This book provides a straightforward explanation of the complex health services system. It explains the basic concepts as well as current issues to clarify how the U.S. health services system is organized, managed, and financed. This edition addresses the many changes happening in the U.S. health care system and updates data and statistics so readers can understand and discuss the current issues. New in the fourth edition: An update on the changes to Medicare coverage, including adding means testing on optional coverage for beneficiaries, a new discussion of the legislation the current administration would like to implement for universal healthcare coverage, a new focus on the quality-of-care debate and pay-for-performance incentives, new requirements for not-for-profit hospitals to report services provided in order to validate their tax status An update on managed care and how universal coverage could change payment and delivery Updated information on biomedical research and the debate on whether the United States will remain a leader in this effort, a new discussion of the effects of the current economic downturn on healthcare An updated discussion on the status of the healthcare workforce and how nursing and possible physician shortages will affect our system, a discussion on health care expenditures and the estimated 47 million people who are currently uninsured, a master bibliography has been created and is now located at the back of the book, updated glossary and acronym list.