2/5/23,M10:31MP Ovid:MJonas'MIntroductionMtoMtheMU.S.MHealthMCareMSy
M stem
Test Bank For M M
Jonas' Introduction to the U.S. He
M M M M M
alth Care System, 9th Edition
M M M M
Goldsteen, Raymond L.; GoldsteM M M
en, Karen; Goldsteen, Benjamin
M M M
MZ
Authors:M Goldsteen,MRaymondML.;MGoldsteen,MKaren;MGoldsteen,MBenjaminMZ.M
Title:M Jonas'MIntroductionMtoMtheMU.S.MHealthMCareMSystem,M9thMEdition
Copyright M©2021MSpringer MPublishing
>MTableMof MContentsM>MIM-MU.S.MHealthMCareMSystem:MPresentMStateM>M2M-MTheMSettingsMforMHealthMCareMDelivery
2
The Settings for Health Care Delivery
M M M M M
©MArtizans MEntertainmentMInc.MByMHarley Mschwadron.
LEARNINGMOBJECTIVES
After McompletingMthisMchapter,Mstudents MwillMbeMableMto:
DifferentiateMamongMambulatoryMcare,MinpatientMacuteMcare,MandMpostacuteMcar
e.MIdentifyMtheMmajor MambulatoryMcareMsettings MandMtheirMrelativeMsize.
ContrastMtheMkinds MofMhealthMproblems MtreatedMinMhospitals MtoMthoseMcaredMforMinMambulatoryMsettings.M
DescribeMtheMhistoryMofMhospitals MandMidentifyMtheMcharacteristicsMusedMtoMclassifyMthemMtoday.
DescribeMtheMfiveMtypes MofMlong-termMcareMandMtheirMroles MinMtheMhealthMcareMsystem.
Mhealth
INTRODUCTION Mcare M
HealthMcareMisMdeliveredMinMaMvariety MofMsettings,MwhichMareMgenerallyMdistinguishedMasMinpatientMorMambulatory.MInpatient MsettingsMincludeMgene deliver
ralMandMspecialtyMshort-termMhospitals;Mlong- y,Msuch
termMcareMfacilities,MsuchMasMnursingMhomes MandMskilledMnursingMfacilities;MandMothers.MAmbulatory Msettings MincludeMambulatory MsurgeryMcentersM( Mas Ma M
ASCs),MmedicalMgroupMpractices, workpl
aceMor
community MhealthMcenters M(CHCs),MdialysisMcenters,MurgentMcareMcenters,MretailMclinics,MimagingMcenters,MsleepMcenters,Mcatheterization Mlabs,Mvas Mschool
cular Maccess Mcenters,MandMtelemedicineMproviders M(JointMCommission,M2018).MHealthMcareMprovidedMinMsettings MthatMareMnotMprimarilyMmeantMfor Mclinics
https://ovidsp-dc2-ovid-com.proxy.library.nyu.edu/ovid-b/ovidweb.cgi 1/38
,2/5/23,M10:31MP Ovid:MJonas'MIntroductionMtoMtheMU.S.MHealthMCareMSy
M ,MisMalsoMconsideredMambulatory.MAMwideMrangeMofMhealthMstem
careMservices MareMalsoMdeliveredMinMtheMhome,MwhichMisMusually MlessMexpensiveMandMm
oreMconvenientMforMtheMpatientMthanMtheMcareMprovidedMinMaMhospitalMorMskilledMnursingMfacilityM(CentersMforMMedicare M&MMedicaidMServices M[CM
S],M2020).MThisMchapter Mfocuses MonMtheMsettingsMinMwhichMhealthMservices MareMdeliveredMbyMhealthMprofessionals MinMdedicatedMfacilitiesMsuchMasM
hospitals,Mlong-termMcareMfacilities,MphysicianMoffices,Mclinics,MandMotherMfacilities,MasMdefinedMbyMtheMJointMCommission.
InMaMthemeMthatMwillMbeMrepeatedMthroughout MthisMbook,MthereMareMnoMdefinitiveM(orMabsolute)Mdefinitions MforMmanyMelementsMofMtheMU.S.Mhealt
P.34
hMcareMsystem,MbutMrather ManMinterconnectedMwebMofMdefinitionsMdevelopedMbyMstakeholdersMrangingMfromMtheMfederal,Mstate,MandMlocalMgovern
mentMagenciesMtoMtheMprivateMfor-
profitMandMnonprofitMsectors,MincludingMnongovernmental MorganizationsM(NGOs),MindependentMaccreditingMorganizations,MandMhealthMcareMpayers.M
For Mexample,MtheMCMS,MaMfederalMagency MthatMadministers MtheMMedicareMprogram,MhasMaMspecificMpaymentMmodelMfor M“short-
termMacuteMhospitals”,MtheMbulkMofMwhichMareMprivatelyMownedMandMlicensedMbyMeachMstateMandMaccreditedMbyMorganizations MsuchMasMtheMJointM
Commission.
WhatMconstitutes MaMhospital—and,Mtherefore,MgetsMtheMblueM“H”MsignMalongMtheMroadMthatMguides MthoseMinMneedMtoMsuchMaMfacility—
andMwhatMrequirements MitMmustMmeetMvary MfromMstateMtoMstate.MForMexample,MinMNewMYork,MhospitalsMareMdefinedMandMregulatedMinMtheMPublicM
HealthMLawMasMArticleM28Mfacilities,MwhileMCaliforniaMdefines Mhospitals MinMTitleM22,MDivisionM5,MinMitsMCodeMofMRegulations.MThus,MtheMrequiremen
tsMforMbeingMaMhospitalMandMwhatMservices McanMorMcannotMbeMperformedMinMaMhospitalMdifferMbyMstate,MwithMsomeMcommonality MdueMtoMparticipa
tionMinMfederalMgovernmentMprograms MsuchMasMMedicareMandMMedicaidM(whichMwillMbeMdiscussedMfurtherMinMChapter M6,MFinancingMtheMHealthMCar
eMSystem).
AlthoughMtheMdetailsMandMtheMavailabilityMofMservicesMandMfacilitiesMdeviateMthroughout MtheMhealthMcareMsystem,MtheMsystemMisMrichMwithMdelivery
Msettings MandMtypesMofMproviders. MThe MCMS Mdefines M13Mdifferent Mmajor Mprovider Mtypes M(those Mwith MdistinctMpayment Mmodels MorMrate Mschedules),
Mover M50Mdistinct M“placesMofMservice,”Mover M100Mprovider/supplier Mtypes,MandM overM500Mprovider MtaxonomiesM(CMS,M 2019;MData.CMS.gov, M2019).M
OneMwayMtoMvisualizeMtheMarrayMofMsettings MforMhealthMcareMisMdisplayedMinMFigureM2.1,MwhichMincludes:
Community-basedM care
Self-care
AmbulatoryMcare
Hospitals M(inpatientMacuteMcare)
PostacuteM care
Long-termMcare:MadultMdayMcare,MhomeMhealthMcare,Mhospice,MskilledMnursingMfacilities,MandMresidentialMcareMfacilities
https://ovidsp-dc2-ovid-com.proxy.library.nyu.edu/ovid-b/ovidweb.cgi 2/38
,2/5/23,M10:31MP Ovid:MJonas'MIntroductionMtoMtheMU.S.MHealthMCareMSy
M stem
AmbulatoryMrehabilitationMcenters
Long-termMacuteMcareMandMother Mspecialty Mhospitals
VerticalMandMHorizontalMIntegrationMinMHealthMCare
AnMimportantMdevelopmentMinMtheMU.S.MhealthMcareMsystemMisMtheMverticalMandMhorizontalMintegrationMacrossMtheMspectrumMofMcare:Mcommunity-
basedMcare,MinpatientMacuteMcare,MandMpostacuteMcare.MTheMtrendMtowardMhorizontal MconsolidationMwasMnotedMwhenMhospitalsMbeganMtoMmergeMi
nMtheM1990s M(Cuellar M&MGertler,M2003).MTheMintegratedMsystems MthatMhaveMemerged
P.35
sinceMtheM2000s MareMbothMhorizontalMandMverticalMandMmayMcontainMmultipleMhospitals,Mclinics,Mlong-
termMcareMfacilities,MphysicianMpractices,MhomeMhealthMcareMorganizations,MandMhospices.MRevCycleMIntelligence,MaMtradeMpublication,Mreports Mon
MthisMtrendMas Mfollows:
AsMvalue-
basedMreimbursementMputs Mfinancial MpressureMonMproviders,MhealthMcareMorganizations MareMstrivingMforMefficiency,McostMcont
rol,MandMsustainability.MAnMincreasingly Mpopular MstrategyMtoMfulfillMallMtheseMgoals MisMtoMengageMinMhospitalMmerger MandMacq
uisitionM(M&A)Mactivity.MHospitalMmergers MandMacquisitionsMareMincreasingMatMaMrapidMrate.MHealthMcareMorganizations Mannou
ncedM115Mmerger MandMacquisition Mtransactions MinM2017,MtheMhighestMnumber MinMrecentMhistory.M2018MisMlikelyMtoMmeetMorMev
enMexceedMtheMnumber MofMhospitalMmerger MandMacquisitionMdeals MmadeMinM2017,MhealthMcareMexperts Mpredict.MRecentMdata
MfromMconsultingMfirmMKaufman MHallMshows Mthat Morganizations Malready MannouncedM50Mtransactions MinMtheMfirstMhalfMofM2018
.M(LaPointe,M2019).MSeeMFigureM2.2.
InMthisMchapter,MweMdiscuss MeachMofMtheMsettingsMforMhealthMcareMdeliveryMinMtheMU.S.MhealthMsystem,MbeginningMwithMcommunity-
basedMcareMandMendingMwithMpostacuteMcare.
FIGUREM2.1MSettings MforMhealthMcareMdeliveryMinMtheMUnitedMStates.MSource:MTheMSg2MSystemMofMCARE™M(ClinicalMAlignmentMandM
ResourceMEffectiveness)MillustratesMtheMalignmentMofMhealthMservices MfromMtheMpatient's MperspectiveMacrossMtheMcareMcontinuum,M
andMoftenMacross Mgeographically MdispersedMsites MofMcare.M(One-
timeMpermissionMtoMreproduceMgrantedMbyMSg2,M2019/10/17).MRetrievedMfromMhttps://newsroom.vizientinc.com/vizient-
blog/clinical-performance/health-systems-find-large-opportunity-microhospitals
COMMUNITY-BASEDM CARE
Self-Care
AlthoughMtheMhospitalMmayMbeMseenMasMtheMflagshipMofMtheMhealthMcareMsystem— P.36
itMisMtheMlargestMsingleMcategoryMofMNationalMHealthMExpenditures MandMtheMsettingMforMmanyMtelevisionMshows—
theMvastMmajorityMofMpeopleMwillMnotMreceive MinpatientMacuteMcareMinManyMgivenMyear.
OutsideMofMpeopleMwhoMareMunexpectedly Mincapacitated,MtheMfirstMhealthMcareMdecisionMpeopleMmakeMisMwhether MtoMaccess MtheMdeliveryMsystem
,MatMall,MandManMestimatedM80%MtoM95%MofMhealthMproblems MareMnever MbroughtMforwardMtoMaMphysicianMorMotherwiseMinvolveMprofessionalMmedical
Mcare. MFrequently, Mailments MperceivedMtoMbeMminor Mare Meither MaddressedMwith Ma M“take-no-action,”M“wait-and-see,”M or Mself-
medicationMapproach.MFevers,Mheadaches,MandMindigestionMareMamongMtheMmostMcommonMailmentsMtreatedMwithMnonprescription MorM“over-the-
counter”M(OTC)Mmedicines M(Dean,M1981).MLevinMandMIdler M(1983)MprovideMaMconsensus MdefinitionMofMself-careMasMfollows:M“Self-
careM… MrefersMtoMthoseMactivities Mindividuals MundertakeMinMpromotingMtheirMownMhealth,MpreventingMtheirMownMdisease,MlimitingMtheirMownMillnes
s,MandMrestoringMtheirMownMhealth.MTheseMactivitiesMareMundertakenMwithoutMprofessional Massistance,MalthoughMindividuals MareMinformedMbyMtech
nicalMknowledgeMandMskillsMderivedMfromMtheMpoolMofMbothMprofessionalMandMlayMexperienceM….MTheMgenericMattribute MofMself-
careMisMitsMnonprofessional,Mnonbureaucratic, MnonindustrialMcharacter”M(LevinM&MIdler,M1983,Mp.M181).MAfterMselfdiagnosisMandMpossiblyMadviceMfr
omMfriends MandMfamily,ManMindividualMmayMdecideMtoMbecomeMaMpatientMandMenterMtheMhealthMcareMsystem.
FIGUREM2.2MHospitalMandMhealthMsystemMmerger MandMacquisitionMactivity,M2000MtoM2017.MSource:MDataMfromMKaufman,MHall,MandMAssociates
.M(2018).M2017MinMreview:MTheMyearMM&AMshookMtheMhealthcareMlandscape.MRetrievedMfromMhttps://www.kaufmanhall.com/sites/default/fil
es/legacy_files/kh_report-ma-year-in-review_d4-rebrand.pdf
AmbulatoryMCare
Ambulatory McareMrefers MtoMmedicalMservices MperformedMwithoutMadmissionMtoMaMhospitalMorMotherMhealthMcareMfacilityMforManMovernightMstay.MAm
bulatory McareMisMprovidedMinMmanyMsettings,MbutMweMbeginMwithMaMbriefMdescriptionMofMthoseMwhereMmostMambulatory MvisitsMareMprovided:Mphysi
cianMoffices,MemergencyMdepartmentsM(EDs),MandMhospitalMoutpatientMclinics.MInM2016,MtheseMvisitsMnumberedM883,725Mmillion,M145,591Mmillion,Ma
ndM125,721Mmillion,Mrespectively M(National MCenterMforMHealthMStatisticsM[NCHS],M2011;MRui,MKang,M&MAshman,M2016;MRui M&MOkeyode,M2016).MAfte
rward,MweMdescribeMsomeMsmaller Mvolume,MestablishedMambulatory McareMsettings:
https://ovidsp-dc2-ovid-com.proxy.library.nyu.edu/ovid-b/ovidweb.cgi 3/38
, 2/5/23,M10:31MP Ovid:MJonas'MIntroductionMtoMtheMU.S.MHealthMCareMSy
M stem
PublicMhealthMclinics
https://ovidsp-dc2-ovid-com.proxy.library.nyu.edu/ovid-b/ovidweb.cgi 4/38
M stem
Test Bank For M M
Jonas' Introduction to the U.S. He
M M M M M
alth Care System, 9th Edition
M M M M
Goldsteen, Raymond L.; GoldsteM M M
en, Karen; Goldsteen, Benjamin
M M M
MZ
Authors:M Goldsteen,MRaymondML.;MGoldsteen,MKaren;MGoldsteen,MBenjaminMZ.M
Title:M Jonas'MIntroductionMtoMtheMU.S.MHealthMCareMSystem,M9thMEdition
Copyright M©2021MSpringer MPublishing
>MTableMof MContentsM>MIM-MU.S.MHealthMCareMSystem:MPresentMStateM>M2M-MTheMSettingsMforMHealthMCareMDelivery
2
The Settings for Health Care Delivery
M M M M M
©MArtizans MEntertainmentMInc.MByMHarley Mschwadron.
LEARNINGMOBJECTIVES
After McompletingMthisMchapter,Mstudents MwillMbeMableMto:
DifferentiateMamongMambulatoryMcare,MinpatientMacuteMcare,MandMpostacuteMcar
e.MIdentifyMtheMmajor MambulatoryMcareMsettings MandMtheirMrelativeMsize.
ContrastMtheMkinds MofMhealthMproblems MtreatedMinMhospitals MtoMthoseMcaredMforMinMambulatoryMsettings.M
DescribeMtheMhistoryMofMhospitals MandMidentifyMtheMcharacteristicsMusedMtoMclassifyMthemMtoday.
DescribeMtheMfiveMtypes MofMlong-termMcareMandMtheirMroles MinMtheMhealthMcareMsystem.
Mhealth
INTRODUCTION Mcare M
HealthMcareMisMdeliveredMinMaMvariety MofMsettings,MwhichMareMgenerallyMdistinguishedMasMinpatientMorMambulatory.MInpatient MsettingsMincludeMgene deliver
ralMandMspecialtyMshort-termMhospitals;Mlong- y,Msuch
termMcareMfacilities,MsuchMasMnursingMhomes MandMskilledMnursingMfacilities;MandMothers.MAmbulatory Msettings MincludeMambulatory MsurgeryMcentersM( Mas Ma M
ASCs),MmedicalMgroupMpractices, workpl
aceMor
community MhealthMcenters M(CHCs),MdialysisMcenters,MurgentMcareMcenters,MretailMclinics,MimagingMcenters,MsleepMcenters,Mcatheterization Mlabs,Mvas Mschool
cular Maccess Mcenters,MandMtelemedicineMproviders M(JointMCommission,M2018).MHealthMcareMprovidedMinMsettings MthatMareMnotMprimarilyMmeantMfor Mclinics
https://ovidsp-dc2-ovid-com.proxy.library.nyu.edu/ovid-b/ovidweb.cgi 1/38
,2/5/23,M10:31MP Ovid:MJonas'MIntroductionMtoMtheMU.S.MHealthMCareMSy
M ,MisMalsoMconsideredMambulatory.MAMwideMrangeMofMhealthMstem
careMservices MareMalsoMdeliveredMinMtheMhome,MwhichMisMusually MlessMexpensiveMandMm
oreMconvenientMforMtheMpatientMthanMtheMcareMprovidedMinMaMhospitalMorMskilledMnursingMfacilityM(CentersMforMMedicare M&MMedicaidMServices M[CM
S],M2020).MThisMchapter Mfocuses MonMtheMsettingsMinMwhichMhealthMservices MareMdeliveredMbyMhealthMprofessionals MinMdedicatedMfacilitiesMsuchMasM
hospitals,Mlong-termMcareMfacilities,MphysicianMoffices,Mclinics,MandMotherMfacilities,MasMdefinedMbyMtheMJointMCommission.
InMaMthemeMthatMwillMbeMrepeatedMthroughout MthisMbook,MthereMareMnoMdefinitiveM(orMabsolute)Mdefinitions MforMmanyMelementsMofMtheMU.S.Mhealt
P.34
hMcareMsystem,MbutMrather ManMinterconnectedMwebMofMdefinitionsMdevelopedMbyMstakeholdersMrangingMfromMtheMfederal,Mstate,MandMlocalMgovern
mentMagenciesMtoMtheMprivateMfor-
profitMandMnonprofitMsectors,MincludingMnongovernmental MorganizationsM(NGOs),MindependentMaccreditingMorganizations,MandMhealthMcareMpayers.M
For Mexample,MtheMCMS,MaMfederalMagency MthatMadministers MtheMMedicareMprogram,MhasMaMspecificMpaymentMmodelMfor M“short-
termMacuteMhospitals”,MtheMbulkMofMwhichMareMprivatelyMownedMandMlicensedMbyMeachMstateMandMaccreditedMbyMorganizations MsuchMasMtheMJointM
Commission.
WhatMconstitutes MaMhospital—and,Mtherefore,MgetsMtheMblueM“H”MsignMalongMtheMroadMthatMguides MthoseMinMneedMtoMsuchMaMfacility—
andMwhatMrequirements MitMmustMmeetMvary MfromMstateMtoMstate.MForMexample,MinMNewMYork,MhospitalsMareMdefinedMandMregulatedMinMtheMPublicM
HealthMLawMasMArticleM28Mfacilities,MwhileMCaliforniaMdefines Mhospitals MinMTitleM22,MDivisionM5,MinMitsMCodeMofMRegulations.MThus,MtheMrequiremen
tsMforMbeingMaMhospitalMandMwhatMservices McanMorMcannotMbeMperformedMinMaMhospitalMdifferMbyMstate,MwithMsomeMcommonality MdueMtoMparticipa
tionMinMfederalMgovernmentMprograms MsuchMasMMedicareMandMMedicaidM(whichMwillMbeMdiscussedMfurtherMinMChapter M6,MFinancingMtheMHealthMCar
eMSystem).
AlthoughMtheMdetailsMandMtheMavailabilityMofMservicesMandMfacilitiesMdeviateMthroughout MtheMhealthMcareMsystem,MtheMsystemMisMrichMwithMdelivery
Msettings MandMtypesMofMproviders. MThe MCMS Mdefines M13Mdifferent Mmajor Mprovider Mtypes M(those Mwith MdistinctMpayment Mmodels MorMrate Mschedules),
Mover M50Mdistinct M“placesMofMservice,”Mover M100Mprovider/supplier Mtypes,MandM overM500Mprovider MtaxonomiesM(CMS,M 2019;MData.CMS.gov, M2019).M
OneMwayMtoMvisualizeMtheMarrayMofMsettings MforMhealthMcareMisMdisplayedMinMFigureM2.1,MwhichMincludes:
Community-basedM care
Self-care
AmbulatoryMcare
Hospitals M(inpatientMacuteMcare)
PostacuteM care
Long-termMcare:MadultMdayMcare,MhomeMhealthMcare,Mhospice,MskilledMnursingMfacilities,MandMresidentialMcareMfacilities
https://ovidsp-dc2-ovid-com.proxy.library.nyu.edu/ovid-b/ovidweb.cgi 2/38
,2/5/23,M10:31MP Ovid:MJonas'MIntroductionMtoMtheMU.S.MHealthMCareMSy
M stem
AmbulatoryMrehabilitationMcenters
Long-termMacuteMcareMandMother Mspecialty Mhospitals
VerticalMandMHorizontalMIntegrationMinMHealthMCare
AnMimportantMdevelopmentMinMtheMU.S.MhealthMcareMsystemMisMtheMverticalMandMhorizontalMintegrationMacrossMtheMspectrumMofMcare:Mcommunity-
basedMcare,MinpatientMacuteMcare,MandMpostacuteMcare.MTheMtrendMtowardMhorizontal MconsolidationMwasMnotedMwhenMhospitalsMbeganMtoMmergeMi
nMtheM1990s M(Cuellar M&MGertler,M2003).MTheMintegratedMsystems MthatMhaveMemerged
P.35
sinceMtheM2000s MareMbothMhorizontalMandMverticalMandMmayMcontainMmultipleMhospitals,Mclinics,Mlong-
termMcareMfacilities,MphysicianMpractices,MhomeMhealthMcareMorganizations,MandMhospices.MRevCycleMIntelligence,MaMtradeMpublication,Mreports Mon
MthisMtrendMas Mfollows:
AsMvalue-
basedMreimbursementMputs Mfinancial MpressureMonMproviders,MhealthMcareMorganizations MareMstrivingMforMefficiency,McostMcont
rol,MandMsustainability.MAnMincreasingly Mpopular MstrategyMtoMfulfillMallMtheseMgoals MisMtoMengageMinMhospitalMmerger MandMacq
uisitionM(M&A)Mactivity.MHospitalMmergers MandMacquisitionsMareMincreasingMatMaMrapidMrate.MHealthMcareMorganizations Mannou
ncedM115Mmerger MandMacquisition Mtransactions MinM2017,MtheMhighestMnumber MinMrecentMhistory.M2018MisMlikelyMtoMmeetMorMev
enMexceedMtheMnumber MofMhospitalMmerger MandMacquisitionMdeals MmadeMinM2017,MhealthMcareMexperts Mpredict.MRecentMdata
MfromMconsultingMfirmMKaufman MHallMshows Mthat Morganizations Malready MannouncedM50Mtransactions MinMtheMfirstMhalfMofM2018
.M(LaPointe,M2019).MSeeMFigureM2.2.
InMthisMchapter,MweMdiscuss MeachMofMtheMsettingsMforMhealthMcareMdeliveryMinMtheMU.S.MhealthMsystem,MbeginningMwithMcommunity-
basedMcareMandMendingMwithMpostacuteMcare.
FIGUREM2.1MSettings MforMhealthMcareMdeliveryMinMtheMUnitedMStates.MSource:MTheMSg2MSystemMofMCARE™M(ClinicalMAlignmentMandM
ResourceMEffectiveness)MillustratesMtheMalignmentMofMhealthMservices MfromMtheMpatient's MperspectiveMacrossMtheMcareMcontinuum,M
andMoftenMacross Mgeographically MdispersedMsites MofMcare.M(One-
timeMpermissionMtoMreproduceMgrantedMbyMSg2,M2019/10/17).MRetrievedMfromMhttps://newsroom.vizientinc.com/vizient-
blog/clinical-performance/health-systems-find-large-opportunity-microhospitals
COMMUNITY-BASEDM CARE
Self-Care
AlthoughMtheMhospitalMmayMbeMseenMasMtheMflagshipMofMtheMhealthMcareMsystem— P.36
itMisMtheMlargestMsingleMcategoryMofMNationalMHealthMExpenditures MandMtheMsettingMforMmanyMtelevisionMshows—
theMvastMmajorityMofMpeopleMwillMnotMreceive MinpatientMacuteMcareMinManyMgivenMyear.
OutsideMofMpeopleMwhoMareMunexpectedly Mincapacitated,MtheMfirstMhealthMcareMdecisionMpeopleMmakeMisMwhether MtoMaccess MtheMdeliveryMsystem
,MatMall,MandManMestimatedM80%MtoM95%MofMhealthMproblems MareMnever MbroughtMforwardMtoMaMphysicianMorMotherwiseMinvolveMprofessionalMmedical
Mcare. MFrequently, Mailments MperceivedMtoMbeMminor Mare Meither MaddressedMwith Ma M“take-no-action,”M“wait-and-see,”M or Mself-
medicationMapproach.MFevers,Mheadaches,MandMindigestionMareMamongMtheMmostMcommonMailmentsMtreatedMwithMnonprescription MorM“over-the-
counter”M(OTC)Mmedicines M(Dean,M1981).MLevinMandMIdler M(1983)MprovideMaMconsensus MdefinitionMofMself-careMasMfollows:M“Self-
careM… MrefersMtoMthoseMactivities Mindividuals MundertakeMinMpromotingMtheirMownMhealth,MpreventingMtheirMownMdisease,MlimitingMtheirMownMillnes
s,MandMrestoringMtheirMownMhealth.MTheseMactivitiesMareMundertakenMwithoutMprofessional Massistance,MalthoughMindividuals MareMinformedMbyMtech
nicalMknowledgeMandMskillsMderivedMfromMtheMpoolMofMbothMprofessionalMandMlayMexperienceM….MTheMgenericMattribute MofMself-
careMisMitsMnonprofessional,Mnonbureaucratic, MnonindustrialMcharacter”M(LevinM&MIdler,M1983,Mp.M181).MAfterMselfdiagnosisMandMpossiblyMadviceMfr
omMfriends MandMfamily,ManMindividualMmayMdecideMtoMbecomeMaMpatientMandMenterMtheMhealthMcareMsystem.
FIGUREM2.2MHospitalMandMhealthMsystemMmerger MandMacquisitionMactivity,M2000MtoM2017.MSource:MDataMfromMKaufman,MHall,MandMAssociates
.M(2018).M2017MinMreview:MTheMyearMM&AMshookMtheMhealthcareMlandscape.MRetrievedMfromMhttps://www.kaufmanhall.com/sites/default/fil
es/legacy_files/kh_report-ma-year-in-review_d4-rebrand.pdf
AmbulatoryMCare
Ambulatory McareMrefers MtoMmedicalMservices MperformedMwithoutMadmissionMtoMaMhospitalMorMotherMhealthMcareMfacilityMforManMovernightMstay.MAm
bulatory McareMisMprovidedMinMmanyMsettings,MbutMweMbeginMwithMaMbriefMdescriptionMofMthoseMwhereMmostMambulatory MvisitsMareMprovided:Mphysi
cianMoffices,MemergencyMdepartmentsM(EDs),MandMhospitalMoutpatientMclinics.MInM2016,MtheseMvisitsMnumberedM883,725Mmillion,M145,591Mmillion,Ma
ndM125,721Mmillion,Mrespectively M(National MCenterMforMHealthMStatisticsM[NCHS],M2011;MRui,MKang,M&MAshman,M2016;MRui M&MOkeyode,M2016).MAfte
rward,MweMdescribeMsomeMsmaller Mvolume,MestablishedMambulatory McareMsettings:
https://ovidsp-dc2-ovid-com.proxy.library.nyu.edu/ovid-b/ovidweb.cgi 3/38
, 2/5/23,M10:31MP Ovid:MJonas'MIntroductionMtoMtheMU.S.MHealthMCareMSy
M stem
PublicMhealthMclinics
https://ovidsp-dc2-ovid-com.proxy.library.nyu.edu/ovid-b/ovidweb.cgi 4/38
