Description
Health Services Policy and Systems for Therapists Edition 3 by Robert Sandstrom EBOOK PDF Instant Download
Table of Contents
Health Services Policy and Systems for Therapists
Contents
Preface to the Third Edition
Reviewers
1 Public policy and therapists
Chapter Objectives
Key Words
Case Example
Case Example Question:
Introduction
Policy and Power
Sources of Power
Government
Political Process
Private Enterprise
Ethics and Values
Experience of Disablement
Biomedical Model
Social Disability Model
Universalism
Therapists and The Health Care System
Conclusion
Chapter Review Questions
Chapter Discussion Questions
References
2 Access and Cost of Health Care
Chapter Objectives
Key Words
Case Example
Case Example Questions/Discussion:
Introduction
Access to Health Care Services
Availability
Accessibility
Accommodation
Acceptability
Affordability
Access and Health Insurance
Characteristics of the Uninsured
Health Status of the Uninsured
The Working Uninsured
Cost of Health Care Services
Health Care Financing: Where It Comes From
Health Care Financing: Where It Goes
The Growth of Health Care Expenditures
Payment Mechanisms
Access and Cost: A Therapist Perspective
Effects of Direct Access on Therapy Practice
Conclusion
Chapter Review Questions
Chapter Discussion Questions
References
3 Quality of Health Care
Chapter Objectives
Key Words
Case Example
Case Example Question:
Introduction
Perspectives on Health Care Quality
Structure, Process, and Outcomes: Three Dimensions of Quality
Structure
Process
Outcomes
Report Cards
Utilization Review
Accreditation
Joint Commission
Legal Issues and Quality
The Future of Health Care Quality
Conclusion
Chapter Review Questions
Chapter Discussion Questions
References
4 Public Policies Addressing Social Disablement
Chapter Objectives
Key Words
Case Example
Case Example Questions:
Introduction
Public Policies Supporting Youths and older adults
IDEA and Therapy
The Developmental Disabilities Act (DDA)
The DDA and Therapy
The Older Americans Act (OAA)
Work-Related Policy Acts
Case Example
The Rehabilitation Act (RA) and the Workforce Investment Act (WIA)
The Rehabilitation Act, the Workforce Investment Act, and Therapy
Work Incentives Improvement Act of 1999 (P.L. 106–170) and Ticket to Work (TWWIIA) and Self-Sufficiency Program
The Future of Work-Related Public Policies
The Americans with Disabilities Act (ADA)
Therapy and the ADA
Social Security Income Programs
Housing Programs for Persons with Disabilities
Technology and Persons with Disabling Conditions
The Assistive Technology Act of 1998
The Assistive Technology Act of 2004
Therapists and the ATA
Working with Policies Addressing Social Disablement
Conclusion
Chapter Review Questions
Chapter Discussion Questions
References
5 Effecting Policy Change: Therapist as Advocate
Chapter Objectives
Key Words
Case Example
Case Example Questions
Introduction
Research and Literature Related to Advocacy
Advocacy and Ethics
Therapist Skills for Advocacy
Assertive Communication
Patient/Client Advocacy Skills
Professional Level of Advocacy
Advocacy with Professional Organizations
Advocacy with the Health Care Environment
Sequence for Advocacy
Step I: Knowledge
Step II: Research
Step III: Implementing Political Action
A Legislative Visit
Appearing at Hearings and Preparing Testimony
Implementing Political Action on the State Level
Step IV: Critical Thinking/Reflection
Policy Making, Advocacy, and Evidence
Public Policy, Advocacy, and the Social Media
Conclusion
Self-Reflection
Chapter Review Questions
Chapter Discussion Questions
References
6 Fundamentals of Insurance
Chapter Objectives
Key Words
Case Example
Case Example Question:
Introduction
Why Have Health Care Insurance?
Purpose of Insurance
Risk and Insurance
Basics of an Insurance Contract
Eligibility
Covered Events
Covered Services
Cost Limits
Beneficiary Cost Limits
Provider Cost Limits
Coordination of Benefits
Organization and Administration of Health Care Insurance
Actuarial Adjustment and Insurance
Moral Hazard and Insurance
Insurance Markets
Employer- Based Insurance
Individual Insurance
American Health Benefit Exchanges
Regulation of Insurance
State Regulation
Employee Retirement Income Security Act of 1974
Continuation Issues
Conclusion
Chapter Review Questions
Discussion/Case Questions
References
7 Private Insurance and Therapy practice
Chapter Objectives
Key Words
Case Example
Case Example Questions:
Introduction
Managed Care
Defining Managed Care
Managed Care Principles
Payment Mechanisms That Reward Efficiency
Enhanced Quality-Improvement Monitoring
Managed Care Products
Managed Indemnity
Preferred Provider Organizations
Health Maintenance Organizations
Point of Service (POS)
Consumer-Directed Health Plans
Market Shares of Health Plan Types
Managed Care Provider Structures
Staff model
Group Model
Network Model
Independent Practice Associations
Other Forms of Private Insurance
Long-Term-Care Insurance
Workers’ Compensation Insurance
Casualty Insurance
Working with Insurance Companies: Importance of Good Communication
Conclusion
Chapter Review Questions
Chapter Discussion Questions
References
8 Medicare
Chapter Objectives
Key Words
Case Example
Case Example Question:
Introduction
History of Medicare
Scope and Organization of Medicare
Medicare Eligibility
Part A Eligibility
Part B Eligibility
Original Medicare Part A: Hospital Insurance
Benefits
Benefit Period
8-1 Case Example 8-1?Medicare Part A Benefit Period
Part A Payment Structures
Acute and Long-Term Care Hospital Benefit
Hospital Prospective Payment
Skilled Nursing Facility Benefit
Minimum Data Set (MDS)
Other Medicare Required Assessments (OMRA)
Skilled Nursing Facility Prospective Payment
Home Health Care Benefit
Hospice Benefit
Home Health Agency Prospective Payment
Inpatient Rehabilitation Facility Benefit
Inpatient Rehabilitation Facility Prospective Payment
Case Example of a Part A Prospective Payment System Calculation
Part B: Supplementary Medical Insurance (SMI)
Benefits
Provider Types
Outpatient Hospital Programs
Comprehensive Outpatient Rehabilitation Facility
Physical Therapists and Occupational Therapists in Private Practice
Part B Payment Structures
Fee Schedule
Financial Limitations on Medicare Part B Therapy Services
Future of Medicare Part B Therapy Reimbursement
Provider Participation
Medicare and Therapy Services
Therapy Documentation
Evaluation/Reevaluation
Progress Reports/Treatment Notes/Discharge Summary
“Incident To” Therapy Procedures
Medicare Managed Care
Medicare Advantage Plans
Medicare Outpatient Prescription Drug Benefit
Private Health Insurance and Medicare
Quality and Medicare
Fraud and Abuse
Medicare Reform
Conclusion
Chapter Review Questions
Chapter Discussion Questions
References
9 Medicaid, Military/Veterans Medical Insurance, and Indian Health Service
Chapter Objectives
Key Words
Case Example
Case Example Question:
Introduction
Medicaid
What Is Medicaid?
Who Receives Medicaid?
Who Is Eligible for Medicaid?
Medicaid Services
Medicaid Managed Care
Veterans Affairs and Military Health Insurance Programs
Veterans Affairs Health System
TRICARE
Indian Health Service
Conclusion
Chapter Review Questions
Chapter Discussion Questions
References
10 The Acute Medical Care System
Chapter Objectives
Key Words
Case Example
Case Example Questions:
Introduction
Hospitals
Historical Development
Hospital Structure
Hospital Characteristics
Size
Ownership
General vs. Specialty
Acute Care vs. Long-Term Care
Teaching Hospitals
Safety-Net Hospitals
Multihospital Systems and Networks
Professionals Working in Hospitals
Levels of Acute Care
Primary Care
Therapists Working in Primary Care
Secondary Care
Tertiary and Quartenary Care
Hospital Integration
Physician-Hospital Relationships
Accountable Care Organizations and Patient-Centered Medical Homes
Conclusion
Chapter Review Questions
Chapter Discussion Questions
References
11 The Post-Acute Health Care System
Chapter Objectives
Key Words
Case Example
Case Example Question:
Introduction
Informal Care
What Is Informal Care?
Who Receives Informal Care?
Who Provides Informal Care?
How Important Is Informal Care to the Health Care System?
Formal Care
Nonresidential Formal Care
Home Health Care
What Is Home Health Care?
Who Receives Home Health Care?
Who Provides Home Health Care?
What Services Are Provided in Home Health Care?
Hospice
Adult Day Services
Residential Formal Care
Assisted Living
Skilled Nursing Facilities
Subacute Care
Inpatient Rehabilitation Facilities
Conclusion
Chapter Review Questions
Chapter Discussion Questions
References
12 Special Education and Mental Health Systems
Chapter Objectives
Key Words
Case Example
Case Example Question:
Introduction
Special Education
Individualized Education Program (IEP)
Team Communication Case Example
Related Services in the School Setting
Early Intervention Services
Special Considerations in School-Based and Early Intervention Practice
Mental Health
Mental Health Policy
Mental Health Practice Settings
Traditional
Community-Based
Children’s Mental Health
Role of Occupational Therapy
Future Implications for Health Care Professionals
Conclusion
Chapter Review Questions
Discussion Questions
References
13 Global and Population Health
Chapter Objectives
Key Words
Case Example
Case Example Question:
Introduction
An Overview of Five Countries’ Health Care Systems
Canada
United Kingdom
Germany
France
United States
Comparing Performance of Health Care Systems
Access and Level of Expenditures
Quality
Efficiency
Satisfaction
A Public Health and Population Health Perspective
The Importance of Population Health in Improving Health
Conclusion
Chapter Review Questions
Chapter Discussion Questions
References
Appendix A Resources on Policies Addressing Social Disablement
General Resources
Americans with Disabilities Act (ADA)
Assistive Technology Act (ATA)
Developmental Disability Act (DDA)
Fair Housing Act (FHA)
Individuals with Disabilities Education Improvement Act (IDEA)
Appendix B Advocacy Resources
General Internet Sites Related to Health Care Public Policy
Government Public Policy Resources and Bill Language
Professional Organizations with Public Policy Resources
National Organizations for Disease and Disability Conditions
Glossary
