Demanding Medical Excellence

Demanding Medical Excellence is a groundbreaking and accessible work that reveals how the information revolution is changing the way doctors make decisions. Michael Millenson, a three-time Pulitzer Prize nominee as a health-care reporter for the Chicago Tribune, illustrates serious flaws in contemporary medical practice and shows ways to improve care and save tens of thousands of lives. "If you read only one book this year, read Demanding Medical Excellence. It's that good, and the revolution it describes is that important."—Health Affairs "Millenson has done yeoman's work in amassing and understanding that avalanche of data that lies beneath most of the managed-care headlines. . . . What he finds is both important and well-explained: inconsistency, overlap, and inattention to quality measures in medical treatment cost more and are more dangerous than most cost-cutting measures. . . . [This book] elevates the healthcare debate to a new level and deserves a wide readership."—Library Journal "An involving, human narrative explaining how we got to where we are today and what lies ahead."—Mark Taylor, Philadelphia Inquirer "Read this book. It will entertain you, challenge, and strengthen you in your quest for better accountability in health care."—Alex R. Rodriguez, M.D., American Journal of Medical Quality "Finally, a health-care book that doesn't wring its hands over the decline of medicine at the hands of money-grubbing corporations. . . . This is a readable account of what Millenson calls a 'quiet revolution' in health care, and his optimism makes for a refreshing change."—Publishers Weekly "With meticulous detail, historical accuracy, and an uncommon understanding of the clinical field, Millenson documents our struggle to reach accountability."—Saty Satya-Murti, M.D., Journal of the American Medical Association

Health care delivery in the United States is an enormously complex enterprise, and its $1.6 trillion annual expenditures involve a host of competing interests. While arguably the nation offers among the most technologically advanced medical care in the world, the American system consistently under performs relative to its resources. Gaps in financing and service delivery pose major barriers to improving health, reducing disparities, achieving universal insurance coverage, enhancing quality, controlling costs, and meeting the needs of patients and families. Bringing together twenty-five of the nation’s leading experts in health care policy and public health, this book provides a much-needed perspective on how our health care system evolved, why we face the challenges that we do, and why reform is so difficult to achieve. The essays tackle tough issues including: socioeconomic disadvantage, tobacco, obesity, gun violence, insurance gaps, the rationing of services, the power of special interests, medical errors, and the nursing shortage. Linking the nation’s health problems to larger political, cultural, and philosophical contexts, Policy Challenges in Modern Health Care offers a compelling look at where we stand and where we need to be headed.

Doctors are obviously influential in determining the costs of their services. But even more important, many believe, is the influence physicians have over the use and cost of nonphysician health-care resources and services. Doctors and Their Workshops is the first comprehensive attempt to use economic analysis to understand some of the physician effects on nonphysician aspects of health care.

With computerized health information receiving unprecedented government support, a group of health policy scholars analyze the intricate legal, social, and professional implications of the new technology. These essays explore how Health Information Technology (HIT) may alter relationships between physicians and patients, physicians and other providers, and physicians and their home institutions. Patient use of web-based information may undermine the traditional information monopoly that physicians have long enjoyed. New IT systems may increase physicians' legal liability and heighten expectations about transparency. Case studies on kidney transplants and maternity practices reveal the unanticipated effects, positive and negative, of patient uses of the new technology. An independent HIT profession may emerge, bringing another organized interest into the medical arena. Taken together, these investigations cast new light on the challenges and opportunities presented by HIT.

This book describes an overlooked solution to a long-standing problem in health care. The problem is an informational supply chain that is unnecessarily dependent on the minds of doctors for assembling patient data and medical knowledge in clinical decision making. That supply chain function is more than the human mind can deliver. Yet, dependence on the mind is built into the traditional role of doctors, who are educated and licensed to rely heavily on personal knowledge and judgment. The culture of medicine has long been in denial of this problem, even now that health information technology is increasingly used, and even as artificial intelligence (AI) tools are emerging. AI will play an important role, but it is not a solution. The solution instead begins with traditional software techniques designed to integrate novel functionality for clinical decision support and electronic health record (EHR) tools. That functionality implements high standards of care for managing health information. This book describes that functionality in some detail. This description is intended in part to be a starting point for developers in the open source software community, who have an opportunity to begin developing an integrated, cloud-based version of the tools described, working with interested clinicians, patients, and others. The tools grew out of work beginning more than six decades ago, when this book’s lead author (deceased) originated problem lists and structured notes in medical records. The electronic tools he later developed led him to reconceive education and licensure for doctors and other health professionals, which are also part of the solution this book describes.

Health Care USA, Sixth Edition is an ideal text for introductory courses on the organization and delivery of U.S. health care for students in schools of public health, medicine, nursing, dentistry, health administration, and other health professions. It provides an introduction to the health care system and an overview of the professional, political, social, and economic forces that have shaped it and will continue to do so. The Sixth Edition has been thoroughly revised to reflect the most recent changes of this growing and dynamic industry. Revisions include: Updated data on the size and cost of the U.S. health care system. New information on Managed Care Organizations, PPOs, and HMOs. New information on the variety of efforts of hospitals to reduce medical errors. Developments from the “Freedom Commission on Mental Health” initiative. A new discussion on the hospital competition with privately owned outpatient facilities. Updated Department of Labor estimates on health care personnel and the factors that influence demand and utilization. New data on the number of un- or under-insured Americans. A new discussion of government and private insurer cost savings initiatives through education and case management. A new discussion of the effect of the influx of Iraq War causalities on VA services. Updates on federal, state, and local public health initiatives in emergency preparedness. and much more!

During the last few years, components of the health care system in the United States have changed more rapidly than ever before. New industry developments, health insurance changes, and major cost increases have significant implications for both providers and consumers. Changes in the Medicare program on which all other service charges are based, double digit premium increases by managed care companies, the growing number of uninsured, and a nation-wide movement among physicians to set up ambulatory diagnostic, surgical, and other treatment centers in competition with hospitals are changing the structure and operation of the U.S. health care system. The 5th edition contains updated service utilization and financial information as well as updated health care industry trends with the latest developments. All existing tables and charts have been updated and new tables and charts have been added to highlight trends and illustrate major points of the narrative.