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Index
Part I: The Nature of the Beast
Chapter 1. Introduction
Chapter 2. Are We Getting What We’re Paying For?
Life Expectancy
Our Chances of Dying
Does Healthcare Even Make a Difference?
But at Least We Don’t Have to Wait for Care...!
What’s Left?
Chapter 3. Where Does All Our Money Go?
Exactly What Are We Buying?
Hospital Care
Pharmaceuticals
Outpatient Care
Chapter 4. Into Thin Air
How Much Is That Surgery in the Window?
Paying More for Less
Is Change Allowed?
Chapter 5. The Healthcare Machine
Millions of Moving Parts
Chapter 6. How and Why They Spin: Inside Key Wheels
Doctors and Other Healthcare Providers
Physician Economics and Motivation
Health Insurers
Private Insurers
Private Insurance Economics and Motivation
Self-Insured Businesses
Public Insurers
Government
How Government Works with Respect to Healthcare
Regulators and Providers: Friend or Foe?
Government As a Growth Industry Within the Healthcare System
Patients
Economic Behavior
Patient Economic Behavior As a Way to Control Resource Utilization
Part II: Why the Machine Is Breaking Down
Chapter 7. Too Many Parts
Why So Many Parts?
Thousands of Insurers
Medical Licensure
Professional Credentialing
Gilding the Lily: The Multi-Billion Dollar Certification Industry
Chapter 8. Sand in the Gears
Pricing and Billing for Medical Services
How American Clinicians Get Paid
From Theory to Practice—the Failure of RBRVS
Regulatory True Grit
Quality Improvement
Medical Malpractice Liability
What Is the Current System Trying to Accomplish?
Medical Malpractice Liability—The Existing System
Defensive Medicine
Chapter 9. Friction
Unique Patient Identifiers
Medical Recordkeeping and Transaction Processing
Paper-Based Healthcare Information Systems
Electronic Healthcare Information Systems
Paper Versus Computers—The Evidence to Date
Electronic Healthcare Information Technology: Friction or Grit?
Part III: How to Fix It
Chapter 10. Defining the Desired Outcome
Presumptive Goals: An Efficient, Effective, Fair, and Sustainable Healthcare System
Structural Requirement #1—Universal Healthcare Coverage
Structural Requirement #2—Retention of a Private Market for Additional Healthcare Services
Structural Requirement #3—Providers Must Be Able to Price Their Services Freely
Structural Requirement #4—The Price of All Healthcare Goods and Services Must Be Transparent, Fully Disclosed, and Easily Available
Structural Requirement #5—The System Must Ration Healthcare Overtly, Rather Than Covertly
Chapter 11. Overhauling Payment for Healthcare Goods and Services
Essential Elements of an Efficient Health Insurance Plan
Using Universal Coverage to Generate Efficiencies in Financing
Too Many Gears
Simplifying and Retooling Payment for Medical Services
Simplifying Provider Payment Based Upon Well-Established Market Principles
Minimizing Insurance and Regulatory Overhead
Application of Market Principles to Other Healthcare Goods and Services
Putting It All Together: Streamlined Healthcare Financing and Payment
Chapter 12. Dumping Redundancy
Credentialing Made Easy
The Financial Benefits of Eliminating Redundancy
Medical Licensure and Credentialing
Unique Patient Identifiers
Chapter 13. Blowing Sand Out of the System
The Role of Government in Healthcare
Government Regulation: The Quest for Quality
Quantifying Cost and Benefit
Government Regulation: Forestalling “Fraud and Abuse”
Addressing Medical Malpractice and Defensive Medicine
Reducing Errors Versus Reducing Harm Versus Reducing Claims
Reducing Unwarranted Medical Malpractice Claims
Resolving the Malpractice Claims That Do Occur
The Financial Impact of “Grit Reduction”
Chapter 14. Lubricating Points of Friction
Understanding the Role of Transactions and Information in the Healthcare Industry
Primary Sources of Friction in Healthcare Transaction Processing
Rationally Applying Healthcare Information Technologies
What Are We Trying to Accomplish?
Paying Attention to What’s Important
The Financial Impact of Realistic HIT Deployment
Chapter 15. Where Does the Money Come From?
Healthcare Providers
Private Health Insurers
Pharmaceutical Manufacturers
Administrative Staff and Intermediaries
HIT Vendors
Government
Chapter 16. The End of an Era
Appendix A. “Brief Strategy B” from the Federal Guidelines Regarding Smokers Who Report That They Are Unwilling to Quit
References
Index
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