Our Unsystematic Healthcare System

by Grace Budrys

Overview

Our Unsystematic Healthcare System presents readers with a comprehensive overview of the U.S. healthcare system with an emphasis on change. It opens with a comparison of U.S. life expectancy and national expenditures with those of other economically advanced countries. The chapters that follow outline the different sectors of the healthcare system including public health, physician and hospital networks, private and public health insurance plans, and the pharmaceutical industry. The book’s conclusion considers forces outside of the healthcare system that play a role in determining Americans’ health status and longevity. Our Unsystematic Healthcare System is the ideal book for introducing readers to the basics of the complex U.S. healthcare system in an accessible way.

New to this Edition:

• New chapter on public health outlines public health origins, workings, and achievements to give students the background needed to discuss current crises such as COVID-19 and the overturning of Roe v Wade (Chapter 2)
• New chapter on the pharmaceutical industry explores drug development, advertising, and legislation to explore why the cost of drugs is so high (Chapter 7)
• New chapter on the social determinants of health considers the World Health Organization's view that neither behavior nor healthcare arrangements are primarily responsible for people’s health (Chapter 9)

Product Details

ISBN-13:	9781538177037
Publisher:	Rowman & Littlefield Publishers, Inc.
Publication date:	09/08/2023
Edition description:	Fifth Edition
Pages:	166
Product dimensions:	6.21(w) x 9.45(h) x 0.73(d)
Age Range:	18 Years

About the Author

Grace Budrys is Professor Emerita of Sociology at DePaul University in Chicago. She is the author of numerous books, including Market-Based Health Care: All Myth, No Reality, Unequal Health: How Inequality Contributes to Health or Illness, Third Edition, and How Nonprofits Work. In addition to teaching, she chaired the Department of Public Services and the Masters of Public Health programs at DePaul University.

Table of Contents

Preface

1 Introduction

2 Public Health

Public Health and Controversy

Public Health Origins and Development

State and Local Public Health Agencies

Non-Governmental Public Health

Public Health Accomplishments

Efficacy of the COVID Vaccine

A Recent Special Case

Another Recent Case

3 Private Health Insurance

Origins of Private Health Insurance

From a Community Rate to Risk Rating

From Prepaid Care to Health Maintenance

The Affordable Care Act

The Individual Mandate

The Employed Mandate

Health Insurance and Prices

Legislation Aimed at Health System Reform

4 Health Insurance – Public Programs

Origins of Medicare and Medicaid

Medicare

Part A

Part B

Part D

Part C – Medicare Advantage Plans

Medicare Advantage Business Operations

Medicaid

The ACA and Reform

Public Opinion and Medicaid

Medicaid and Managed Care

State Child Health Insurance Program

Continuing Policy Debates

5 Health Care Occupations

The Medical Profession

Medical Specialization

The Medical Education System

The Organization of Medical Practice

How Physicians Get Paid

Medical Professionalism

Medical Error and Malpractice

Nurses

Therapists

Technicians and Technologists

Other Practitioners

Administrators and Other Administrative Workers

6 Hospital and Other Healthcare Organizations

A Brief History of the Modern Hospital

Growth and Development

Rising Costs of Care

The Shorter Length of Stay

Hospitals and Quality of Care

Growth of the For-Profit Hospital Sector

Consolidation of Nonprofit Hospitals

The Chargemaster

Differences by Hospital Ownership

Other Healthcare Organizations

Initiatives Aimed at Reducing Costs

7 Pharmaceuticals

Steps Involved in Creating a Drug

Generic Drugs

Orphan Drugs

Pharmacy Benefit Managers

Getting Drugs to Market Sooner

Pharmacies

Pharmaceutical Companies and the COVID-19 Vaccine

Why Drugs Are So Expensive

Where Things Stand in Trying to Control Costs

8 Healthcare Systems in Other Countries

Canada

England

Switzerland

Japan

Spain

France

Germany

More On International Comparisons

Some Final Observations

9 Determinants of Health

Education and Inequality

Deaths of Despair

Health Disparities and Race

Social Support Networks

Upstream Versus Downstream Intervention

Final Thoughts

Addendum

Editorial Reviews

Budrys' Our Unsystematic Healthcare System is timely, informative, logical, and strikes a perfect balance between conversational and academic writing. Useful to students, professors, and the broader public, it is my favorite text for medical sociology classes, and it should be required reading for policy makers.

Eric Vogelsang

This fifth edition of Our Unsystematic Healthcare System explores important debates and offers a comprehensive synopsis of health care delivery in the US. Chapter 1 begins by posing questions about life expectancy and health care costs in the US compared to other countries. Similar to the fourth edition, this edition explores the Affordable Care Act but expands the discussion to include the polarizing public health efforts to prevent the spread of COVID-19 and the political and social turmoil caused by overturning Roe v. Wade (1973) in 2022. In the discourse about health insurance, occupations, and hospital systems, Budrys presents the complexities of reimbursement formulas and the havoc that network consolidation is causing. She warns how consolidation poses a serious threat to American health care arrangements. The fifth edition includes a new chapter on the pharmaceutical industry, which explores why big pharma has become the most reviled arena in health care today. The final chapter ("Determinants of Health") delves into how personal choices regarding diet, exercise, and sleep impact health, examining the WHO’s view that neither behavior nor health care arrangements are responsible for people’s health. Recommended. General readers through faculty; professionals.

Choice Reviews

This fifth edition of Our Unsystematic Healthcare System is an outstanding, realistic description and critical analysis of the US and other national healthcare systems. This is an honest, comprehensive, clearly written book, which parts the curtains on the history and contemporary structure of the US healthcare system and its medical, economic, political, and social influences. Excellent textbook for anyone interested in understanding and reforming the US healthcare system.

Michael Diamond

Our Unsystematic Healthcare System fills a niche not addressed by other introductory texts about the health care system of the United States. Budrys provides an accessible narrative that illuminates both social and historical influences on the extant system. This book enriches the discussion about our problematic approach to care by offering explanations.

From the Publisher

With a writing style that encourages an active learning environment, Budrys offers students from a range of academic backgrounds in-depth exposure to the complexities of the American healthcare system.

Duane Matcha

Budrys once again uses academic storytelling at its finest by weaving together the complex interplay of healthcare stakeholders, social systems, and public policy – while carefully acknowledging the essential context of U.S. history, culture, and values. The fifth edition of Our Unsystematic Healthcare System boasts a new section exploring the story of the U.S. pharmaceutical industry that describes key influences and processes that have resulted in the current problem of high drug prices. As a pharmacy educator, I can attest that it is rare to find a source on this topic with a concise explanation of the interaction between public and private sectors on research/discovery, patents, intermediary organizations, as well as the ethics and influence of marketing and lobbying. Overall, this text is both accessible to novices as well as professionals looking to widen their perspectives on the how’s and why’s of the U.S. healthcare system.

Andrea L. Kjos

Dr. Budrys’s narrative is unique among texts on the topic of the healthcare system of the United States. I have used her texts for 13 years. The fifth edition of Our Unsystematic Healthcare System carefully integrates the effects of private sector strategies and the context of the social determinants of health.

Richard Dozal-Lockwood

Our Unsystematic Healthcare System is a must-read for anyone interested in how the organizational structure of the healthcare system affects the health of the people it is intended to serve. I’ve used this book since I started teaching. It is comprehensive, yet accessible to a wide audience.

Mitchell Peck

A succinct, up-to-date, and informative look at our health system. This resource is one that students will find straightforward and easy to consume, which is a big plus, since these topics get complicated with many intersecting and often competing stakeholder interests, systems, and infrastructures needed to make it work. The book is well-written, with straightforward language and a thorough, comprehensive presentation - engaging and informative.

Shawn Ekwall

An excellent overview of the U.S. health care system. Grace Budrys has produced a very useful guide to a system that can be very difficult to understand. In straightforward language, and with gripping case examples, Budrys analyzes a wide range of important issues, including managed care, the division of labor in health care, insurance and lack of insurance, and alternative medicine. The comparisons with other countries' systems are enlightening. This book will be helpful for people already familiar with the problems and prospects of U.S. health care, and also for those who are just beginning to study these issues.

Howard Waitzkin

This fourth edition of Our Unsystematic Health Care System is a concise yet comprehensive review of the health care delivery system in the United States. In it, Budrys presents all of the critical elements of the Affordable Care Act (ACA) and explains what each means for health care users, providers, and policymakers. This book is a must-read for those who want to understand the current status of the ACA, how health care got to this point, and how it continues to evolve. It provides readers with the facts about the ACA and its political, economic, and social context to make every reader a more informed participant in the discussion on current and future health care in this country.

Kimberly R. Barber

Our Unsystematic Health Care System provides a comprehensive and critical introduction to the institutions of the US health care system. It is an indispensable resource for advanced students in economics or politics embarking on the study of health and health care (as well as for sociologists, its primary audience). Throughout, Budrys poses thoughtful questions and identifies interesting paradoxes and conflicts in the arena of health care. Budrys's book explains not only where we are but how we got here.

Michael Ash

This fourth edition of Our Unsystematic Health Care System maintains the accessibility to undergraduate, interdisciplinary audiences from the previous editions. Grace Budrys explains health care reform in a very understandable way without sacrificing the complexity and continued debate around the implementation of the legislation. New to this edition is a well-balanced assessment of whether health care reform is working. Budrys asks readers to consider what they want reform to accomplish, then lays out the empirical findings related to access, cost containment, and quality, and leaves it for the reader to decide what is ‘working’ and what is left unresolved.

Lara Foley

A good overview of the structure and functions of the current U.S. health care system. This volume will be especially useful for beginning students of this subject or for those who are already knowledgeable but who are looking for a quick and easily accessible source of information.

Journal Of Community Health

Designed for courses on sociology of medicine, public health, community medicine, and health care delivery, this accessible textbook explores the current debate about health care in American society.

Business Horizons

Fairly complete coverage of important healthcare system topics, with particularly good coverage of the hospital and other healthcare organizations, and alternative medicine and healthcare systems in other countries.

Contemporary Sociology

Budrys explains the evolution of the health care delivery system in the U.S. and presents a clear, accurate picture of current health care arrangements. An excellent overview, written in a conversational tone, and a welcome addition to the health care system literature. All levels.

Choice

The 2010 Patient Protection and Health Care Affordability Act still remains a bit of a mystery to most people, and it is hard to tell just exactly where the US is headed with health care. Budrys (sociologist, DePaul Univ.) has done a remarkable job in providing a 10,000-foot snapshot of the system as of June 2011. In two previous editions (2nd ed., 2005; 1st ed., CH, Dec'01, 39-2219), the author rendered images of the forces that helped to shape US health care. Building on those prior descriptions, this work focuses on the origins of reform legislation and subsequent changes. The book begins with an overview across an array of disciplines and then discusses effects on various components of the system including hospitals, health care professions, and public/private insurance. One chapter focuses on opinions regarding the new legislation. The last two chapters review health systems in other countries and provide case studies on the dilemmas of reform. Budrys captures the plenum nature of the system across economic and political landscapes, and the policy choices that the country faces. The text is clearly written and indexed with chapter references. A valuable resource for academic readers and health professionals, especially those in the social sciences. Summing Up: Highly recommended.

CHOICE