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The Health Care Handbook - A Clear and Concise Guide to the American Health Care System

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The 2nd edition of the best-selling practical, neutral, and readable overview of the US health care system is now available. This updated edition of the Health Care Handbook covers:

• New sections on health IT, team-based care and health care quality
• A clear summary of health policy and the Affordable Care Act
• Inpatient & outpatient health care and delivery systems
• Health insurance and the factors that make health care so expensive
• Concise summaries of 32 different health professions
• Medical devices, pharmaceuticals, and the research world
• And much, much more

The Handbook is the one-stop guide to the people, organizations and industries that make up the U.S. health care system and major issues the system faces today. It is rigorously researched and scrupulously unbiased yet written in a conversational and humorous tone that's a pleasure to read and illuminates the convoluted health care system and its many components. The Handbook is now used by hundreds of academic programs and health care companies.

Each section of the book includes an introduction to the key facts and foundations that make the health care system work along with balanced analyses of the major challenges and controversies within health care, including medical errors, government regulation, medical malpractice, and much more. Suggested readings are included for readers who wish to learn more about specific topics.

256 pages, Paperback

First published January 1, 2012

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Elisabeth Askin

1 book3 followers

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5 stars
193 (39%)
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198 (40%)
3 stars
73 (15%)
2 stars
15 (3%)
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7 (1%)
Displaying 1 - 30 of 42 reviews
Profile Image for Beth Haynes.
234 reviews
June 1, 2018
A valiant effort from 2 (former)medical students to provide basic background on the US healthcare system - with the stated goal of presenting the material in a neutral, unbiased way. They did their best, and are to be commended on their effort and work. But neutral and unbiased it is not.

Most medical students enter their training with little idea of how healthcare is delivered or the extent and complexity of how medical care is payed for in the US. (Most doctors don't understand it either.) The subtitle "a clear an concise guide" is apt. The book is a great starting place to obtain an introduction and overview - but, as the authors readily admit, there is no way to cover it all.

Some of the topics are presented with opposing views included, but the presentation as a whole is colored by the author's skepticism toward markets and money in medicine. I suspect the authors, steeped in the viewpoint of academic medicine, are unaware of how much that viewpoint permeates and limits their ability to even think about U.S. healthcare, let alone explain it in an unbiased way.

Because I disagree so intensely with the pervasive government-centric viewpoint of academic medicine, areas of bias leap out at me. It's easy for me to be critical. I can't emphasize enough how impressed I am at the authors' overall job. This book will be of tremendous help to any one interested in better understanding U.S. healthcare. It is indeed "clear and concise" and the authors deserve our gratitude.

My only really beef is their claim of neutrality. The book needs a companion commentary which addresses and challenges their underlying assumptions.

A few examples:
1. The ACA is described as having "many unforeseen problems." Unforeseen? Really? I gave up clinical medicine to work in policy because even before the ACA passed, I could see the disruption of the patient-doctor relationship which would occur. The cost overruns, rising premiums, and failure to curb the rising cost of medical care were predicted by many, many people. Supporters of the ACA may not have foreseen the problems - but its critics most certainly did.
2. Quoting the poor ranking of US in infant mortality in international comparisons. This has become a meme in arguments for more government involvement in healthcare. However, multiple critiques bring serious question to this claim, demonstrating how the data it's based on is inadequate in both quality and quantity.
3. Almost all of the the sources quoted are biased toward a large role for government in healthcare and critical of free markets: Sara Kliff, Jonathan Cohn, Atul Gawande, Commonwealth Fund, Dartmouth Atlas study, Kaiser Family Foundation. They did reference John Goodman - but what about Michael Cannon (Cato) and Bob Moffit (Heritage) or even Avik Roy (Forbes/Manhattan Institute)?
4. Stating physician-owned hospitals are subject to possible conflict of interests - which of course they are - but this implies that somehow non-physician owned hospitals are somehow LESS subject to conflicts of interest. Really? As proof, they quote a study showing physician owners of ambulatory surgery centers are more likely to recommend surgery. Even if this is true, it tells us nothing about whether those recommendations are better or worse for patients.
5. Lauding the "comprehensive and coordinated care" within Patient-Centered Medical Homes while in the next sentence describing"Boutique/Concierge" practices, with no mention of low-cost direct primary care. PCMH and Accountable Care Organizations were the inadequately tested models of policy wonks heavily conscripted into the carrots-and-stick payment formulas of the ACA. Promoters of these models too often take their lofty goals and descriptions as equivalent to having achieved those goals. (ACOs are designed to increase care coordination and lower costs, therefore that's what they do - in absence of adequate real experience and data.) The authors do state these models "show promise but it's unclear what their long-term impact will be." If this is so - was it really wise to make these payment models a key part of health reform law, and require an act of Congress to escape from a bad idea?
6. References to the US healthcare "system" as "fragmented" demonstrates a bias against the spontaneous order of markets and in favor of centrally designed and implemented planning. Our "system" can also be viewed as multi-sourced and anti-fragile. Same system, different viewpoint, different language and you end up with a whole different connotation to the description. Fragmentation is "bad" - but "anti-fragile" is "good.
7. Failure to connect the shortage of primary care physicians, or the soaring cost of education, to government policies
8. Standard misunderstanding of the purpose and function of insurance, and the cause of adverse selection
9. characterization of HSAs as primarily benefiting the young and healthy with a steady income
10. the belief that "healthcare is different" and can not be handled as other types of goods and services.

And there are so many more.

With these examples I am not trying to denigrate the work of these authors. I'm really not. I am so grateful they took on this much needed task. Their underlying assumptions are based on what is taught and defended in academic medicine. Just don't call it neutral.

I could not write a neutral book on healthcare. We all are fish swimming in our sea of personal experience and knowledge - and there's no other way to be! And, we can't see the water we swim in. Reading this book has given me the idea that if I ever write a book, well before it's published, I need to have it previewed and critiqued by people who do not share my free market orientation.

Nor am I saying the U.S. doesn't need substantial improvement in how we treat healthcare. We have an incredibly toxic mix of government control and market forces which insulates medical care from competition on price and quality. We've ended up with the worst of both worlds: artificially high prices, and quality of care that neither physicians nor patients are satisfied with.

Conclusion: Excellent start on a much needed resource introducing the basic components of U.S. healthcare. And, there's more that needs to be explained.
43 reviews1 follower
November 25, 2021
Great 101-style overview of the US healthcare system. I have spent a good amount of time reading about healthcare from various other sources including newsletters (often with a technology / entrepreneurship bent) as well as other books. However, most of the time these pieces either zoom into one particular aspect of the healthcare system or defend some sort of thesis rather than simply trying to convey information. I think because this book is geared towards straightforwardly informing medical students of how the broader healthcare world works, it provides a relatively unbiased birds eye view. It assumes zero knowledge so if you have knowledge of healthcare already, pieces of it might be somewhat redundant. I think for me I had familiarity with ~75% of the book’s content, but I am still glad I read it because it helped me flesh out my mental model of the care ecosystem and fill some key gaps in my understanding.
It starts off with important statistics around cost and quality of care to context-set. It then dives into detailing healthcare entities and how they work (e.g., the diversity of provider types and services offered, how payors work). It additionally covers underlying dynamics influencing care economics (e.g., physician shortage, AMA RVU committee, the centrality of employer sponsored insurance). Space is also spent discussing specific cost/quality drivers, ranging from coordination costs to overtreatment; I thought the discussion here was fairly comprehensive. There was additionally discussion of pharma / medtech and how they interface with providers/payors via PBMs. A chapter on policy discussed the ACA at length – I learned a lot from this chapter, but it was particularly dense.
My only major gripe is that now the book is outdated. Information provided about the ACA has since become obsolete (e.g., repeal of individual mandate), and some trends may have also changed. I wish there was also more of an explanation of different payment models, especially as value based care accelerates – perhaps this isn’t included because all of that innovation is too recent. But all in all, learned a ton from this!
9 reviews1 follower
August 29, 2013
This was one of the most intellectually gratifying nonfiction books I've read in quite some time. Even in the Introduction you get a good sense of how these two doe-eyed, green medical professionals are going to approach the profuse amount of information that they've collected in trying to write this handbook for the John Everyman.

I am no stranger to medical terminology, but the way that these two authors (Askin & Moore) were able to break down and simplify some of the most complex (sometimes muddled) concepts in the healthcare industry made me smile proudly and happy to be a Millenial in America.

This book is worth the read if you've ever had a question about how doctors get paid
This book is worth the read if you've ever had a question about insurance.
This book is worth the read if you've ever had a question about how hospitals operate.
This book is worth the read if you've ever had a question about how complicated is healthcare.
This book is worth the read if you have questions about Obamacare.
This book is worth the read if you have questions about why you wait as long as you do.
This book is worth the read if you have questions about your health.
This book is worth the read if you have questions about where we go from here.

This book isn't a panacea onto all of your questions, but it's a wonderful primer that I hope more people use to start learning more and asking better questions. In terms of providing "healthcare fluency" this book would be a great one to keep on your shelves at home.
Profile Image for Maria.
121 reviews11 followers
April 25, 2013
I read this after starting a new job in health insurance (switching from a completely different field); it eased some of my confusion and helped me ask better questions. It is what it says on the tin: Clear and concise.

There is no narrative, but if you're already motivated to ingest the information the authors make it possible to do so efficiently and more or less painlessly. In places it suffers from failure of imagination when discussing the costs/benefits of particular policies or potential alternatives, and such discussions are always minimal. So this won't help you be a better armchair policy wonk or political arguer, except inasmuch as it will prevent you from getting your facts embarrassingly wrong.

Recommended for anyone who woke up one day surprised to find themselves embedded in this mess.
15 reviews1 follower
May 19, 2016
A great book for anyone that wants to delve into our healthcare system. NO it is not a particularly captivating book unless you are interested in learning more about our healthcare system. YES it is very useful. One of my favorite parts was that it was unbiased. Very glad I read it before medical school
February 20, 2017
It is refreshing to read a book that is exactly what it claims to be: a well-organized, clearly written overview of the US healthcare system. It is even more remarkable that it was written by two aspiring medical students, who had yet to gain the years of experience with the system that some of their readers may have. I did find that a lot of the information was familiar to me, as someone who has been a working adult for 30 years, but that is no reason to penalize the book's rating. It definitely filled some gaps in my knowledge and will be a valuable quick reference when needed. I also highly recommend the book to young adults both to help them navigate the healthcare system for themselves and to understand one of the most controversial topics in America today. In fact, my copy is about to be loaned to a 22 year old planning to start medical school in a few months.
Profile Image for Michael.
476 reviews1 follower
May 19, 2013
A first-rate intro to health care in the U.S., with chapters on the following:

1. Health Care Systems and Delivery
2. Health Care Providers
3. Insurance and Economics
4. Research, Pharmaceuticals, and Medical Devices
5. Policy and Reform

Quite an accomplishment, especially since the authors are in medical school! Great resources for further reading too.
Profile Image for Renzhong.
24 reviews45 followers
April 12, 2013
Clear and concise. This book was an invaluable part of my interview prep for the medical school application process. The authors laid out a very easy to understand version of the basic structure of the US healthcare system.
19 reviews
August 12, 2013
An excellent primer for anyone interested in learning about how the U.S. healthcare system works (or doesn't work...); concise and easy to read with numerous figures, charts, and tables. The section that explains the Affordable Care Act (Obamacare) is particularly useful.
1 review1 follower
October 21, 2012
Very informative if you want to get an overview of the U.S. health care system. Goes over new health care law and other health care issues (e.g. insurance, payments, etc.)
5 reviews
February 14, 2013
Very nice short overview of the healthcare system. It includes some information that is hard to access such as the financing system for Graduate Medical Education.
Profile Image for John.
249 reviews
March 22, 2015
A clearly written survey of the structure of the US healthcare system, including the impacts of recent reforms.
24 reviews
July 13, 2020
Another review from the back catalog...

This is the one resource I recommend if someone is asking to get a better high-level understanding of the US health care system. It covers the basic entities and dynamics (providers, payers, regulators, hybrid entities, payment reform, EMRs) of the US system quite well, and is the only guide of this level I've read that does it in a somewhat impartial way. This book does have certain policy leanings, and is a bit more statist than I'd like, but it does a very admirable job of being self-aware and pointing out where certain policies or ideas are unsettled and evolving.

Of course, even at 200+ pages, it does not go so deeply enough into any one part of the US ecosystem that the reader can engage intelligently and meaningfully in policy news and debates, and that's probably the one place where this book falls short -- I don't expect it to cover more, but rather to more pointedly indicate to readers where a little knowledge is a dangerous thing.
95 reviews
April 18, 2018
As I now work in health care, I found this book to be an amazingly helpful quick guide to how health care in America works. While there were lots of definitions and tons of acronyms (a symptom of government agencies), this book gave me a good overview while allowing me to dive in deeper to particular sections of interest. I think it would make for a good reference book in the future, and as time permits, I hope to dive into the suggested readings.

I also recommended this book to my mom who I thought would find various sections and stats presented within insightful. It’s a quick read for anyone who wants to understand some of the problems our system faces.
91 reviews
October 8, 2021
The book was a helpful introduction to the healthcare industry - it described the myriad players in the space, including over 30 pages describing the various types of health care providers. It provided many definitions and graphs and lays out some of the complexity of the space.

Given the rapid changes in healthcare though, many metrics and the market situation are no longer current (e.g. the book was written before the Affordable Care Act rollout).
1 review
May 9, 2017
Great Introduction to a Complex Industry

If you are looking for a fast but effective introduction to healthcare systems, this is it! From Politics to Structure, this touches on it all.
Profile Image for Sarah.
52 reviews
November 17, 2021
Solid overview of the us health industry. Would benefit from an update for more relevancy on policy changes post 2019 and impact of covid. Very easy to read, very much captures the breadth of what makes our health system tick.
34 reviews10 followers
January 4, 2023
I’m reading this book to help prepare for medical school interviews. I’m about 25% done but I think it’s a must read for everyone. It does a great job at breaking down the immensely complex US health care system in an understandable way for the lay person.
Profile Image for Adam.
190 reviews5 followers
February 14, 2017
Literally everyone I know should read this book. All Americans should read this book. If you have ANY opinion about health care but aren't sure you know the facts, you should read this book.
Profile Image for Alexandra.
306 reviews4 followers
November 19, 2018
Read for Public Health class in medical school; actually very painless and pretty good layout for learning.
October 23, 2019
Great, concise summary of the U.S. healthcare industry. Recommend this book to anyone who simply wants to learn why Americans pay so much for healthcare.
Profile Image for Mochi.
52 reviews12 followers
January 6, 2020
Good concise overview of American healthcare system
19 reviews
June 9, 2020
Good high level overview for those interested in healthcare and issues they may face
15 reviews
August 21, 2020
Very good overview of the medical system. As a future medical student, it has helped me gain a broad understanding of the field that I wish to enter, but the structure and the struggles.
Profile Image for Greg.
21 reviews
December 31, 2021
Concise and informative. Reasonably impartial commentary that follows America's health care litigation. Enjoyed the chapter on the ACA. Great read before medical school interviews.
Profile Image for Kristen H.
25 reviews2 followers
March 31, 2022
Great material, but a newer edition is sorely needed. (This was written in 2014.)
Displaying 1 - 30 of 42 reviews

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