uninsured Nonelderly Persons, United States,
2010 173
7.1 Trends in Private Insurance Coverage in the United States,
1994–2010, Ages 0–64 193
7.2 Average Annual Premiums for Single and Family Coverage,
1999–2012 202
7.3 Distribution of Health Plan Enrollment for Covered Workers, by
Plan Type, 1988–2012 204
8.1 Distinction Between Accounting and Economic Profits 227
10.1 Share of Personal Health Expenditures, 1960–2010 271
10.2 Rate of Increase of Personal Health Care Components from
Previous Year (Percentage), 1960–2011 272
11.1 Quality-of-Life Publications by Year 308
11.2 Conceptualization of HRQL 312
11.3 Cost-per-QALY Ratios 316
11.4 Framework for Measuring Health Status 320
11.5 Cost Per QALY in DPP 325
11.6 Mean Cumulative QALYs, Years 1 through 3 327
12.1 Conceptual Framework for Quality Assessment 347
14.1 Fields of Biomedical Informatics and Domains of Application 415
14.2 HIT Linkages Between Evidence-Based Medicine and Quality
Improvement 420
17.1 Continuum of Engagement for HIV Care 542
18.1 Where Services can Effect Change in Healthy Development 565
18.2 How Risk-reduction and Health-promotion Strategies Influence
Health Development 584
20.1 Conceptual Framework for Assessing Changes in the Health Care
Delivery System 626
20.2 Joint Principles of the Patient-Centered Medical Home 638
23.1 Payer Mix for NAPH Member Hospitals, 2010 714
Tables
1.1 Summary of Major ACA Regulations Affecting Private
Insurance 15
2.1 Percent of the U.S. Population Under Sixty-five with No Health
Insurance Coverage and Regular Source of Medical Care by Age,
Race or Ethnicity, and Poverty Level 44
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Figures and Tables xvii
2.2 Percent of the U.S. Population with Hospital Admissions, Physician
Visits, and Dental Visits by Poverty Level 46
2.3 Selected Measures of Need by Race or Ethnicity and Poverty
Level 50
2.4 Percent of the U.S. Population with Hospital Admissions, Physician
Visits, and Dental Visits by Race or Ethnicity 52
2.5 Selected Measures of Effectiveness and Efficiency by Race or
Ethnicity and Income 57
3.1 Leading Causes of Death by Ethnicity 75
6.1 Percentage of Nonelderly Population Who are Uninsured, Ages
0–64, United States, Selected Years 170
8.1 Consumer Price Index for Selected Items: United States, Selected
Years, 1980–2011 234
8.2 Annual Change in Consumer Price Index for Selected Items:
United States, Selected Years, 1980–2010 234
8.3 Consumer Price Index for All Items and for Medical Care
Components: United States, Selected Years, 1980–2011 235
8.4 Average Annual Change in Consumer Price Index for All Items
and for Medical Care Components: United States, Selected Years,
1980–2003 236
8.5 Personal Health Care Expenditures, by Selected Types of
Expenditure and Sources of Payment, 2008 237
8.6 Annual Change in Personal Health Care Expenditures, by Selected
Type of Service, United States, 1980–2008 238
8.7 Health Expenditures as a Percentage of Gross Domestic Product:
Selected Countries and Years, 1980–2007 240
9.1 Hospital Payment-To-Cost Ratios, 1990–2009 251
11.1 Conceptual Framework for the Medical Outcomes Study 322
15.1 Comparison of Changes in Top Ten RN Activities During Three
Years of Work Redesign 459
15.2 Nurses’ Time, by Category, 2008 460
15.3 NQF-Endorsed National Voluntary Consensus Standards for
Nursing-Sensitive Care 467
15.4 NQF-Endorsed Recommendations for Research and
Implementation 469
15.5 Pooled Odds Ratios of Patient Outcomes Corresponding to an
Increase of One Registered Nurse Full-time Equivalent Per Patient
Day 480
16.1 Individuals With Impairments Needing Help Carrying Out Routine
Household Activities By Age and Sex, United States, 2010 497
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xviii Figures and Tables
16.2 Characteristics of Selected Direct Care and All Other Occupations,
United States, 2008–2010 511
16.3 Institutionalization Rates by Nativity, Race, and Ethnicity, Age
Sixty-five and Over, United States, 2010 514
17.1 Cumulative AIDS Cases in the United States Through December
2009 527
17.2 Estimated Deaths of Persons with AIDS in the United States,
2006–2008 529
18.1 Public Programs in Child Health Service and Health Need
Domains 570
22.1 Actual Causes of Death in the United States, 2000 683
22.2 Decline of Selected Acute Communicable Disease Cases, United
States, 1920–2000 687
22.3 Death Rates from Major Noncommunicable Diseases, United
States, 1950–2000, selected years 688
22.4 Hospitals, Beds, and Occupancy Rates, According to Type of
Hospital, United States, Selected Years, 1975–2008 692
23.1 Characteristics of Community Health Center Users and the Overall
U.S. Population, 2011 710
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FOREWORD TO THE THIRD EDITION
The book you hold in your hand is a gift. With his wife, Audrey, the
late Samuel J. Tibbitts gave generously to the Department of Health
Services in the UCLA School of Public Health to commission a study of
key issues in health policy and management challenging the U.S. health
care system. The leadership, scholarship, and charity that Sam exhibited
in making this gift typified his life in a number of ways.
Sam changed the health care system in California and the nation,
perhaps as much as anyone else of his generation. After receiving a B.S. in
public health from the University of California, Los Angeles, in 1949 and
anM.S. in public health and hospital administration from the University of
California, Berkeley, in 1950, he pioneered the development of integrated
health care delivery and financing systems. His career course trajectory led
in 1988 to the creation of the nonprofit UniHealth America, where he was
chairman of the board until his death in 1994.
Along the way, Sam founded and chaired both PacifiCare Health
Systems, one of the first major health maintenance organizations, and
AmericanHealth Care Systems, a group of thirty-two hospital systems across
the country that organized thenation’s first preferredprovider system, PPO
Alliance. Both a leader and a scholar, he served as chairman of the board
of trustees of the American Hospital Association and published more than
xix
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xx Foreword to the Third Edition
one hundred articles. Sensing the need to establish a corporate conscience
in a changing health care environment, he was founding chairman of
Guiding Principles for Hospitals, the first program to delineate ethical and
quality principles in the industry.
Even while he entered the twilight of a long and storied career, his
concern for the future of health care remained. For this reason, he invested
in the school that had nurtured him and asked its faculty to address the
challenges that are crucial to the future of health care in the United States:
those relating to cost, quality, and access.
To achieve Sam Tibbitts’s vision, the editors sought to gather, in a
single book, ‘‘a comprehensive, yet readable’’ account of these issues. We
believe that they succeeded remarkably in the first two editions, published
in 1996 and 2001, as well as in their efforts to update those issues in this
new edition. In particular, the addition of four new chapters covering such
issues as disparities in health and health care, the nursing shortage, and
information technology make the volume especially useful in confronting
key issues for the new millennium and beyond.
We commend this volume to you, sharing the hope of Sam and
Audrey Tibbitts that training and discourse shall result, in turn leading to
innovations in policy and management that enable the gift of health to be
shared by all.
Abdelmonem A. Afifi
dean emeritus and professor of biostatistics
UCLA School of Public Health
Linda Rosenstock
dean, UCLA School of Public Health
January 2007
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FOREWORD TO THE FOURTH EDITION
Ourhealth and that of our familymembers and friends has as profound
an impact on the quality of our daily lives as any experience. Given
the importance of health to all our lives, it should come as no surprise
that access to medical care and preventive public health measures are
fundamental rights captured in the Universal Declaration of Human
Rights. Moreover, one hundred countries guarantee or aspire to the right
to medical care services in their constitutions. Yet, despite this widespread
agreement on the importance of health, the United States has struggled.
The United States does not have a constitutional provision guaran-
teeing access to health care services and has been an outlier when it
comes to health care coverage. A recent study of nineteen Organisation
for Economic Co-operation and Development (OECD) countries demon-
strated that the United States had fallen to last place in addressing deaths
amenable to health care. At least as disturbing as the overall health picture
in the United States are the disparities. Men and women with less than
a high school diploma can expect to live nearly a decade less than those
with a bachelor’s degree or higher, and the life-expectancy gap has been
widening. Not only are Americans with less education and lower incomes
more likely to die, but they are more likely to live with a chronic condition
or disability.
xxi
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xxii Foreword to the Fourth Edition
The United States is failing to address preventable conditions
adequately—from cancer to heart disease, from diabetes to infections.
Better population and public health measures could help reduce the hun-
dreds of thousands of deaths linked to preventable causes—overweight
and obesity contributed to 216,000 deaths in one year, physical inactivity
contributed to 191,000 deaths, and tobacco smoking was linked to
467,000. At the same time, medical care that is accessible and affordable
to all, including early interventions, would help reduce the 395,000 deaths
linked to high blood pressure and the 190,000 linked to high blood sugar,
among others.
Public health insurance has been available in most affluent countries
for decades. In 1966, Canada passed the Medical Care Act to ensure all
Canadians had access to acute hospital services, and in 1984 the Canada
Health Act guaranteed access to a wide range of outpatient care. Canada
was hardly the first; social health insurance in Germany began in 1893.
Physician services have been covered in Norway since 1912. The United
Kingdom created its National Health Service to cover medical services
in 1948. Sweden followed suit shortly thereafter in 1955. The spread of
health insurance across the globe is not limited to Europe and Canada;
Chile passed legislation in the 1950s, Japan has had public health insurance
since 1961, and the United Arab Emirates since 1971.
So what happened in the United States? It is not that no one tried to
pass health insurance. In fact, a century ago Theodore Roosevelt made
health insurance a part of his campaign. Health care was debated as an
element for inclusion in FDR’s New Deal in the 1930s, but was ultimately
omitted due to the fear that it would sink Social Security. In 1945, Truman
sought to addhealth insurance to Social Security, but failed. Finally, in 1965
the Johnson administration succeeded in establishing health insurance for
older and poor Americans through Medicare and Medicaid. While there
were multiple subsequent attempts to expand coverage, it took nearly fifty
years to pass a plan for near-universal expansion. Proposals by Nixon for
comprehensive health insurance, which included an employer mandate,
and by Carter for universal care funded by payroll taxes, failed. Clinton’s
initial efforts for universal coverage could not make it through Congress;
an expansion of care for children was all that passed.
This edition of Changing the U.S. Health Care System comes out at an
extraordinary moment in American history. After more than a century
of repeated efforts, the United States is taking a major step closer to
universal health coverage. The Affordable Care Act is expected to cover
twenty-nine million more Americans and improve the coverage of many
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Foreword to the Fourth Edition xxiii
others. With tens of millions of Americans uncovered or poorly covered by
health insurance and with a national debt that many have argued cannot
be addressed without improving the efficiency and effectiveness of U.S.
health care expenditures, the need is urgent.
Leaders in their fields, the contributors to Changing the U.S. Health CareSystem lay out foundational information for the generation who will lead us
at this critical stage and address the issues central to transformingAmerican
health care. The contributors examine crucial questions including: Are
we supporting the social conditions and providing the services needed to
prevent illness and injuries? Once people become sick, do Americans have
access to the care they need? Is the medical care provided affordable to
the individuals and communities receiving it, and to society as a whole?
Are we providing the best quality of care we can? Is the same quality of
medical care accessible to poor and marginalized populations? Each of
these questions is covered from many angles.
In looking at access to care, the book begins with an in-depth look at
the Affordable Care Act, the greatest transformation in access to medical
care the United States has seen in generations. Other chapters investigate
what can be done to extend overall coverage, coverage through private
insurers, as well as coverage through the largest public system,Medicare. In
examining quality, chapters in the book focus on how we can successfully
measure outcomes that will lead to improving quality of life—the ultimate
outcome—and change health care delivery systems. Improving health
care is covered with particular attention to addressing disparities, be they
due to age, ethnicity, social class, or position. Similarly broad and deep
in its attention to costs, the book examines cost trends, the best ways to
measure expenses, approaches to containing costs, and new drivers of
costs, including expansion in pharmaceutical access and the implications
for pricing; it also addresses issues looming large on the horizon, like
long-term care. Importantly, as health care is only half of the equation,
commonly coming into play only after people become sick or injured,
Changing the U.S. Health Care System examines how social conditions shape
health in the first place.
In striving to ensure that we all understand the opportunities and
challenges the United States faces in transforming health and health care,
the contributors to and readers of Changing the U.S. Health Care Systemcould not be taking on a more important task.
Jody Heymann
dean, UCLA Fielding School of Public Health
August 2013
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THE EDITOR
Gerald F. Kominski is a professor of health policy and management and
director of the UCLA Center for Health Policy Research in the UCLA
Fielding School of Public Health. He also currently serves as an asso-
ciate director of the California Medicaid Research Institute (CaMRI), a
multicampus organizational unit that brings together University of Califor-
nia researchers to collaborate with the California Department of Health
Services on issues related to the Medi-Cal program.
Dr. Kominski’s research interests focus on evaluating the costs and
cost-effectiveness of health care programs and interventions, with a special
emphasis on public insurance programs, including Medicare, Medicaid,
andWorkers’ Compensation.He is principal investigator atUCLAof a joint
project with the UC Berkeley Center for Labor Research and Education
to develop and apply the California Simulation of Insurance Markets
(CalSIM) model. CalSIM is currently being used to develop estimates for
the California Health Benefit Exchange Board to determine eligibility and
likely enrollment in the subsidized exchange starting in 2014.
Prior to joining the faculty at UCLA in 1989, Dr. Kominski worked
for three and a half years as a staff member for the agency now known as
the Medicare Payment Advisory Commission (MedPAC), which develops
recommendations for Congress regarding updates to Medicare payment
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xxvi The Editor
policy. Dr. Kominski is a fellow of Academy Health and a member of the
National Academy of Social Insurance. Dr. Kominski received his PhD
in public policy analysis from the University of Pennsylvania Wharton
School in 1985 and his AB in chemistry from the University of Chicago
in 1978.
Kominski f05.tex V2 - 10/17/2013 5:13 P.M. Page xxvii
THE AUTHORS
John L. Adams is a senior statistician in the health program at RAND.
His current work focuses on improved quantitative methods in quality
assessment. His interests include statistical methods for profiling managed
care organizations, provider groups, and providers. With Elizabeth McG-
lynn, he has worked on the QA Tools quality measurements system. He
is currently involved in the development of a quality measurement system
for cancer care and the validation of patient self-reports of quality of care.
Ronald M. Andersen is the Wasserman Professor Emeritus in the UCLA
Departments of Health Policy and Management and Sociology. Previously
he chaired the Department of Health Services at UCLA and was professor
at the University of Chicago, serving for ten years as director of the
Center for Health Administration Studies and the Graduate Program in
Health Administration. Dr. Andersen has studied health behavior and
access to medical care for his entire professional career of almost fifty
years. He developed the Behavioral Model of Health Services Use that
has been used extensively nationally and internationally as a framework
for utilization studies including special studies of minorities, low-income
persons, children, women, the elderly, oral health, and the homeless.
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xxviii The Authors
Lisa Arangua is senior research analyst in the Department of Family
Medicine, David Geffen School of Medicine at UCLA. She has been a
health services researcher and policy analyst for more than a decade. She is
a National WoodrowWilson Public Policy and International Affairs Fellow.
Prior to her appointment at UCLA, she was on the research staff at UCData
Archive and Technical Assistance at the University of California, Berkeley,
where she evaluated health and welfare programs for the state and federal
government. Her professional activities include social justice and health,
epidemiology, clinical trials, women and child/adolescent health, cancer
research, mental health research, illicit drug use and treatment research,
and concurrent behavior change research of severely underserved health
populations. She received her M.P.P. from UCLA in 1999.
Roshan Bastani is professor in the Department of Health Policy and
Management in the Fielding School of Public Health at UCLA. She
is a social and health psychologist and her research interests are in
chronic disease prevention and control among disadvantaged groups, with
a focus on testing the efficacy of patient, community, and health care
system–directed interventions to improve access and reduce disparities.
Dr. Bastani leads a number of research centers, including the UCLA
Kaiser PermanenteCenter forHealth Equity, theUCLA/RANDPrevention
Research Center, and the Center for Cancer Prevention and Control
Research, all of which are focused on addressing health disparities.
Sebastian E. Baumeister, is a senior epidemiologist and a member of the fac-
ulty at the University of Greifswald. As head of the statistics unit of the
Study of Health in Pomerania, a large population-based cohort study, he is
primarily responsible for statistical analyses and consulting. Previously he
worked on other large-scale epidemiological studies, including the Ger-
man Epidemiological Survey of Substance Abuse and the WHO MONICA
Surveys. He teaches graduate courses in epidemiology and biostatistics. He
has published and worked on various research projects in epidemiology,
health care access, health economics, and substance use. Currently, he
is working on consortia investigating the role of genetic background on
social science phenotypes.
Jeanne T. Black received her PhD in health services research from UCLA
and currently is manager of Health Policy Research at Cedars-Sinai Health
System in Los Angeles. Her research interests include the effect of health
reform incentives on academic medical centers and the cross-cultural