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Healthcare Policy

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Abstract

The policies that dictate the way in which healthcare is administered in the United States today are rooted in a rich history, influenced by a number of stakeholders, and far-reaching in their implications on practice. This chapter will cover an overview of this history beginning with the development of health insurance as a method to finance healthcare, the advent of employer-based health insurance, the implementation of the Medicare and Medicaid programs, and the conception of managed care. How and why insurance financing works is then discussed, before summarizing the history and provisions of the Affordable Care Act along with some proposed alternatives. Next, this chapter dives deeper into the workings of the Medicare and Medicaid programs in addition to current controversies surrounding their execution. Managed care is covered in additional detail, touching on features of the Health Maintenance Organization, Preferred Provider Organization, and Accountable Care Organization. Emphasis is given to developing an understanding of the bundled payment model of physician reimbursement. This chapter concludes with a review of the medical malpractice system, as well as future proposals for tort reform.

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Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Ramin M. Lalezari

  2. Department of Orthopedic Surgery, Division of Hand and Upper Extremity Surgery, Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA

    Christopher J. Dy

Authors
  1. Ramin M. Lalezari
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  2. Christopher J. Dy
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Correspondence to Christopher J. Dy .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, MI, USA

    Eric C. Makhni

  2. Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Melvin C. Makhni

  3. Department of Orthopedic Surgery, UMass Memorial Health Care, Worcester, MA, USA

    Eric F. Swart

  4. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Charles A. Bush-Joseph

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Lalezari, R.M., Dy, C.J. (2019). Healthcare Policy. In: Makhni, E., Makhni, M., Swart, E., Bush-Joseph, C. (eds) Orthopedic Practice Management. Springer, Cham. https://doi.org/10.1007/978-3-319-96938-1_11

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  • DOI: https://doi.org/10.1007/978-3-319-96938-1_11

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-96937-4

  • Online ISBN: 978-3-319-96938-1

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