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Fraud is the result of government and insurance company control of health care. The growth of bureaucracy is a precursor to incompetence and soaring costs of medical care. A lack of clinical diagnosis and a dependence on expensive testing has increased costs while decreasing the doctor's competence. The FBI and the attorneys general of all states are dealing with exploding health care fraud. The result is a trillion dollars in waste and deception. Trillion Dollar Scam details the origin of this fraud and waste, and offers solutions to fixing the broken U.S. health care system.

Foreword by Harvey V. Fineberg, President of the Institute of Medicine

For decades, experts have puzzled over why the US spends more on health care but suffers poorer outcomes than other industrialized nations. Now Elizabeth H. Bradley and Lauren A. Taylor marshal extensive research, including a comparative study of health care data from thirty countries, and get to the root of this paradox: We’ve left out of our tally the most impactful expenditures countries make to improve the health of their populations—investments in social services.

In The American Health Care Paradox, Bradley and Taylor illuminate how narrow definitions of “health care,” archaic divisions in the distribution of health and social services, and our allergy to government programs combine to create needless suffering in individual lives, even as health care spending continues to soar. They show us how and why the US health care “system” developed as it did; examine the constraints on, and possibilities for, reform; and profile inspiring new initiatives from around the world.

Offering a unique and clarifying perspective on the problems the Affordable Care Act won’t solve, this book also points a new way forward.

As health care concerns grow in the U.S., medical anthropologist Linda M. Whiteford and social psychologist Larry G. Branch present their findings on a health care anomaly, from an unlikely source. Primary Health Care in Cuba examines the highly successful model of primary health care in Cuba following the 1959 Cuban Revolution. This model, developed during a time of dramatic social and political change, created a preventive care system to better provide equity access to health care. Cuba's recognition as a paragon of health care has earned praise from the World Health Organization, UNICEF, and the Pan American Health Organization. In this book, Whiteford and Branch explore the successes of Cuba's preventive primary health care system and its contribution to global health.

The U.S. healthcare system is in critical condition--but this should come as a surprise to no one. Yet until now the solutions proposed have been unworkable, pie-in-the-sky plans that have had little chance of becoming law and even less of succeeding. In Code Red, David Dranove, one of the nation's leading experts on the economics of healthcare, proposes a set of feasible solutions that address access, efficiency, and quality.

Dranove offers pragmatic remedies, some of them controversial, all of them crucially needed to restore the system to vitality. He pays special attention to the plight of the uninsured, and proposes a new direction that promises to make premier healthcare for all Americans a national reality. Setting his story against the backdrop of healthcare in the United States from the early twentieth century to the present day, he reveals why a century of private and public sector efforts to reform the ailing system have largely failed. He draws on insights from economics to diagnose the root causes of rising costs and diminishing access to quality care, such as inadequate information, perverse incentives, and malfunctioning insurance markets. Dranove describes the ongoing efforts to revive the system--including the rise of consumerism, the quality movement, and initiatives to expand access--and argues that these efforts are doomed to fail without more fundamental, systemic, market-based reforms. Code Red lays the foundation for a thriving healthcare system and is indispensable for anyone trying to make sense of the thorny issues of healthcare reform.

The Oxford Handbook of Health Economics provides an accessible and authoritative guide to health economics, intended for scholars and students in the field, as well as those in adjacent disciplines including health policy and clinical medicine. The chapters stress the direct impact of health economics reasoning on policy and practice, offering readers an introduction to the potential reach of the discipline. Contributions come from internationally-recognized leaders in health economics and reflect the worldwide reach of the discipline. Authoritative, but non-technical, the chapters place great emphasis on the connections between theory and policy-making, and develop the contributions of health economics to problems arising in a variety of institutional contexts, from primary care to the operations of health insurers. The volume addresses policy concerns relevant to health systems in both developed and developing countries. It takes a broad perspective, with relevance to systems with single or multi-payer health insurance arrangements, and to those relying predominantly on user charges; contributions are also included that focus both on medical care and on non-medical factors that affect health. Each chapter provides a succinct summary of the current state of economic thinking in a given area, as well as the author's unique perspective on issues that remain open to debate. The volume presents a view of health economics as a vibrant and continually advancing field, highlighting ongoing challenges and pointing to new directions for further progress.

Americans are understandably concerned about the runaway costs of medical care and the fact that one citizen out of seven is without health insurance coverage. Solving these problems is a top priority for the Clinton administration, but as Victor Fuchs shows, the task is enormously complex. In this book Fuchs provides the reader with the necessary concepts, facts, and analyses to fully comprehend the complicated issues of health policy. He shows why health care reform that benefits society as a whole will unavoidably burden certain individuals and groups.

Gain confidence in ICD-9-CM diagnostic and procedure coding across medical specialties with this comprehensive, hands-on worktext. UNDERSTANDING ICD-9 CM CODING: A WORKTEXT, 4th Edition has been fully updated to the latest code sets and guidelines for coding and reporting, with plenty of practice exercises, case studies, and full-color illustrations of anatomy and procedures to help you master ICD-9-CM coding. Includes a chapter on the coming transition to ICD-10-CM and ICD-10-PCS.
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Glycemic Control in the Hospitalized Patient: A Comprehensive Clinical Guide is a unique, practical resource for health care providers dealing with hyperglycemia in the inpatient setting. Outlining a hands-on approach used by the Duke University Inpatient Diabetes Management team, the book discusses a wide range of scenarios that occur while treating patients with hyperglycemia, including challenging circumstances such as steroids and tube feeding regimens. Special emphasis is given to insulin therapy. The chapters are written by a group of health care providers with extensive, pioneering experience in hyperglycemia control in the inpatient setting at the Duke University Medical Center. The book includes the most up-to-date scientific evidence and information and is addressed to not only hospitalists and general internists but also endocrinology fellows, residents, nurse practitioners, nurses, and other primary care practitioners who treat patients in the inpatient setting. The focus is clearly on practical, patient-care topics. Glycemic Control in the Hospitalized Patient: A Comprehensive Clinical Guide is a first-of-its kind, comprehensive guide to state-of-the-art inpatient glycemic management.

After reviewing the growth of health care spending and the causes of that growth, Enthoven (health policy, international studies, and public and private management, Stanford) sets out elements of the fundamental reform he finds necessary to solve the problem. Primarily that involves freer choice for

Understanding Health Insurance, 12th Edition, is the essential learning tool your students need when preparing for a career in medical insurance billing. This comprehensive and easy-to-understand text is fully-updated with the latest code sets and guidelines, and covers important topics in the field like managed care, legal and regulatory issues, coding systems, reimbursement methods, medical necessity, and common health insurance plans. The twelfth edition has been updated to include new legislation that affects healthcare, ICD-10-CM coding, implementing the electronic health record, the Medical Integrity Program (MIP), medical review process, and more. The practice exercises in each chapter provide plenty of review, and the workbook (available separately) provides even more application-based assignments and additional case studies for reinforcement. Includes free online SimClaimTM CMS-1500 claims completion software, and free-trial access to Optum’s EncoderPro.com—Expert encoder software.
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