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The Health Care Handbook

Created January 9, 2015 by Nathan Moore, MD

Health economics, delivery and policy have a huge impact on patient care.

Anyone who’s worked in a hospital or other health care setting knows that clinical knowledge is not the only thing that determines how well your patients do. Imagine seeing a patient with three months of cough and shortness of breath and diagnosing them with a rare infection – great job, right? But what if the patient’s insurance won’t cover the antibiotic to treat it? Or you can’t get authorization for a CT scan to determine the spread of the disease? These aren’t just abstract questions; they are scenarios that most physicians face every day. Making the correct diagnosis is only one step in the long process to helping patients. To cite just one study, “Lack of health insurance is associated with as many as 44,789 deaths per year in the United States, more than those caused by kidney disease.” (Source: Wilper, et al. “Health Insurance and Mortality In US Adults”) Many physicians and patients feel that dealing with the health care system is the most difficult and frustrating aspect of medicine.

Most colleges and medical schools teach their students little, if any, about the health care system

Despite the importance of health economics, delivery and policy to patient care, most pre-meds and medical students (and physicians) know very little about how the system works. There are no requirements for medical schools to teach these subjects, despite multiple surveys showing that medical students want to learn more. The medical school that I attended was no different – providing less than four hours of education on health systems over the entire four years of medical school – and I felt vastly unprepared as a third-year medical student interacting with patients on my clinical rotations. Patients asked me questions regarding insurance, costs of medicines and testing, and health policy on a daily basis, and I knew too little to even tell them where to find the right answer. Even worse, the residents and attendings knew scarcely more than I did, and a surprising amount of their knowledge was based on incorrect hearsay and anecdotes.

We wrote The Health Care Handbook as a guide to the health care system for health professions students 

I tried to educate myself about the health care system through books, magazines and websites, but almost every resource was either too in-depth, too biased, too boring – or all three. I then partnered with Elisabeth Askin, a classmate, to create the resource we were looking for: a clear, concise and neutral guide to the basics of the health care system for health professions students. We originally planned for a pamphlet on their health care system of about 15 pages but by the time all was said and done we had created a 256 page book that we called The Health Care Handbook. The first edition did extremely well; it was covered in the New York Times and other media outlets, sold more than 16,000 copies, and is now being used by dozens of academic programs to teach health professions students about health economics, delivery and policy.

Writing the Handbook has changed the way I practiced medicine

Most importantly, doing research for the Handbook convinced me to change my choice of specialty to primary care. Many studies have shown that primary care is the most effective (and cheapest) way to improve health outcomes for the most people, but the US health care system values specialty care over primary care. Not surprisingly, the US has more specialists and fewer primary care physicians than other industrialized countries.

Writing the book also opened my eyes to consider systems factors when caring for patients in the clinic, ER and hospital. The hospital where I work, like most, has a number of “frequent fliers” – patients who show up in the ER multiple times every month. Nationwide, only 5% of the population accounts for 50% of health care spending. When I see one of these patients, I always ask him or her about their insurance, whether or not they have a primary care provider and if they can afford the medicines that other physicians have prescribed. Not surprisingly, I often find out new and useful information by asking the patient about these “non-clinical” questions, which can lead to improved plans to keep these patients healthy and out of the hospital. Just another example of how health care systems knowledge can directly affect patient care.

The health care system is changing rapidly

This is a great time to learn more about the health care system because it is changing on a daily basis. The Affordable Care Act, aka Obamacare, was the most significant change to government health policy in a generation, and its effects are just now being felt across the health care system. Hospitals, insurance companies, and physician groups are changing the way that they care for patients in many exciting and unique ways. Several states have opted to develop new models of care and coordination, and health IT is rapidly advancing. The health care system needs qualified leaders who also understand patient care – another reason it’s important for health professions students to learn it.

The health care system also affects providers 

Oh yeah, the health care system also determines how health care providers are taught, measured and paid. Anyone who intends to work in the health care field ought to know exactly where the money they make comes from, and how their career is likely to change over the next 10 years.

The second edition of the Health Care Handbook is now out!

The 2nd edition of the Handbook includes new sections on the ACA, team-based care, health IT and health quality. It’s only $15.99 for the paperback or $7.99 for the eBook. You can find more information at

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