Part ONE Introduction
1 of Health and Health Policy
Introduction
Determinants of Health: A Biopsychosocial Perspective
Biological Factors
Psychological Factors
Social Factors
Biopsychosocial Dynamics
A Biopsychosocial Approach to Health
Approaches to Health Policy
Stage One: Disease and Health Care
Stage Two: Escalating Costs
Stage Three: A New Concept of Health
Stage Four: A New Framework for Health Policy
Stage Five: Costs and Benefits of Health Policy
International Policy Efforts
Implications for Health and Health Care Policy in the United States
Highlights
References
Part TWO National Health and Mental Health Policy in the United States
2 The Failure to Enact National Health Insurance: 1865-1946
Early Efforts to Reform National Health and Mental Health Care: 1865-1912
The Beginnings of Social Work and Public Health
The Need for Public Health Services
The Mental Hygiene Movement
Compulsory Health Insurance Efforts: 1912-1920
American Association for Labor Legislation
Establishment of the U.S. Public Health Service
Federal-State Reforms and Private Insurance: 1920-1932
Sheppard-Towner Infancy and Maternity Bill
The Creation of Blue Cross and Blue Shield and the Veterans Health Administration
The New Deal Reforms: 1932-1940
Maternal and Child Health Services
The Failure to Enact Compulsory Insurance
Federal Health and Mental Health Policy and Services: 1941-1946
Emergency Maternal and Infant Care Program
Public Health Services Act
National Mental Health Act
Hill-Burton Hospital Survey and Construction Act
Highlights
References
3 Emergence of Employment-Based Insurance and Managed Care: 1943 to the Present
Political Opposition to National Health Insurance: 1943-1950
The Defeat of National Health Care Legislation: 1943-1949
The Enactment of Medicare: 1950-1965
Health Care Inflation and Strategies for Reform: 1970-1988
Renewed Struggle for National Health Insurance
The Rise of HMOs
Regulatory Reform
Diagnosis-Related Groups
The Creation and Role of Community Mental Health Centers: 1963-1992
Mental Retardation and Community Mental Health Centers Construction Act
Medicaid's Role in Deinstitutionalization
Alcohol and Drug Abuse Services
Consumer Protection Efforts: Patients' Rights
Community Support Program
The Decline of Community Mental Health: 1980-1992
State Comprehensive Mental Health Services Plan Act
Stewart B. McKinney Homeless Assistance Act
The Rise and Fall of the Health Security Act: 1988-1996
Proposals for a Single-Payer Plan
Clinton's Proposal: The Health Security Act of 1993
Mental Health Parity
Why the Act Failed
Political Weakness of Reformers
Strong Opposition
Public Ambivalence and Confusion
The Aftermath of the Health Security Act: 1995-2003
Health Insurance Portability and Accountability Act
State Children's Health Insurance Program
Mental Health Parity Act
Reforming the Veterans Health Administration
Efforts to Renew Public Health
Reform during the Bush Years
Public Health Concerns after September 11, 2001
Bioterrorism
Spread of Infectious Disease
The President's New Freedom Commission on Mental Health
Medicare Prescription Drug, Improvement, and Modernization Act of 2003
Prescription Drug Coverage
Health Savings Accounts
Health Care in the 2004 Election
United States Health Care Costs in International Perspective
Quality of Health Care in the United States
Highlights
References
Part THREE The U.S. Health Care System Today
4 Access to Care
The Need for Access
What Is Access?
Why Is Access Important?
Trends in Coverage and Reasons for Concern
Health Insurance Coverage in the United States
Declining Coverage
Rising Costs
Jobs without Coverage
Changing Work Force
Reductions in Coverage
The Uninsured Population in the United States
Uninsured Workers
Regional and State Differences
Age
Race and Ethnicity
Latinas/os
African Americans
Asian Americans
Native Hawaiians and Pacific Islanders
Native Americans
Health Insurance and Utilization of Services
Differences in Access among the Insured and Uninsured
Use Patterns by People of Color
U.S. Indian Health Service
Community Benefits: The Free-Care Safety Net
Improving Access to Health Care
Principles of Access
Expanding Coverage
Highlights
Websites to Obtain Updated and Additional Information
References
5 The Growth and Development of Managed Care
The Health Maintenance Act of 1973
From HMOs to Managed Care
From Managed Care to Managed Competition
Managed-Care Backlash
Managed Care and Medicare
Medicare 1 Choice
Medicare Advantage
Managed Care and Medicaid
Balanced Budget Act of 1997
State Medicaid Managed-Care Plans
Managed Behavioral Health Care
Health Care Plans
Carve-Out Plans
Cost Control
Parity
Clinical Practice
The Future of Managed Care
Highlights
Websites to Obtain Updated and Additional Information
References
6 Medicare and Medicaid
Medicare
Benefits and Financing
Hospital Insurance (Part A)
Medical Insurance (Part B)
Medicare Advantage (Part C)
Medicare Prescription Drugs (Part D)
Gaps in Coverage and Cost Sharing
Medicare Benefit Payments
Beneficiaries
Older Adults
Adults with Disabilities
Women
Managed Care and Medicare
Future of Medicare
Medicaid
Benefits and Financing
Mandatory and Optional Benefits
Mandatory and Optional Eligibility
Medicaid Benefit Payments
Recipients
Poor and Low-Income Pregnant Women, Children, and Families
State Children's Health Insurance Program (S-CHIP)
Personal Responsibility and Work Opportunity Reconciliation Act of 1996
Poor and Low-Income Children and Adults with Disabilities
SSI and Children
S-CHIP Today
SSI and Adults
Medically Needy
Poor and Low-Income Older Adults (Medicare and Medicaid Dual Eligibles)
Managed Care and Medicaid
Highlights
Websites to Obtain Updated and Additional Information
References
Part FOUR At-Risk and Underserved Populations
7 in Health: People of Color
Defining Risk
Measuring Health Disparities
Demography
Morbidity
Mortality
Life Expectancy
Epidemiology
Health Targets
African Americans
Life Expectancy and Infant Mortality
HIV/AIDS
Cancer and Cardiovascular Disease
Cancer
Cardiovascular Disease
Diabetes
Unintentional Injuries: Neighborhood Violence
Latinas/os (Hispanics)
Life Expectancy and Infant Mortality
Diabetes
HIV/AIDS
Asian Americans and Pacific Islanders
Life Expectancy
Cancer and Cardiovascular Disease
Diabetes
Native Americans
Chronic Diseases and Infant Mortality
Alcoholism and Alcohol-Related Mental Health Problems
Environmental Health Risks
Cancer
Racial Differences in the Delivery of Medical Care
Infant and Child Health
Heart Disease and Stroke
Cancer
Diabetes
HIV/AIDS
Highlights
Websites to Obtain Updated and Additional Information
References
8 Disparities in Health: Gender and Age-Based Differences
Women and Infants
Cancer and Cardiovascular Disease
HIV/AIDS
Maternal and Infant Mortality
Maternal, Prenatal, and Child Health Services
Family Planning Services
Violence against Women
Depression
Women in Medical Research
Children and Adolescents
Infectious Diseases
Risky Behaviors: Substance Abuse
Youth Smoking
Youth Drinking
Youth Drug Abuse
Child Abuse and Neglect
Exposure to Violence
Older Adults
Long-Term Care
Elder Abuse
Older Adults in Medical Research
Highlights
Websites to Obtain Updated and Additional Information
References
Part FIVE New Directions for Health and Health Policy
9 Beyond Health Care
What Determines Good Health?
Inequality and Health
Absolute versus Relative Poverty
Inequality and Mortality
Explaining the Health Gradient
Psychosocial Variables
Social Cohesion
Childhood Development
Material Conditions
Conclusion
Implications for Change
Highlights
References
Glossary
Index
