Our Unsystematic Healthcare System presents readers with a comprehensive overview of the U.S. healthcare system with an emphasis on change. It opens with a comparison of U.S. life expectancy and national expenditures with those of other economically advanced countries. The chapters that follow outline the different sectors of the healthcare system including public health, physician and hospital networks, private and public health insurance plans, and the pharmaceutical industry. The book’s conclusion considers forces outside of the healthcare system that play a role in determining Americans’ health status and longevity. Our Unsystematic Healthcare System is the ideal book for introducing readers to the basics of the complex U.S. healthcare system in an accessible way.
New to this Edition:
Grace Budrys is Professor Emerita of Sociology at DePaul University in Chicago. She is the author of numerous books, including Market-Based Health Care: All Myth, No Reality, Unequal Health: How Inequality Contributes to Health or Illness, Third Edition, and How Nonprofits Work. In addition to teaching, she chaired the Department of Public Services and the Masters of Public Health programs at DePaul University.
2 Public Health
Public Health and Controversy
Public Health Origins and Development
State and Local Public Health Agencies
Non-Governmental Public Health
Public Health Accomplishments
Efficacy of the COVID Vaccine
A Recent Special Case
Another Recent Case
3 Private Health Insurance
Origins of Private Health Insurance
From a Community Rate to Risk Rating
From Prepaid Care to Health Maintenance
The Affordable Care Act
The Individual Mandate
The Employed Mandate
Health Insurance and Prices
Legislation Aimed at Health System Reform
4 Health Insurance – Public Programs
Origins of Medicare and Medicaid
Part C – Medicare Advantage Plans
Medicare Advantage Business Operations
The ACA and Reform
Public Opinion and Medicaid
Medicaid and Managed Care
State Child Health Insurance Program
Continuing Policy Debates
5 Health Care Occupations
The Medical Profession
The Medical Education System
The Organization of Medical Practice
How Physicians Get Paid
Medical Error and Malpractice
Technicians and Technologists
Administrators and Other Administrative Workers
6 Hospital and Other Healthcare Organizations
A Brief History of the Modern Hospital
Growth and Development
Rising Costs of Care
The Shorter Length of Stay
Hospitals and Quality of Care
Growth of the For-Profit Hospital Sector
Consolidation of Nonprofit Hospitals
Differences by Hospital Ownership
Other Healthcare Organizations
Initiatives Aimed at Reducing Costs
Steps Involved in Creating a Drug
Pharmacy Benefit Managers
Getting Drugs to Market Sooner
Pharmaceutical Companies and the COVID-19 Vaccine
Why Drugs Are So Expensive
Where Things Stand in Trying to Control Costs
8 Healthcare Systems in Other Countries
More On International Comparisons
Some Final Observations
9 Determinants of Health
Education and Inequality
Deaths of Despair
Health Disparities and Race
Social Support Networks
Upstream Versus Downstream Intervention
This fifth edition of Our Unsystematic Healthcare System explores important debates and offers a comprehensive synopsis of health care delivery in the US. Chapter 1 begins by posing questions about life expectancy and health care costs in the US compared to other countries. Similar to the fourth edition, this edition explores the Affordable Care Act but expands the discussion to include the polarizing public health efforts to prevent the spread of COVID-19 and the political and social turmoil caused by overturning Roe v. Wade (1973) in 2022. In the discourse about health insurance, occupations, and hospital systems, Budrys presents the complexities of reimbursement formulas and the havoc that network consolidation is causing. She warns how consolidation poses a serious threat to American health care arrangements. The fifth edition includes a new chapter on the pharmaceutical industry, which explores why big pharma has become the most reviled arena in health care today. The final chapter ("Determinants of Health") delves into how personal choices regarding diet, exercise, and sleep impact health, examining the WHO’s view that neither behavior nor health care arrangements are responsible for people’s health. Recommended. General readers through faculty; professionals.
Our Unsystematic Healthcare System is a must-read for anyone interested in how the organizational structure of the healthcare system affects the health of the people it is intended to serve. I’ve used this book since I started teaching. It is comprehensive, yet accessible to a wide audience.
Budrys' Our Unsystematic Healthcare System is timely, informative, logical, and strikes a perfect balance between conversational and academic writing. Useful to students, professors, and the broader public, it is my favorite text for medical sociology classes, and it should be required reading for policy makers.
With a writing style that encourages an active learning environment, Budrys offers students from a range of academic backgrounds in-depth exposure to the complexities of the American healthcare system.
Our Unsystematic Healthcare System fills a niche not addressed by other introductory texts about the health care system of the United States. Budrys provides an accessible narrative that illuminates both social and historical influences on the extant system. I have used her texts for 13 years. This book enriches the discussion about our problematic approach to care by offering explanations and carefully integrates the effects of private sector strategies and the context of the social determinants of health.
Budrys once again uses academic storytelling at its finest by weaving together the complex interplay of healthcare stakeholders, social systems, and public policy – while carefully acknowledging the essential context of U.S. history, culture, and values. The fifth edition of Our Unsystematic Healthcare System boasts a new section exploring the story of the U.S. pharmaceutical industry that describes key influences and processes that have resulted in the current problem of high drug prices. As a pharmacy educator, I can attest that it is rare to find a source on this topic with a concise explanation of the interaction between public and private sectors on research/discovery, patents, intermediary organizations, as well as the ethics and influence of marketing and lobbying. Overall, this text is both accessible to novices as well as professionals looking to widen their perspectives on the how’s and why’s of the U.S. healthcare system.
This fifth edition of Our Unsystematic Healthcare System is an outstanding, realistic description and critical analysis of the US and other national healthcare systems. This is an honest, comprehensive, clearly written book, which parts the curtains on the history and contemporary structure of the US healthcare system and its medical, economic, political, and social influences. Excellent textbook for anyone interested in understanding and reforming the US healthcare system.
A succinct, up-to-date, and informative look at our health system. This resource is one that students will find straightforward and easy to consume, which is a big plus, since these topics get complicated with many intersecting and often competing stakeholder interests, systems, and infrastructures needed to make it work. The book is well-written, with straightforward language and a thorough, comprehensive presentation - engaging and informative.
Our Unsystematic Healthcare System fills a niche not addressed by other introductory texts about the health care system of the United States. Budrys provides an accessible narrative that illuminates both social and historical influences on the extant system. This book enriches the discussion about our problematic approach to care by offering explanations.