Chapter 1   Introduction
   The Many Actors
   The U.S. System is Unique, but Not Unparalleled
   Health Policy – What is It?
   The Policy Analysis Process
   Supporting Implementation
   Health Professionals and the Policy Process
   Big Issues to Keep Our Eyes On
   Conclusion
   The Road Ahead

PART I – THE CONTEXT

Chapter 2  Where Are We?
   Introduction
   Current Outcomes and Costs
   A More Systematic Evaluation
   Complexity
   Leadership at the State and Local Level
   Industrializing Structures for Delivery
   Medicalization of Society
   Conclusion

Chapter 3  How Did We Get Here?
   Introduction
   Contending Visions of a System for Delivering Health Care
   A Chronology
   The Current “Era” Emerges
   Employers Want Out: Backing for Consumer-Driven Health Care
   Conclusion   
   Case 3-1 International Comparisons: Where Else Might
   We Have Gone?
   
Chapter 4  Where Do We Want to Go?
   Introduction
   Alignment with the Rest of Society
   Who is the We in “Where Do We Want to Go”?
   Conclusion
   Case 4 -1 National Standards on Culturally and Linguistically
   Appropriate Services (CLAS)

Chapter 5   What Are the Governmental Alternatives?
   Introduction
   Federal Level Alternatives
     Access to Care – Administer System Alternatives
    Access to Care – Oligopolistic Competition Alternatives
    Access to Care – Free-market Competition Alternatives
    Quality of Care – Administer System Alternatives
    Quality of  Care – Oligopolistic Competition Alternatives
    Quality of Care – Free-market Competition Alternatives
    Cost of Care – Administer System Alternatives
    Cost of Care – Oligopolistic Competition Alternatives
    Cost of  Care – Free-market Competition Alternatives
    Other Interventions
   State and Local Government Options
     Access to Care – Administer System Alternatives
    Access to Care – Oligopolistic Competition Alternatives
    Access to Care – Free-market Competition Alternatives
    Quality of Care – Administer System Alternatives
    Quality of  Care – Oligopolistic Competition Alternatives
    Quality of Care – Free-market Competition Alternatives
    Cost of Care – Administer System Alternatives
    Cost of Care – Oligopolistic Competition Alternatives
    Cost of Care – Free-market Competition Alternatives
    Other Interventions
   Conclusion 
   Case 5 -1 Specialty vs. Community Hospitals

Chapter 6  Alternative Responses and Initiatives of Institutions and Professions
   Introduction
   Common Responses
   Payers
   Providers
   Institutions
   Professions
   Consumers
   Not-for-Profit vs. For-Profit
   The Value-Driven Care Initiative
   Conclusion
   Case 6-1 Global Health Coverage

PART II – THE POLICY ANALYSIS PROCESS

Chapter 7   The Policy Analysis Process - Identification and Definition
   Introduction
   Getting the Scenario Right
   Hidden Assumptions
   Defining What is Medical Problem
   Conclusion
   Case 7 -1 Small Area Variations

Chapter 8 The Policy Analysis Process - Evaluation – Technology Assessment 
   Introduction
   Terminology
   Technological Forecasting
   Levels of Technological Forecasting
   Not Just What, But Also When
   Forecasting Methods
   Changing Business Models
   Organizations Devoted to Health Care Technology Assessment
   Conclusion
   Case 8-1 Health Information Networks

Chapter 9  The Policy Analysis Process -Evaluation – Political Feasibility
   Introduction
   Terminology
   Overview
   Authorizing Environments
   Key Government Actors
   Political Inputs
   Non-Governmental Actors
   Methods for Analyzing Political Feasibility
   Conclusion
   Case 9-1 Politics of The Clinton Health Plan

Chapter 10  The Policy Analysis Process - Evaluation – Economic Viability
   Introduction
   Defining the Health Care Process Involved
   Agreeing in Detail on the Delivery System Involved
   Selecting the Analytical Approach
   Agreeing on the Outcomes Produced
   Determining Relevant Costs
   Basic Tools
     Supply and Demand Concepts
    Benefit/Cost Concepts
   Valuing the Outcomes Produced
     Determining the Present Values of Costs and Outcomes
    Inflation Adjusting
    Discounting
   Dealing With Important Uncertainties
   Identifying Financing Methods
   Considering Distributional Effects
   Comparing Competing Alternatives
   Financial Feasibility
   Conclusion
   Case 10-1 Folic Acid Fortification

Chapter 11  The Policy Analysis Process - Analysis of Values – Last But Not Least
   Introduction
   Influence on Society – A Broader Question
   Ethical Review
   Conclusion
   Case 11-1 Voluntary Codes

Chapter 12  Implementation Strategy and Planning
   Introduction
   Levels of Implementation Failure
   Implementation Planning
   Setting Up to Succeed
   That All-Important Start
   The Post-Mortem
   Conclusion
   Case 12-1 Evidence-Based Medicine in Mental Health

PART III – THE PROFESSIONAL AS AN ACTOR

Chapter 13  What is Likely to Work
   Introduction
   Working Out Your Own Scenarios
   Why Not an Unraveling?
   Conclusion

Chapter 14 Professional Leadership
   Introduction
   To Influence Locally, Start Locally
   Health Policy Analysis: A Relevant School for Leadership
   Enhancing the Professional’s Role
   Conclusion

Chapter 15 Conclusion – All Those Levers and No Fulcrum
   Where to Stand
   The Physician’s Dilemma
   The ERISA Problem
   Tradeoffs