Health Care Organization and Finance

This book is designed for a specialized health law course focusing on the organization and finance of health care. It is also well-suited for health law courses in health administration or management programs. The 7th Edition focuses heavily on the many changes that the Affordable Care Act is bringing about in the regulation of health care and health insurance. The book begins with an introduction to fundamental concepts affecting health law and policy, and then explores conventional and emerging methods of quality control regulation applicable to health care professionals and health care institutions. The next section of the book examines in depth the policy and legal issues presented by varying approaches to providing access to health care and controlling its cost. This section explores in depth the provisions of the Affordable Care Act that are expanding access to health care, and analyzes the challenges to that law, including the National Federation of Independent Business Supreme Court decision. This section also considers legal issues presented by private health insurance, managed care, Medicare, and Medicaid, as well as obligations to provide medical services under state and federal law. The final section of the book explores legal issues that affect health care institutions and the relationships between professionals and institutions, including medical staff privileging, physician-hospital contracting, accountable care organizations, employment and labor law, tax exempt organization law, fraud and abuse issues, and antitrust law. The 7th edition has been completely updated, covering recent developments involving consumer-driven health care, ERISA, antitrust enforcement, labor law, and tax-exempt organization law, in addition to the Affordable Care Act developments.