"A marvelous collection of ideas and insights by first-rate scholars. This book lays a foundation for more creative and effective policy-making." - Stephen M. Shortell, Dean and Blue Cross of California Professor of Health Policy and Management, University of California, Berkeley

Health care delivery in the United States is an enormously complex enterprise, and its $1.6 trillion annual expenditures involve a host of competing interests. While arguably the nation offers among the most technologically advanced medical care in the world, the American system consistently under performs relative to its resources. Gaps in financing and service delivery pose major barriers to improving health, reducing disparities, achieving universal insurance coverage, enhancing quality, controlling costs, and meeting the needs of patients and families.

Bringing together twenty-five of the nation's leading experts in health care policy and public health, this book provides a much-needed perspective on how our health care system evolved, why we face the challenges that we do, and why reform is so difficult to achieve. The essays tackle tough issues including: socioeconomic disadvantage, tobacco, obesity, gun violence, insurance gaps, the rationing of services, the power of special interests, medical errors, and the nursing shortage.

Linking the nation's health problems to larger political, cultural, and philosophical contexts, Policy Challenges in Modern Health Care offers a compelling look at where we stand and where we need to be headed.

Mental illness takes a different toll on African Americans than it does whites. For example, research by social psychologist Harold W. Neighbors, Ph.D., has shown that although the estimated lifetime prevalence of major depressive disorder is higher among whites than among blacks, the burden of depression is higher for blacks because it is usually untreated, more serious, more persistent, and more disabling. Contributing to the problem is the fact that African Americans—particularly men—are far less likely than whites to seek treatment for mental health problems when they need it. “Large numbers of African Americans are experiencing severe emotional problems and choosing not to seek professional help,” says Neighbors, director of the Center for Research on Ethnicity, Culture, and Health, and director, Program for Research on Black Americans, at the University of Michigan. “We need to understand why. More importantly, we need to do something about it.”

Neighbors has conducted research on mental health disparities for more than 20 years. With the support of a Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research, he has explored differences in the prevalence of serious mental disorders, levels of impairment, and help-seeking behavior among African Americans. He has looked at why African Americans seek professional help less frequently than white Americans and at how reliance on informal help from social support networks may reduce blacks’ use of professional treatment.

Neighbors’ research, which has been published in more than a dozen academic journals, reveals subtle nuances in racial and ethnic disparities around mental illness and treatment. Fears of stigma and discrimination play an important role in keeping blacks from seeking treatment for mental illness, as do age and gender, lack of insurance coverage, and other financial barriers. Neighbors has also taken an in-depth look at ethnicity and immigration status, and finds significant differences in help-seeking patterns among blacks born in the United States versus Caribbean black immigrants. “Ethnic differences among black Americans is an underdeveloped area of mental health disparities research,” Neighbors says.

Here, Neighbors talks about the trajectory of his research, the policy implications of that research, and the work that needs to be done in this area.

In Total Cure, Hal Luft presents a comprehensive new proposal, SecureChoice, which does all that while providing affordable health insurance for every American. SecureChoice is a plan that restructures payment for medical care, harnessing the flexibility and responsiveness of the market by aligning the incentives of clinicians, hospitals, and insurers with those of the patient. It uses the accountability of government to ensure transparency, competition, and equity.

Most experts would agree that the current medical malpractice system in the United States does not work effectively either to compensate victims fairly or prevent injuries caused by medical errors. Policy responses to a series of medical malpractice crises have not resulted in effective reform and have not altered the fundamental incentives of the stakeholders. In Medical Malpractice, economist Frank Sloan and lawyer Lindsey Chepke examine the U.S. medical malpractice process from legal, medical, economic, and insurance perspectives, analyze past efforts at reform, and offer realistic, achievable policy recommendations. They review the considerable empirical evidence in a balanced fashion and assess objectively what works in the current system and what does not. Sloan and Chepke argue that the complexity of medical malpractice stems largely from the interaction of the four discrete markets that determine outcomes--legal, medical malpractice insurance, medical care, and government activity. After describing what the evidence shows about the functioning of medical malpractice, types of defensive medicine, and the effects of past reforms, they examine such topics as scheduling damages as an alternative to flat caps, jury behavior, health courts, incentives to prevent medical errors, insurance regulation, reinsurance, no-fault insurance, and suggestions for future reforms.