81:(i.e. location, housing, education, employment, income, crime, social cohesion) have been shown to significantly influence health. However, at present, population health receives only five percent of national health budgets. By comparison, 95 percent is spent on direct medical care services, yet medical care only accounts for only 10-15 percent of preventable mortality in the United States. Genetics, social circumstances, environmental exposures, and behavioral patterns comprise the bulk of health determinants of health outcomes, which is increasingly considered when creating health policy.
212:
of physicians. Workspaces also contribute to fostering rationing amongst their employees due to high deductibles and premiums. They key in expanding access without having a negative effect on health care is to begin to look at rationing as a way to share these finite resources across the population, and not a way to reallocate care to certain people. When we do this, we can work to improve access to care and effectively treat as many patients as possible.
166:
and flourishing industry. Medical industrial complex includes proprietary hospitals and nursing homes, diagnostic laboratories, home care and emergency room services, renal hemodialysis units, and a wide variety of other medical services that had formerly been provided largely by public or private not-for-profit community-based institutions or by private physicians in their offices.
174:. In the U.S, there are loose regulations on healthcare industries, often driving companies to charge high prices and fragment standards of care. For instance, pharmaceutical companies can charge high prices for drugs, as we have recently seen with EpiPen. Furthermore, since manufacturers of medical devices fund medical education programs such as
247:
professionals such as internists and family practitioners. This sector is often the initial point of contact for patients. The human services sector consists of social service agencies and criminal justice/prison-based services, among others. The final sector is the volunteer support network sector, consisting of services like self-help groups.
200:
additional cost. If all
Americans practice the appropriate level of preventative care, “100,000 lives would be saved each year.” Even with the expanded access to preventative care services and other healthcare related services, the insured still experience rationing due to increasing premiums and rising healthcare costs.
251:
similar benefits for both types of care. The
Affordable Care Act of 2010 (ACA) expanded this development by requiring parity for additional plans, expanding parity protections to an additional 62 million people. Both acts significantly reduced cost as a barrier to care, but there are still areas for progress.
232:
The history of mental health care services in the U.S. can best be understood as a gradual shift from institutionalized provision of care to interventions focused in a community setting. World War II resulted in heightened awareness of mental illness as thousands of soldiers returned home traumatized
203:
From 2005 to 2015, the average annual employer-sponsored health insurance premiums for family coverage increased 61%. During this time, worker contribution increased even higher by 83%. The growth in employer-sponsored premiums as well as deductibles has led individuals and families to ration health
165:
who served as an editor of the journal from 1977 to 1991. According to Dr. Relman, American health care system is a profit-driven industry and it has become a widely accepted theory these days. Since the term was introduced 40 years ago, health care industry has developed into even a larger, greater
124:
The main factors driving these variations are not limited to; increasingly complex healthcare technology, exponentially increasing medical knowledge and over reliance on subjective judgement. Unwarranted variations have measurable consequences in terms of over/under utilization, increased mortality,
99:
Federal, state, and local governments can improve population health by evaluating all proposed social and economic policies for potential health impacts. Future efforts within health policy can incorporate appropriate incentives and tactical funding for community-based initiatives that target known
250:
Recent legislation continues to improve access to care by requiring cost parity. The 2008 Health Parity and
Addiction Equity Act required certain plans to provide mental illness coverage on par with general health coverage, requiring providers to provide care at similar out-of-pocket costs and with
211:
Imagine a world without health care rationing is impractical due to a finite amount of resources. Prior to contrary belief, universal healthcare isn’t the answer to solve rationing, in fact, rationing may increase if more people have access to healthcare without an equivalent increase in the number
195:
occurs due to scarcity; everyone cannot have access to every service and treatment because it would not be an efficient use of resources. Some argue that price should not be the biggest factor in determining who has access to which services and treatments, but rather that healthcare is a right that
104:
may be conducted in order to identify the most potentially effective mechanisms for each given community. Such assessments may identify a demand for increased and reliable forms of transportation, which would allow individuals to have continuous resources to preventative and acute care. As well,
69:
Health systems management ensures that specific outcomes are attained, that departments within a health facility are running smoothly, that the right people are in the right jobs, that people know what is expected of them, that resources are used efficiently and that all departments are working
207:
In Canada citizens have a universal healthcare system which grants them access to healthcare but requires them to deal with rationing issues. The system works through level of importance, with urgent care having priority as well as certain disease/disorder treatment as some are life and death
254:
This legislation has been successful in improving mental health treatment rates across the entire population. However, there are still large disparities in these rates amongst whites and non-whites. This may be because states that opted out of
Medicaid expansion under the ACA had much larger
199:
Preventative care is an important component of HPAM because the levels of preventative care measures taken by individuals can help to determine the health of the population. The ACA opened the door for increased access to preventative care by mandating insurers to offer these services at no
132:
Medical practice variations are an important dimension of health policy and management - understanding the causes and effects of variations will guide policymakers to develop and improve upon existing policies. In managing practice variations, it is important to perform assessments of the
246:
Mental health is treated by an array of providers representing multiple disciplines working in both public and private settings. The psychiatric and behavioral health sector consist of behavioral health professionals, such as psychiatrists. The primary care sector consists of health care
237:
of individuals with mental illness. The effects of deinstitutionalization were mixed; individuals with mental illness were no longer subject to poor conditions in asylums, however, community support was inadequate to provide treatment and services for the severe and chronically ill.
120:
when he observed small area (geographic) and practice style variations, which were not based on clinical rationale. The existence of unwarranted variations suggests that some individuals do not receive adequate care or that health resources are not being used appropriately.
208:
situations. Although Great
Britain was the first to boast a universal healthcare system it also suffers from rationing issues. Although the no cost sharing system seems generous on the surface, the overall lack of access or options creates serious issues for patients.
233:
from the war. During that time, development of psychotropic medications also offered new treatment options. In 1963, John F. Kennedy implemented the
Community Health Act, ending 109 years of federal non-involvement in mental health services, spurring the
182:
industry could be a possible solution to the fragmentation of care, however, there are currently no government regulations for telehealth companies. Clearly, the government must impose stronger regulations that focus on patient well-being.
105:
funding for job training initiatives within communities with low employment would allow individuals to build their capacity to not only earn income, but also engage in health-seeking behaviors which typically are at an elevated cost.
157:") when warning the nation, as he was retiring, about the growing influence of arms manufacturers over American political and economic policies. Then the term "medical industrial complex" started to spread from 1980 through
136:
Policymakers should take a comprehensive approach to align policies, leadership, and technology in order to effectively reduce unwarranted variations in care. Effective reduction requires active patient involvement and
169:
In countries where the medical industrial complex is too influential, there are legal limitations to consumer options for accessing diverse healthcare services due to regulations in international markets such as the
133:
diseases/procedures with high levels of unwarranted variations; a comparison between the care delivered and the standard care guidelines will highlight discrepancies and provide insight into improvement areas.
178:
and physicians and hospitals directly to adopt the use of their devices, there is a controversy that such education has a bias to promote the interests of its funders. The recent development of the
204:
care. High premiums and deductibles encourage individuals and families to think twice before they use health services and lessens the ability for individuals to consume other goods and services.
116:
in medical practice refer to the differences in care that cannot be explained by the illness/medical need or by patient preferences. The term “unwarranted variations” was first coined by Dr.
191:
Access to care and
Rationing are important dimensions of Health Policy and Management (HPAM) because they address the market force that impacts how and when people get health care services.
267:. Recently, care integration has been a key policy priority, and numerous federal agencies have adopted initiatives to promote the integration of primary care and mental health services.
351:
66:, management of a single institution (e.g. a hospital) is also referred to as "medical and health services management", "healthcare management" or "health administration".
499:
Newhouse, Joseph; Garber, Alan (September 25, 2015). "Geographic
Variation in Health Care Spending in the United States Insights From an Institute of Medicine Report".
153:
is the network of corporations which supply health care services and products for a profit. The term was derived from the language that
President Eisenhower had used ("
410:
Mercuri, Mathew (April 19, 2011), "Medical practice variations: what the literature tells us (or does not) about what are warranted and unwarranted variations",
125:
and increased costs. For example, a 2013 study found that in terms of
Medicare costs, higher expenditures were not associated with better outcomes or higher
659:
1010:
769:
96:
by hospitals has occurred in many states, and has specifically addressed social determinants of health like education and housing.
141:
though standardization of clinical care with a focus on adherence to care guidelines and an emphasis on quality based outcomes.
171:
220:
As a field, health policy and management seeks to improve access, reduce costs, and improve outcomes for individuals with
158:
471:
915:
876:
611:"International trade in health services and the medical industrial complex: implications for national health systems"
334:
92:
must conduct community health needs assessments and participate in community improvement projects. The creation of
1140:
1145:
154:
150:
1095:"Seizing Opportunities Under The Affordable Care Act For Transforming The Mental And Behavioral Health System"
864:
Medicine & culture : Varieties of treatment in the United States, England, West Germany, and France
175:
445:
550:
93:
36:
686:"The Medical-Industrial Complex, Professional Medical Associations, and Continuing Medical Education"
868:
862:
84:
At the federal level, policymakers are addressing social determinants through provisions in the
54:
or health care systems management describes the leadership and general management of hospitals,
1150:
234:
1044:"Access to Mental Health Care Increased But Not For Substance Abuse, While Disparities Remain"
907:
901:
1004:
192:
113:
51:
352:"The Role of Hospitals in Improving Non-Medical Determinants of Community Population Health"
138:
1024:
8:
126:
89:
85:
78:
73:
1070:
1043:
987:
962:
287:
McGinnis, JM (2002). "The case for more active policy attention to health promotion".
1116:
1075:
992:
978:
921:
911:
882:
872:
818:
810:
750:
715:
707:
702:
685:
640:
632:
591:
516:
427:
423:
392:
330:
304:
32:
627:
610:
1106:
1065:
1055:
982:
974:
802:
742:
697:
622:
581:
508:
419:
382:
296:
162:
101:
55:
903:
The Healing of America: A Global quest for better, cheaper and fairer health care
264:
221:
793:
Bloche, M. Gregg (2012-05-24). "Beyond the "R Word"? Medicine's New Frugality".
586:
569:
609:
Santos, Maria Angelica Borges dos; Passos, Sonia Regina Lambert (August 2010).
1111:
1094:
1060:
1134:
963:"A Political History of Federal Mental Health and Addiction Insurance Parity"
925:
886:
814:
711:
636:
512:
117:
63:
59:
47:
20:
300:
62:. In international use, the term refers to management at all levels. In the
1120:
1079:
996:
822:
754:
719:
644:
520:
431:
396:
308:
940:
746:
595:
806:
387:
370:
179:
19:
is the field relating to leadership, management, and administration of
74:
Applying social determinants of health in health policy and management
108:
28:
660:"How Marketing Turned the EpiPen Into a Billion-Dollar Business"
941:
The U.S. Mental Health Delivery System Infrastructure: A Primer
371:"We can do better--improving the health of the American people"
24:
733:
Dorsey, E. Ray; Topol, Eric J. (2016). "State of Telehealth".
960:
241:
263:
An ongoing and future trend in mental health care is
1041:
836:
534:Relman, Arnold S (2005). "The health of nations".
446:"Clinical Variation in Your Medical Organization?"
109:Variations in medical practice and quality of care
1031:. U.S. Department of Health & Human Services.
470:Alexander, Dana; Kinhan, Peter; Savage, Brandon.
469:
1132:
258:
186:
658:Koons, C.; Langreth, R. (September 23, 1025).
498:
1025:"Health Insurance and Mental Health Services"
867:. New York: Henry Holt and Company. pp.
770:"'Rationing' Health Care: What Does It Mean?"
657:
144:
1009:: CS1 maint: multiple names: authors list (
608:
538:. Vol. 232, no. 8. pp. 23–30.
282:
280:
732:
683:
472:"Eliminating Unwarranted Variation in Care"
938:
412:Journal of Evaluation in Clinical Practice
39:are considered health care professionals.
1110:
1069:
1059:
986:
701:
626:
585:
386:
327:Health care delivery in the United States
277:
1092:
368:
286:
443:
409:
242:Delivery of services and current policy
1133:
961:Barry, Huskamp, & Goldman (2010).
792:
567:
548:
533:
329:(11th ed.). Springer Publishing.
324:
255:populations of adult people of color.
172:General Agreement on Trade in Services
860:
767:
939:Sundaraman, Ramya (April 21, 2009).
906:. New York: Penguin Press. pp.
899:
570:"The new medical-industrial complex"
320:
318:
159:the New England Journal of Medicine
13:
549:Angell, Marcia (August 14, 2014).
369:Shroeder, S (September 20, 2007).
14:
1162:
325:Kovner, Anthony (April 8, 2015).
315:
979:10.1111/j.1468-0009.2010.00605.x
703:10.1111/j.1526-4637.2011.01282.x
424:10.1111/j.1365-2753.2011.01689.x
349:
215:
1086:
1035:
1017:
954:
932:
893:
854:
829:
795:New England Journal of Medicine
786:
761:
726:
677:
651:
628:10.1590/s0102-311x2010000800003
602:
574:New England Journal of Medicine
561:
542:
375:New England Journal of Medicine
948:Congressional Research Service
837:"The Kaiser Family Foundation"
551:"On Arnold Relman (1923-2014)"
527:
492:
463:
437:
403:
362:
343:
196:we should all have access to.
42:
1:
1042:Creedon & LeCook (2016).
270:
259:Opportunities for improvement
100:gaps in social determinants.
684:Schofferman, Jerome (2011).
444:Haughom, John (2014-06-16).
187:Rationing and access to care
176:continuing medical education
161:(Nov. 4, 1971, 285:1095) by
17:Health policy and management
7:
587:10.1056/nejm198010233031703
155:military-industrial complex
94:public-private partnerships
10:
1167:
227:
151:medical–industrial complex
145:Medical industrial complex
37:Health care administrators
1112:10.1377/hlthaff.2011.0623
1061:10.1377/hlthaff.2016.0098
615:Cadernos de Saude Publica
568:Relman, Arnold S (1980).
52:health systems management
555:New York Review of Books
513:10.1001/jama.2013.278139
222:mental health conditions
193:Rationing in health care
1141:Health care occupations
301:10.1377/hlthaff.21.2.78
70:towards a common goal.
1146:Health care management
235:deinstitutionalization
114:Unwarranted variations
967:The Milbank Quarterly
747:10.1056/nejmra1601705
356:NYS Health Foundation
900:Reid, T. R. (2009).
861:Payer, Lynn (1996).
807:10.1056/NEJMp1203521
388:10.1056/NEJMsa073350
139:physician engagement
90:non-profit hospitals
86:Affordable Care Act
79:Social determinants
60:health care systems
25:health care systems
768:Reinhardt, Uwe E.
50:and management or
1093:Mechanic (2012).
801:(21): 1951–1953.
507:(12): 1227–1228.
102:Needs assessments
56:hospital networks
33:hospital networks
1158:
1125:
1124:
1114:
1090:
1084:
1083:
1073:
1063:
1054:(6): 1017–1021.
1039:
1033:
1032:
1029:MentalHealth.gov
1021:
1015:
1014:
1008:
1000:
990:
958:
952:
951:
945:
936:
930:
929:
897:
891:
890:
858:
852:
851:
849:
847:
833:
827:
826:
790:
784:
783:
781:
780:
765:
759:
758:
730:
724:
723:
705:
681:
675:
674:
672:
670:
655:
649:
648:
630:
621:(8): 1483–1493.
606:
600:
599:
589:
565:
559:
558:
546:
540:
539:
536:The New Republic
531:
525:
524:
496:
490:
489:
487:
485:
476:
467:
461:
460:
458:
456:
441:
435:
434:
407:
401:
400:
390:
366:
360:
359:
347:
341:
340:
322:
313:
312:
284:
265:care integration
163:Arnold S. Relman
1166:
1165:
1161:
1160:
1159:
1157:
1156:
1155:
1131:
1130:
1129:
1128:
1091:
1087:
1040:
1036:
1023:
1022:
1018:
1002:
1001:
959:
955:
943:
937:
933:
918:
898:
894:
879:
859:
855:
845:
843:
835:
834:
830:
791:
787:
778:
776:
766:
762:
731:
727:
682:
678:
668:
666:
656:
652:
607:
603:
580:(17): 963–970.
566:
562:
547:
543:
532:
528:
497:
493:
483:
481:
474:
468:
464:
454:
452:
450:Health Catalyst
442:
438:
408:
404:
367:
363:
348:
344:
337:
323:
316:
285:
278:
273:
261:
244:
230:
218:
189:
147:
127:quality of care
111:
76:
45:
12:
11:
5:
1164:
1154:
1153:
1148:
1143:
1127:
1126:
1105:(2): 376–382.
1099:Health Affairs
1085:
1048:Health Affairs
1034:
1016:
953:
931:
916:
892:
877:
853:
828:
785:
760:
741:(2): 154–161.
725:
696:(12): 1713–9.
676:
650:
601:
560:
541:
526:
491:
462:
436:
418:(4): 671–677,
402:
381:(12): 1221–8.
361:
342:
335:
314:
289:Health Affairs
275:
274:
272:
269:
260:
257:
243:
240:
229:
226:
217:
214:
188:
185:
146:
143:
110:
107:
75:
72:
44:
41:
9:
6:
4:
3:
2:
1163:
1152:
1151:Health policy
1149:
1147:
1144:
1142:
1139:
1138:
1136:
1122:
1118:
1113:
1108:
1104:
1100:
1096:
1089:
1081:
1077:
1072:
1067:
1062:
1057:
1053:
1049:
1045:
1038:
1030:
1026:
1020:
1012:
1006:
998:
994:
989:
984:
980:
976:
973:(3): 404–33.
972:
968:
964:
957:
949:
942:
935:
927:
923:
919:
917:9781594202346
913:
909:
905:
904:
896:
888:
884:
880:
878:9780805048032
874:
870:
866:
865:
857:
842:
838:
832:
824:
820:
816:
812:
808:
804:
800:
796:
789:
775:
774:Economix Blog
771:
764:
756:
752:
748:
744:
740:
736:
729:
721:
717:
713:
709:
704:
699:
695:
691:
690:Pain Medicine
687:
680:
665:
661:
654:
646:
642:
638:
634:
629:
624:
620:
616:
612:
605:
597:
593:
588:
583:
579:
575:
571:
564:
556:
552:
545:
537:
530:
522:
518:
514:
510:
506:
502:
495:
480:
479:GE Healthcare
473:
466:
451:
447:
440:
433:
429:
425:
421:
417:
413:
406:
398:
394:
389:
384:
380:
376:
372:
365:
357:
353:
346:
338:
336:9780826125279
332:
328:
321:
319:
310:
306:
302:
298:
294:
290:
283:
281:
276:
268:
266:
256:
252:
248:
239:
236:
225:
223:
216:Mental health
213:
209:
205:
201:
197:
194:
184:
181:
177:
173:
167:
164:
160:
156:
152:
142:
140:
134:
130:
128:
122:
119:
118:John Wennberg
115:
106:
103:
97:
95:
91:
87:
82:
80:
71:
67:
65:
64:United States
61:
57:
53:
49:
48:Health policy
40:
38:
34:
30:
26:
22:
21:public health
18:
1102:
1098:
1088:
1051:
1047:
1037:
1028:
1019:
1005:cite journal
970:
966:
956:
947:
934:
902:
895:
863:
856:
846:December 20,
844:. Retrieved
840:
831:
798:
794:
788:
777:. Retrieved
773:
763:
738:
735:N Engl J Med
734:
728:
693:
689:
679:
669:December 18,
667:. Retrieved
663:
653:
618:
614:
604:
577:
573:
563:
554:
544:
535:
529:
504:
500:
494:
482:. Retrieved
478:
465:
453:. Retrieved
449:
439:
415:
411:
405:
378:
374:
364:
355:
345:
326:
295:(2): 78–93.
292:
288:
262:
253:
249:
245:
231:
219:
210:
206:
202:
198:
190:
168:
148:
135:
131:
123:
112:
98:
83:
77:
68:
46:
16:
15:
484:16 December
455:16 December
88:, in which
43:Terminology
1135:Categories
779:2016-12-20
271:References
180:telehealth
950:(Report).
926:314597097
887:632376710
815:0028-4793
712:1526-2375
664:Bloomberg
637:1678-4464
350:Chen, M.
58:, and/or
29:hospitals
23:systems,
1121:22323168
1080:27269017
997:20860577
823:22551108
755:27410924
720:22145759
645:21229208
521:24008265
432:21501341
397:17881753
309:11900188
1071:7033262
988:2950754
841:kff.org
596:7412851
228:History
1119:
1078:
1068:
995:
985:
924:
914:
885:
875:
821:
813:
753:
718:
710:
643:
635:
594:
519:
430:
395:
333:
307:
31:, and
944:(PDF)
475:(PDF)
1117:PMID
1076:PMID
1011:link
993:PMID
922:OCLC
912:ISBN
883:OCLC
873:ISBN
848:2016
819:PMID
811:ISSN
751:PMID
716:PMID
708:ISSN
671:2016
641:PMID
633:ISSN
592:PMID
517:PMID
501:JAMA
486:2016
457:2016
428:PMID
393:PMID
331:ISBN
305:PMID
149:The
1107:doi
1066:PMC
1056:doi
983:PMC
975:doi
908:290
869:204
803:doi
799:366
743:doi
739:375
698:doi
623:doi
582:doi
578:303
509:doi
505:310
420:doi
383:doi
379:357
297:doi
1137::
1115:.
1103:31
1101:.
1097:.
1074:.
1064:.
1052:35
1050:.
1046:.
1027:.
1007:}}
1003:{{
991:.
981:.
971:88
969:.
965:.
946:.
920:.
910:.
881:.
871:.
839:.
817:.
809:.
797:.
772:.
749:.
737:.
714:.
706:.
694:12
692:.
688:.
662:.
639:.
631:.
619:26
617:.
613:.
590:.
576:.
572:.
553:.
515:.
503:.
477:.
448:.
426:,
416:17
414:,
391:.
377:.
373:.
354:.
317:^
303:.
293:21
291:.
279:^
224:.
129:.
35:.
27:,
1123:.
1109::
1082:.
1058::
1013:)
999:.
977::
928:.
889:.
850:.
825:.
805::
782:.
757:.
745::
722:.
700::
673:.
647:.
625::
598:.
584::
557:.
523:.
511::
488:.
459:.
422::
399:.
385::
358:.
339:.
311:.
299::
Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.