Bodenheimer Thomas - Understanding health policy: a clinical approach

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Understanding Health Policy: A Clinical Approach is a book about health policy as well as about individual patients and caregivers and how they interact with each other and with the overall health system. We, the authors, are practicing primary care physiciansone in a public hospital and clinic and the other, for many years, in a private practice. We are also analysts of our nations health care system. In one sense, these two sides of our lives seem quite separate. When treating a patients illness, it seems that health expenditures as a percentage of gross domestic product or variations in surgical rates between one city and another seem remote if not irrelevantbut they are neither remote nor irrelevant. Health policy affects the patients we see on a daily basis. Managed care referral patterns determine to which specialist we can send a patient, the coverage gaps for outpatient medications in the Medicare benefit package affects how we prescribe medications for our elderly patients, and differences in access to care between families on Medicaid and those with private coverage influences which patients ended up seeing one of us (in the private sector) and which the other (in a public setting). In Understanding Health Policy, we hope to bridge the gap separating the microworld of individual patient visits and the macrouniverse of health policy.

The book is primarily written for health science studentsmedical, nursing, nurse practitioner, physician assistant, pharmacy, social work, public health, and otherswho will benefit from understanding the complex environment in which they will work. Physicians feature prominently in the text, but in the actual world of clinical medicine, patients encounters with other health care givers are an essential part of their health care experience. Physicians would be unable to function without the many other members of the health care team. Patients seldom appreciate the contributions made to their well-being by public health personnel, research scientists, educators, and many other health-related professionals. We hope that the many nonphysician members of the clinical care, public health, and health science education teams as well as students aspiring to join these teams will find the book useful. Nothing can be accomplished without the combined efforts of everyone working in the health care field.

Understanding Health Policy attempts to explain how the health care system works. We focus on basic principles of health policy in hopes that the reader will come away with a clearer, more systematic way of thinking about health care in the United States, its problems, and the alternatives for managing these problems. Most of the principles also apply to understanding health care systems in other nations.

Given the publics concerns about health care in the United States, the book concentrates on the failures of the system. We spend less time on the successful features because they need less attention. Only by recognizing the difficulties of the system can we begin to fix its problems. The goal of this book, then, is to help all of us understand the health care system so that we can better work in the system and change what needs to be changed.