Introduction to U.S. Health Policy: The Organization, Financing, and Delivery of Health Care in America by Donald A. Barr (review)

The passage of the Patient Protection and Affordable Care Act (ACA) of 2010 was an important development in the history of the U.S. health care system. One subtle way the ACA improved the delivery of health care services to millions of Americans was through unprecedented collaboration among health care professionals. The mandate of transitioning to electronic health records was instrumental in making patient information more easily accessible to providers and patients. In addition, new quality of care initiatives emerged, with a focus on standardized measurement of care outcomes as well as pricing for services, offering health care consumers ways to compare pricing and patient outcomes across health care organizations and facilities. Hospitals also instituted a more stringent process in coordinating patient care leading towards the future of integrated care. Even though the ACA helped with closing the gap in accessing health care by increasing the number of insured people, costs of health care have not been reduced, and the United States continues to have the highest expenditures for health care among advanced industrial societies. Health services researchers, health economists, and other disciplinary experts persist in the attempt to unpack the reasons for the high costs and gaps in access and quality care, but the complexity of the health care system doesn't make this job easy.

Among many books and other readings that examine the foundations and inner workings of the American health care system, one has caught our attention: Introduction to U.S. Health Policy: The Organization, Financing, and Delivery of Health Care in America(4th edition, 2016) by Donald A. Barr. The main purpose of the book (per Barr) is to broaden the understanding of health policy as a fundamental component of a health care system by focusing on the U.S. context. Barr does caution the reader that there is no single definition of what health policy is, and he approaches it through the lens of how health care is organized, financed, and delivered. His introduction to health policy takes on a holistic approach by examining the contested history of the American health care system. For instance, he elaborates on the extensive and provocative role that the American Medical Association (AMA) played in the creation of private medicine and the fee-for-service model of health care delivery, which has dominated the 20th -century health care landscape in the U.S. Barr also highlights how communities help shape health policy and sustain the longevity of community-based hospitals and clinics at the local level. Then, turning his focus to the ACA, Barr underscores the law's significant role in laying out the principles and preliminary work for access to care for all Americans.

This 14-chapter book addresses what Barr identifies as the "irony of U.S. healthcare." He reflects on how the United States has one of the most advanced medical systems in the world while at the same time having one of the worst health care delivery systems among advanced industrialized nations. Chapter 1 examines the late 20 ^th/early 21st century state of the U.S. health care system and the politics behind the ACA. Chapters 2 through 4 explain what makes the U.S. health care system unique. Specifically, Chapter 2 reviews important key policy decisions in history that have shaped the contemporary system. Chapter 3 further outlines the institutional norms and values held by Americans that led to the creation of a health care system so different from neighboring Canada's model. Chapter 4 examines the medical profession and the evolving role of nurses. It also analyzes the organizational structure of American hospitals and the growth of specialized referral centers.

Chapters 5 through 7 describe the types of health insurance that have been...