Changing the U.S. Health Care System
Key Issues in Health Services Policy and Management
4. Auflage Januar 2014
848 Seiten, Hardcover
Wiley & Sons Ltd
Kurzbeschreibung
The fourth edition of Changing the U. S. Health Systems addresses the key topics in health care policy and management. Like the previous editions, this important book presents evidence-based views of current issues. Each chapter is written by an expert in the field who integrates evidence to explain the current condition and presents support for needed change. It is especially ideal for students in health administration, public health, nursing, social work, and public administration. This edition will have deep coverage of health reform and its impact on all areas and regions of health services.
ISBN:
978-1-118-12891-6
John Wiley & Sons
The Fourth Edition of Changing the U.S. Health Care System addresses the key topics in health care policy and management, presenting evidence-based views of current issues. Each chapter is written by an expert in the field who integrates evidence to explain the current condition and presents support for needed change. The book examines all the levers in the setting and implementation of health policy, and includes extensive coverage of impact of the Affordable Care Act, particularly on Medicare, Medicaid, and large and small group insurance markets. Also new to this edition is expanded coverage of nursing, disease management, mental health, women's health, children's health, and care for the homeless.
Figures and Tables xv
Foreword to the Third Edition xix
Foreword to the Fourth Edition xxi
The Editor xxv
The Authors xxvii
Introduction and Overview xliii
Acknowledgments lvii
PART ONE: ACCESS TO HEALTH CARE 1
1 The Patient Protection and Affordable Care Act of 2010 3
Gerald F. Kominski
Learning Objectives 3
Events Leading to the Enactment of the ACA 4
Major Provisions of the ACA 7
Future Directions 20
Summary 25
Key Terms 26
Discussion Questions 28
2 Improving Access to Care 33
Ronald M. Andersen, Pamela L. Davidson, Sebastian E. Baumeister
Learning Objectives 33
Understanding Access to Health Care 34
Future Directions 60
Summary 63
Key Terms 63
Discussion Questions 64
3 Racial and Ethnic Disparities in Health Status 71
Antronette K. Yancey, Roshan Bastani, Beth A. Glenn
Learning Objectives 71
Epidemiology of Health Disparities 73
Factors Underlying Chronic Disease-Related Disparities 82
Future Directions 92
Summary 94
Key Terms 94
Discussion Questions 95
4 Racial and Ethnic Disparities in Health Care 103
Arturo Vargas Bustamante, Leo S. Morales, Alexander N. Ortega
Learning Objectives 103
Definition of Disparity in Health Care 105
Historical Overview of Disparities in Medical Care 109
Scientific Evidence of Disparities in Health Care 115
Future Directions 122
Summary 125
Key Terms 126
Discussion Questions 126
5 Multilevel Social Determinants of Health 135
Ninez A. Ponce, Michelle Ko
Learning Objectives 135
Policy Frameworks for Social Determinants of Health 137
Mechanisms by Which Social Context Affects Health Care 142
Future Directions 147
Summary 148
Key Terms 149
Discussion Questions 150
6 Public Health Insurance 157
Shana Alex Lavarreda, E. Richard Brown
Learning Objectives 157
Medicare, Medicaid, and CHIP 159
Who is Left Out of Public Coverage? 169
Enactment of the Affordable Care Act of 2010: A Political Success Story 179
Future Directions 183
Summary 183
Key Terms 184
Discussion Questions 185
7 Private Health Insurance 191
Nadereh Pourat, Gerald F. Kominski
Learning Objectives 191
Evolution of Private Health Insurance 192
Concepts in Private Health Insurance 194
Employment-Based Health Insurance 200
Individually Purchased Health Insurance 207
Significant Trends in Private Health Insurance 208
Future Directions 213
Summary 216
Key Terms 216
Discussion Questions 218
PART TWO: COST OF HEALTH CARE 223
8 Measuring Health Care Expenditures and Trends 225
Thomas H. Rice
Learning Objectives 225
Measuring Health Care Expenditures 226
Trends in Health Care Expenditures 233
Future Directions 239
Summary 239
Key Terms 242
Discussion Questions 243
9 Containing Health Care Costs 245
Thomas H. Rice, Gerald F. Kominski
Learning Objectives 245
Framework 246
Future Directions 263
Summary 264
Key Terms 264
Discussion Questions 265
10 Promoting Pharmaceutical Access While Controlling Prices and Expenditures 269
Stuart O. Schweitzer, William S. Comanor
Learning Objectives 269
The Problem of Drug Expenditures 271
Interpreting Pharmaceutical Price Data 275
International Price Comparisons 279
Determining Drug Prices 281
Approaches for Containing Pharmaceutical Costs 289
The Link Between Pharmaceutical Expenditures and Research 293
Recent Events Surrounding Pharmaceutical Costs and Access 294
Future Directions 298
Summary 298
Note 299
Key Terms 299
Discussion Questions 300
PART THREE: QUALITY OF HEALTH CARE 305
11 Measuring Health-Related Quality of Life and Other Outcomes 307
Patricia A. Ganz, Ron D. Hays, Robert M. Kaplan, Mark S. Litwin
Learning Objectives 307
Definition, Conceptualization, and Measurement of Quality of Life 310
Contributions From the Literature 318
Comparative Effectiveness Research 328
Future Directions 331
Summary 332
Key Terms 333
Discussion Questions 334
12 Evaluating the Quality of Care 343
Elizabeth A. McGlynn
Learning Objectives 343
The Multiple Dimensions of Quality 344
Criteria for Evaluating Quality Measures 345
A Conceptual Framework for Quality Assessment 347
Structure 348
Process 355
Outcomes 365
Future Directions 371
Summary 372
Key Terms 373
Discussion Questions 374
13 Public Release of Information on Quality 381
Elizabeth A. McGlynn, John L. Adams
Learning Objectives 381
Public Information on Quality 383
Some Methodological Issues in Performance Reporting 391
What is Known About the Impact of Public Reporting? 402
Future Directions 406
Summary 406
Key Terms 407
Discussion Questions 408
14 Health Care Information Systems 413
Jeff Luck, Leah J. Vriesman, Paul Fu Jr.
Learning Objectives 413
Information Systems and Informatics 414
Benefits, Implementation Barriers, and Federal Policy Responses 414
Applications of Information Systems by Health Care Providers 417
Public Health Informatics 434
Applications of Information Systems by Health Plans and Payers 438
Future Directions 441
Summary 445
Key Terms 445
Discussion Questions 446
15 Performance Measurement of Nursing Care 455
Jack Needleman, Ellen T. Kurtzman, Kenneth W. Kizer
Learning Objectives 455
Why Measure Nursing Performance? 455
The Scope of Nursing's Contribution to Inpatient Hospital Care 457
Issues in Constructing Nursing-Sensitive Performance Measures 461
Measuring Nursing Performance 463
Measuring Nursing Performance: The State of the Science 478
Future Directions 485
Summary 486
Key Terms 487
Discussion Questions 487
PART FOUR: SPECIAL POPULATIONS 493
16 Long-Term Services and Supports for the Elderly Population 495
Steven P. Wallace, Nadereh Pourat, Linda Delp, Kathryn G. Kietzman
Learning Objectives 495
Institutional Care 497
Community-Based Services 502
Informal Care 507
Workers in the Long-Term Care System 509
Future Directions 516
Summary 517
Note 517
Key Terms 517
Discussion Questions 518
17 HIV and AIDS in the Twenty-First Century 523
Erin G. Grinshteyn, William E. Cunningham
Learning Objectives 523
The Changing Epidemiology and Clinical Treatment of HIV/AIDS 525
Prevention and Education 538
Policy Implications and Research Needs for Management, Planning, and AIDS Policy 543
Future Directions 546
Summary 547
Key Terms 548
Discussion Questions 550
18 Children's Health 559
Moira Inkelas, Neal Halfon, David Lee Wood
Learning Objectives 559
Special Health Needs of Children 561
Health Service Delivery for U.S. Children 564
Financing Children's Health Care 569
Improving the Child Health System 576
Future Directions 585
Summary 585
Key Terms 586
Discussion Questions 587
19 Homeless Persons 593
Lisa Arangua, Lillian Gelberg
Learning Objectives 593
A Profile of the Homeless 594
Health Status 597
Mental Illness and Substance Abuse 604
Use of Physical Health Services 606
Use of Mental Health and Substance Abuse Services 608
Barriers to Health Care 609
Future Directions 610
Summary 612
Key Terms 612
Discussion Questions 613
PART FIVE: DIRECTIONS FOR CHANGE 621
20 Changing the Health Care Delivery System 623
Nadereh Pourat, Hector P. Rodriguez
Learning Objectives 623
Conceptual Framework: Intervention and Innovations to Correct System Failures 625
Future Directions 641
Summary 642
Key Terms 642
Discussion Questions 644
21 Medicare Reform 651
Gerald F. Kominski, Jeanne T. Black, Thomas H. Rice
Learning Objectives 651
Origin and Philosophy of Medicare 652
Evolution of Medicare 656
Is Medicare Facing a Crisis? 663
Future Directions 670
Summary 673
Key Terms 674
Discussion Questions 675
22 Public Health and Clinical Care 681
Jonathan E. Fielding, Lester Breslow, Steven M. Teutsch
Learning Objectives 681
Public Health's Mission and Scope 682
Prevention In Clinical Care Services 685
Public Health and Provision of Clinical Care Services 689
Direct Medical Service Delivery by Government 691
Future Directions 692
Summary 699
Key Terms 700
Discussion Questions 700
23 Strengthening the Safety Net 703
Dylan H. Roby
Learning Objectives 703
Defining the Safety Net 704
Ensuring Access to Care for the Poor, Uninsured, and Underserved 705
Financing the Safety Net 706
Size and Scope of the Safety Net 707
Reducing Costs 715
Improving Quality 716
Future Directions 719
Summary 719
Key Terms 720
Discussion Questions 721
24 Ethical Issues in Public Health and Health Services 727
Pauline Vaillancourt Rosenau, Ruth Roemer, Frederick J. Zimmerman
Learning Objectives 727
Overarching Public Health Principles: Our Assumptions 730
Ethical Issues in the Allocation of Resources 730
Ethical Issues in Research 737
Ethical Issues in Economic Support 738
Ethical Issues in Management of Health Services 740
Ethical Issues in Delivery of Care 741
Future Directions 744
Summary 745
Key Terms 746
Discussion Questions 747
Index 753
11181298573ENPreface xv
CHAPTER 1
Introduction to Systematic Trading 1
1.1 Definition of Systematic Trading 2
1.2 Philosophy of Trading 3
1.2.1 Lessons from the Market 3
1.2.2 Mechanism vs. Organism 5
1.2.3 The Edge of Complexity 5
1.2.4 Is Systematic Trading Reductionistic? 6
1.2.5 Reaction vs. Proaction 6
1.2.6 Arbitrage? 7
1.2.7 Two Viable Paths 7
1.3 The Business of Trading 7
1.3.1 Profitability and Track Record 8
1.3.2 The Product and Its Design 10
1.3.3 The Trading Factory 12
1.3.4 Marketing and Distribution 15
1.3.5 Capital, Costs, and Critical Mass 16
1.4 Psychology and Emotions 19
1.4.1 Ups and Downs 19
1.4.2 Peer Pressure and the Blame Game 20
1.4.3 Trust: Continuity of Quality 20
1.4.4 Learning from Each Other 21
1.5 From Candlesticks in Kyoto to FPGAs in Chicago 22
PART ONE
Strategy Design and Testing
CHAPTER 2
A New Socioeconomic Paradigm 33
2.1 Financial Theory vs. Market Reality 33
2.1.1 Adaptive Reactions vs. Rigid Anticipations 33
2.1.2 Accumulation vs. Divestment Games 37
2.1.3 Phase Transitions under Leverage 38
2.1.4 Derivatives: New Risks Do Not Project onto
Old Hedges 40
2.1.5 Socio-Political Dynamics and Feedbacks 41
2.2 The Market Is a Complex Adaptive System 42
2.2.1 Emergence 43
2.2.2 Intelligence Is Not Always Necessary 44
2.2.3 The Need to Adapt 45
2.3 Origins of Robotics and Artificial Life 45
CHAPTER 3
Analogies between Systematic Trading and Robotics 49
3.1 Models and Robots 49
3.2 The Trading Robot 50
3.3 Finite-State-Machine Representation of the
Control System 52
CHAPTER 4
Implementation of Strategies as Distributed Agents 57
4.1 Trading Agent 57
4.2 Events 60
4.3 Consuming Events 60
4.4 Updating Agents 61
4.5 Defining FSM Agents 63
4.6 Implementing a Strategy 66
CHAPTER 5
Inter-Agent Communications 73
5.1 Handling Communication Events 73
5.2 Emitting Messages and Running
Simulations 75
5.3 Implementation Example 76
CHAPTER 6
Data Representation Techniques 83
6.1 Data Relevance and Filtering of Information 83
6.2 Price and Order Book Updates 84
6.2.1 Elementary Price Events 85
6.2.2 Order Book Data 85
6.2.3 Tick Data: The Finest Grain 88
6.3 Sampling: Clock Time vs. Event Time 89
6.4 Compression 90
6.4.1 Slicing Time into Bars and Candles 90
6.4.2 Slicing Price into Boxes 96
6.4.3 Market Distributions 97
6.5 Representation 97
6.5.1 Charts and Technical Analysis 99
6.5.2 Translating Patterns into Symbols 101
6.5.3 Translating News into Numbers 102
6.5.4 Psychology of Data and Alerts 104
CHAPTER 7
Basic Trading Strategies 105
7.1 Trend-Following 105
7.1.1 Channel Breakout 106
7.1.2 Moving Averages 106
7.1.3 Swing Breakout 112
7.2 Acceleration 114
7.2.1 Trend Asymmetry 115
7.2.2 The Shadow Index 116
7.2.3 Trading Acceleration 117
7.3 Mean-Reversion 118
7.3.1 Swing Reversal 118
7.3.2 Range Projection 120
7.4 Intraday Patterns 122
7.4.1 Openings 122
7.4.2 Seasonality of Volatility 122
7.5 News-Driven Strategies 124
7.5.1 Expectations vs. Reality 124
7.5.2 Ontology-Driven Strategies 125
CHAPTER 8
Architecture for Market-Making 127
8.1 Traditional Market-Making: The Specialists 127
8.2 Conditional Market-Making: Open Outcry 128
8.3 Electronic Market-Making 129
8.4 Mixed Market-Making Model 131
8.5 An Architecture for a Market-Making Desk 134
CHAPTER 9
Combining Strategies into Portfolios 139
9.1 Aggregate Agents 139
9.2 Optimal Portfolios 141
9.3 Risk-Management of a Portfolio of Models 142
CHAPTER 10
Simulating Agent-Based Strategies 145
10.1 The Simulation Problem 146
10.2 Modeling the Order Management System 147
10.2.1 Orders and Algorithms 148
10.2.2 Simulating Slippage 149
10.2.3 Simulating Order Placement 151
10.2.4 Simulating Order Execution 153
10.2.5 A Model for the OMS 155
10.2.6 Operating the OMS 156
10.3 Running Simulations 158
10.3.1 Setting Up a Back Test 158
10.3.2 Setting Up a Forward Test 160
10.4 Analysis of Results 162
10.4.1 Continuous Statistics 163
10.4.2 Per-Trade Statistics 164
10.4.3 Parameter Search and Optimization 165
10.5 Degrees of Over-Fitting 167
PART TWO
Evolving Strategies
CHAPTER 11
Strategies for Adaptation 173
11.1 Avenues for Adaptations 173
11.2 The Cybernetics of Trading 175
CHAPTER 12
Feedback and Control 179
12.1 Looking at Markets through Models 179
12.1.1 Internal World 179
12.1.2 Strategies as Generalized Filters 180
12.1.3 Implicit Market Regimes 181
12.1.4 Persistence of Regimes 183
12.2 Fitness Feedback Control 184
12.2.1 Measures of Fitness 186
12.3 Robustness of Strategies 192
12.4 Efficiency of Control 193
12.4.1 Triggering Control 193
12.4.2 Measuring Efficiency of Control 194
12.4.3 Test Results 196
12.4.4 Optimizing Control Parameters 197
CHAPTER 13
Simple Swarm Systems 199
13.1 Switching Strategies 199
13.1.1 Switching between Regimes 200
13.1.2 Switching within the Same Regime 200
13.1.3 Mechanics of Switching and Transaction Costs 205
13.2 Strategy Neighborhoods 206
13.3 Choice of a Simple Individual from a Population 208
13.4 Additive Swarm System 210
13.4.1 Example of an Additive Swarm 211
13.5 Maximizing Swarm System 214
13.5.1 Example of a Maximizing Swarm 215
13.6 Global Performance Feedback Control 216
CHAPTER 14
Implementing Swarm Systems 219
14.1 Setting Up the Swarm Strategy Set 220
14.2 Running the Swarm 220
CHAPTER 15
Swarm Systems with Learning 223
15.1 Reinforcement Learning 224
15.2 Swarm Efficiency 224
15.3 Behavior Exploitation by the Swarm 225
15.4 Exploring New Behaviors 227
15.5 Lamark among the Machines 227
PART THREE
Optimizing Execution
CHAPTER 16
Analysis of Trading Costs 231
16.1 No Free Lunch 231
16.2 Slippage 232
16.3 Intraday Seasonality of Liquidity 233
16.4 Models of Market Impact 234
16.4.1 Reaction to Aggression 235
16.4.2 Limits to Openness 235
CHAPTER 17
Estimating Algorithmic Execution Tools 237
17.1 Basic Algorithmic Execution Tools 237
17.2 Estimation of Algorithmic Execution
Methodologies 240
17.2.1 A Simulation Engine for Algos 240
17.2.2 Using Execution Algo Results in Model
Estimation 241
17.2.3 Joint Testing of Models and Algos 242
PART FOUR
Practical Implementation
CHAPTER 18
Overview of a Scalable Architecture 247
18.1 ECNs and Translation 247
18.2 Aggregation and Disaggregation 249
18.3 Order Management 250
18.4 Controls 250
18.5 Decisions 251
18.6 Middle and Back Office 251
18.7 Recovery 252
CHAPTER 19
Principal Design Patterns 253
19.1 Language-Agnostic Domain Model 253
19.2 Solving Tasks in Adapted Languages 254
19.3 Communicating between Components 257
19.3.1 Messaging Bus 258
19.3.2 Remote Procedure Calls 259
19.4 Distributed Computing and Modularity 260
19.5 Parallel Processing 262
19.6 Garbage Collection and Memory Control 263
CHAPTER 20
Data Persistence 265
20.1 Business-Critical Data 265
20.2 Object Persistence and Cached Memory 267
20.3 Databases and Their Usage 269
CHAPTER 21
Fault Tolerance and Recovery Mechanisms 273
21.1 Situations of Stress 273
21.1.1 Communication Breakdown 273
21.1.2 External Systems Breakdown 274
21.1.3 Trades Busted at the ECN Level 275
21.1.4 Give-Up Errors Causing Credit Line Problems 276
21.1.5 Internal Systems Breakdown 277
21.1.6 Planned Maintenance and Upgrades 277
21.2 A Jam of Logs Is Better Than a Logjam of Errors 277
21.3 Virtual Machine and Network Monitoring 278
CHAPTER 22
Computational Efficiency 281
22.1 CPU Spikes 281
22.2 Recursive Computation of Model Signals
and Performance 282
22.3 Numeric Efficiency 285
CHAPTER 23
Connectivity to Electronic Commerce Networks 291
23.1 Adaptors 291
23.2 The Translation Layer 292
23.2.1 Orders: FIX 292
23.2.2 Specific ECNs 293
23.2.3 Price Sources: FAST 293
23.3 Dealing with Latency 294
23.3.1 External Constraints and Co-Location 294
23.3.2 Avoid Being Short the Latency Option 295
23.3.3 Synchronization under Constraints 296
23.3.4 Improving Internal Latency 297
CHAPTER 24
The Aggregation and Disaggregation Layer 299
24.1 Quotes Filtering and Book Aggregation 300
24.1.1 Filtering Quotes 300
24.1.2 Synthetic Order Book 301
24.2 Orders Aggregation and Fills Disaggregation 301
24.2.1 Aggregating Positions and Orders 301
24.2.2 Fills Disaggregation 303
24.2.3 Book Transfers and Middle Office 303
CHAPTER 25
The OMS Layer 305
25.1 Order Management as a Recursive Controller 305
25.1.1 Management of Positions 307
25.1.2 Management of Resting Orders 307
25.1.3 Algorithmic Orders 308
25.2 Control under Stress 309
25.3 Designing a Flexible OMS 310
CHAPTER 26
The Human Control Layer 311
26.1 Dashboard and Smart Scheduler 311
26.1.1 Parameter Control 311
26.1.2 Scheduled Flattening of Exposure 312
26.2 Manual Orders Aggregator 313
26.2.1 Representing a Trader by an Agent 313
26.2.2 Writing a Trading Screen 314
26.2.3 Monitoring Aggregated Streams 314
26.3 Position and P & L Monitor 314
26.3.1 Real-Time Exposure Monitor 315
26.3.2 Displaying Equity Curves 315
26.3.3 Online Trade Statistics and Fitnesses 315
26.3.4 Trades Visualization Module 317
CHAPTER 27
The Risk Management Layer 319
27.1 Risky Business 319
27.2 Automated Risk Management 320
27.3 Manual Risk Control and the Panic Button 320
CHAPTER 28
The Core Engine Layer 323
28.1 Architecture 323
28.2 Simulation and Recovery 325
CHAPTER 29
Some Practical Implementation Aspects 327
29.1 Architecture for Build and Patch Releases 327
29.1.1 Testing of Code before a Release 327
29.1.2 Versioning of Code and Builds 328
29.1.3 Persistence of State during Version Releases 328
29.2 Hardware Considerations 329
29.2.1 Bottleneck Analysis 329
29.2.2 The Edge of Technology 330
Appendix
Auxiliary LISP Functions 333
Bibliography 341
Index 351
Foreword to the Third Edition xix
Foreword to the Fourth Edition xxi
The Editor xxv
The Authors xxvii
Introduction and Overview xliii
Acknowledgments lvii
PART ONE: ACCESS TO HEALTH CARE 1
1 The Patient Protection and Affordable Care Act of 2010 3
Gerald F. Kominski
Learning Objectives 3
Events Leading to the Enactment of the ACA 4
Major Provisions of the ACA 7
Future Directions 20
Summary 25
Key Terms 26
Discussion Questions 28
2 Improving Access to Care 33
Ronald M. Andersen, Pamela L. Davidson, Sebastian E. Baumeister
Learning Objectives 33
Understanding Access to Health Care 34
Future Directions 60
Summary 63
Key Terms 63
Discussion Questions 64
3 Racial and Ethnic Disparities in Health Status 71
Antronette K. Yancey, Roshan Bastani, Beth A. Glenn
Learning Objectives 71
Epidemiology of Health Disparities 73
Factors Underlying Chronic Disease-Related Disparities 82
Future Directions 92
Summary 94
Key Terms 94
Discussion Questions 95
4 Racial and Ethnic Disparities in Health Care 103
Arturo Vargas Bustamante, Leo S. Morales, Alexander N. Ortega
Learning Objectives 103
Definition of Disparity in Health Care 105
Historical Overview of Disparities in Medical Care 109
Scientific Evidence of Disparities in Health Care 115
Future Directions 122
Summary 125
Key Terms 126
Discussion Questions 126
5 Multilevel Social Determinants of Health 135
Ninez A. Ponce, Michelle Ko
Learning Objectives 135
Policy Frameworks for Social Determinants of Health 137
Mechanisms by Which Social Context Affects Health Care 142
Future Directions 147
Summary 148
Key Terms 149
Discussion Questions 150
6 Public Health Insurance 157
Shana Alex Lavarreda, E. Richard Brown
Learning Objectives 157
Medicare, Medicaid, and CHIP 159
Who is Left Out of Public Coverage? 169
Enactment of the Affordable Care Act of 2010: A Political Success Story 179
Future Directions 183
Summary 183
Key Terms 184
Discussion Questions 185
7 Private Health Insurance 191
Nadereh Pourat, Gerald F. Kominski
Learning Objectives 191
Evolution of Private Health Insurance 192
Concepts in Private Health Insurance 194
Employment-Based Health Insurance 200
Individually Purchased Health Insurance 207
Significant Trends in Private Health Insurance 208
Future Directions 213
Summary 216
Key Terms 216
Discussion Questions 218
PART TWO: COST OF HEALTH CARE 223
8 Measuring Health Care Expenditures and Trends 225
Thomas H. Rice
Learning Objectives 225
Measuring Health Care Expenditures 226
Trends in Health Care Expenditures 233
Future Directions 239
Summary 239
Key Terms 242
Discussion Questions 243
9 Containing Health Care Costs 245
Thomas H. Rice, Gerald F. Kominski
Learning Objectives 245
Framework 246
Future Directions 263
Summary 264
Key Terms 264
Discussion Questions 265
10 Promoting Pharmaceutical Access While Controlling Prices and Expenditures 269
Stuart O. Schweitzer, William S. Comanor
Learning Objectives 269
The Problem of Drug Expenditures 271
Interpreting Pharmaceutical Price Data 275
International Price Comparisons 279
Determining Drug Prices 281
Approaches for Containing Pharmaceutical Costs 289
The Link Between Pharmaceutical Expenditures and Research 293
Recent Events Surrounding Pharmaceutical Costs and Access 294
Future Directions 298
Summary 298
Note 299
Key Terms 299
Discussion Questions 300
PART THREE: QUALITY OF HEALTH CARE 305
11 Measuring Health-Related Quality of Life and Other Outcomes 307
Patricia A. Ganz, Ron D. Hays, Robert M. Kaplan, Mark S. Litwin
Learning Objectives 307
Definition, Conceptualization, and Measurement of Quality of Life 310
Contributions From the Literature 318
Comparative Effectiveness Research 328
Future Directions 331
Summary 332
Key Terms 333
Discussion Questions 334
12 Evaluating the Quality of Care 343
Elizabeth A. McGlynn
Learning Objectives 343
The Multiple Dimensions of Quality 344
Criteria for Evaluating Quality Measures 345
A Conceptual Framework for Quality Assessment 347
Structure 348
Process 355
Outcomes 365
Future Directions 371
Summary 372
Key Terms 373
Discussion Questions 374
13 Public Release of Information on Quality 381
Elizabeth A. McGlynn, John L. Adams
Learning Objectives 381
Public Information on Quality 383
Some Methodological Issues in Performance Reporting 391
What is Known About the Impact of Public Reporting? 402
Future Directions 406
Summary 406
Key Terms 407
Discussion Questions 408
14 Health Care Information Systems 413
Jeff Luck, Leah J. Vriesman, Paul Fu Jr.
Learning Objectives 413
Information Systems and Informatics 414
Benefits, Implementation Barriers, and Federal Policy Responses 414
Applications of Information Systems by Health Care Providers 417
Public Health Informatics 434
Applications of Information Systems by Health Plans and Payers 438
Future Directions 441
Summary 445
Key Terms 445
Discussion Questions 446
15 Performance Measurement of Nursing Care 455
Jack Needleman, Ellen T. Kurtzman, Kenneth W. Kizer
Learning Objectives 455
Why Measure Nursing Performance? 455
The Scope of Nursing's Contribution to Inpatient Hospital Care 457
Issues in Constructing Nursing-Sensitive Performance Measures 461
Measuring Nursing Performance 463
Measuring Nursing Performance: The State of the Science 478
Future Directions 485
Summary 486
Key Terms 487
Discussion Questions 487
PART FOUR: SPECIAL POPULATIONS 493
16 Long-Term Services and Supports for the Elderly Population 495
Steven P. Wallace, Nadereh Pourat, Linda Delp, Kathryn G. Kietzman
Learning Objectives 495
Institutional Care 497
Community-Based Services 502
Informal Care 507
Workers in the Long-Term Care System 509
Future Directions 516
Summary 517
Note 517
Key Terms 517
Discussion Questions 518
17 HIV and AIDS in the Twenty-First Century 523
Erin G. Grinshteyn, William E. Cunningham
Learning Objectives 523
The Changing Epidemiology and Clinical Treatment of HIV/AIDS 525
Prevention and Education 538
Policy Implications and Research Needs for Management, Planning, and AIDS Policy 543
Future Directions 546
Summary 547
Key Terms 548
Discussion Questions 550
18 Children's Health 559
Moira Inkelas, Neal Halfon, David Lee Wood
Learning Objectives 559
Special Health Needs of Children 561
Health Service Delivery for U.S. Children 564
Financing Children's Health Care 569
Improving the Child Health System 576
Future Directions 585
Summary 585
Key Terms 586
Discussion Questions 587
19 Homeless Persons 593
Lisa Arangua, Lillian Gelberg
Learning Objectives 593
A Profile of the Homeless 594
Health Status 597
Mental Illness and Substance Abuse 604
Use of Physical Health Services 606
Use of Mental Health and Substance Abuse Services 608
Barriers to Health Care 609
Future Directions 610
Summary 612
Key Terms 612
Discussion Questions 613
PART FIVE: DIRECTIONS FOR CHANGE 621
20 Changing the Health Care Delivery System 623
Nadereh Pourat, Hector P. Rodriguez
Learning Objectives 623
Conceptual Framework: Intervention and Innovations to Correct System Failures 625
Future Directions 641
Summary 642
Key Terms 642
Discussion Questions 644
21 Medicare Reform 651
Gerald F. Kominski, Jeanne T. Black, Thomas H. Rice
Learning Objectives 651
Origin and Philosophy of Medicare 652
Evolution of Medicare 656
Is Medicare Facing a Crisis? 663
Future Directions 670
Summary 673
Key Terms 674
Discussion Questions 675
22 Public Health and Clinical Care 681
Jonathan E. Fielding, Lester Breslow, Steven M. Teutsch
Learning Objectives 681
Public Health's Mission and Scope 682
Prevention In Clinical Care Services 685
Public Health and Provision of Clinical Care Services 689
Direct Medical Service Delivery by Government 691
Future Directions 692
Summary 699
Key Terms 700
Discussion Questions 700
23 Strengthening the Safety Net 703
Dylan H. Roby
Learning Objectives 703
Defining the Safety Net 704
Ensuring Access to Care for the Poor, Uninsured, and Underserved 705
Financing the Safety Net 706
Size and Scope of the Safety Net 707
Reducing Costs 715
Improving Quality 716
Future Directions 719
Summary 719
Key Terms 720
Discussion Questions 721
24 Ethical Issues in Public Health and Health Services 727
Pauline Vaillancourt Rosenau, Ruth Roemer, Frederick J. Zimmerman
Learning Objectives 727
Overarching Public Health Principles: Our Assumptions 730
Ethical Issues in the Allocation of Resources 730
Ethical Issues in Research 737
Ethical Issues in Economic Support 738
Ethical Issues in Management of Health Services 740
Ethical Issues in Delivery of Care 741
Future Directions 744
Summary 745
Key Terms 746
Discussion Questions 747
Index 753
11181298573ENPreface xv
CHAPTER 1
Introduction to Systematic Trading 1
1.1 Definition of Systematic Trading 2
1.2 Philosophy of Trading 3
1.2.1 Lessons from the Market 3
1.2.2 Mechanism vs. Organism 5
1.2.3 The Edge of Complexity 5
1.2.4 Is Systematic Trading Reductionistic? 6
1.2.5 Reaction vs. Proaction 6
1.2.6 Arbitrage? 7
1.2.7 Two Viable Paths 7
1.3 The Business of Trading 7
1.3.1 Profitability and Track Record 8
1.3.2 The Product and Its Design 10
1.3.3 The Trading Factory 12
1.3.4 Marketing and Distribution 15
1.3.5 Capital, Costs, and Critical Mass 16
1.4 Psychology and Emotions 19
1.4.1 Ups and Downs 19
1.4.2 Peer Pressure and the Blame Game 20
1.4.3 Trust: Continuity of Quality 20
1.4.4 Learning from Each Other 21
1.5 From Candlesticks in Kyoto to FPGAs in Chicago 22
PART ONE
Strategy Design and Testing
CHAPTER 2
A New Socioeconomic Paradigm 33
2.1 Financial Theory vs. Market Reality 33
2.1.1 Adaptive Reactions vs. Rigid Anticipations 33
2.1.2 Accumulation vs. Divestment Games 37
2.1.3 Phase Transitions under Leverage 38
2.1.4 Derivatives: New Risks Do Not Project onto
Old Hedges 40
2.1.5 Socio-Political Dynamics and Feedbacks 41
2.2 The Market Is a Complex Adaptive System 42
2.2.1 Emergence 43
2.2.2 Intelligence Is Not Always Necessary 44
2.2.3 The Need to Adapt 45
2.3 Origins of Robotics and Artificial Life 45
CHAPTER 3
Analogies between Systematic Trading and Robotics 49
3.1 Models and Robots 49
3.2 The Trading Robot 50
3.3 Finite-State-Machine Representation of the
Control System 52
CHAPTER 4
Implementation of Strategies as Distributed Agents 57
4.1 Trading Agent 57
4.2 Events 60
4.3 Consuming Events 60
4.4 Updating Agents 61
4.5 Defining FSM Agents 63
4.6 Implementing a Strategy 66
CHAPTER 5
Inter-Agent Communications 73
5.1 Handling Communication Events 73
5.2 Emitting Messages and Running
Simulations 75
5.3 Implementation Example 76
CHAPTER 6
Data Representation Techniques 83
6.1 Data Relevance and Filtering of Information 83
6.2 Price and Order Book Updates 84
6.2.1 Elementary Price Events 85
6.2.2 Order Book Data 85
6.2.3 Tick Data: The Finest Grain 88
6.3 Sampling: Clock Time vs. Event Time 89
6.4 Compression 90
6.4.1 Slicing Time into Bars and Candles 90
6.4.2 Slicing Price into Boxes 96
6.4.3 Market Distributions 97
6.5 Representation 97
6.5.1 Charts and Technical Analysis 99
6.5.2 Translating Patterns into Symbols 101
6.5.3 Translating News into Numbers 102
6.5.4 Psychology of Data and Alerts 104
CHAPTER 7
Basic Trading Strategies 105
7.1 Trend-Following 105
7.1.1 Channel Breakout 106
7.1.2 Moving Averages 106
7.1.3 Swing Breakout 112
7.2 Acceleration 114
7.2.1 Trend Asymmetry 115
7.2.2 The Shadow Index 116
7.2.3 Trading Acceleration 117
7.3 Mean-Reversion 118
7.3.1 Swing Reversal 118
7.3.2 Range Projection 120
7.4 Intraday Patterns 122
7.4.1 Openings 122
7.4.2 Seasonality of Volatility 122
7.5 News-Driven Strategies 124
7.5.1 Expectations vs. Reality 124
7.5.2 Ontology-Driven Strategies 125
CHAPTER 8
Architecture for Market-Making 127
8.1 Traditional Market-Making: The Specialists 127
8.2 Conditional Market-Making: Open Outcry 128
8.3 Electronic Market-Making 129
8.4 Mixed Market-Making Model 131
8.5 An Architecture for a Market-Making Desk 134
CHAPTER 9
Combining Strategies into Portfolios 139
9.1 Aggregate Agents 139
9.2 Optimal Portfolios 141
9.3 Risk-Management of a Portfolio of Models 142
CHAPTER 10
Simulating Agent-Based Strategies 145
10.1 The Simulation Problem 146
10.2 Modeling the Order Management System 147
10.2.1 Orders and Algorithms 148
10.2.2 Simulating Slippage 149
10.2.3 Simulating Order Placement 151
10.2.4 Simulating Order Execution 153
10.2.5 A Model for the OMS 155
10.2.6 Operating the OMS 156
10.3 Running Simulations 158
10.3.1 Setting Up a Back Test 158
10.3.2 Setting Up a Forward Test 160
10.4 Analysis of Results 162
10.4.1 Continuous Statistics 163
10.4.2 Per-Trade Statistics 164
10.4.3 Parameter Search and Optimization 165
10.5 Degrees of Over-Fitting 167
PART TWO
Evolving Strategies
CHAPTER 11
Strategies for Adaptation 173
11.1 Avenues for Adaptations 173
11.2 The Cybernetics of Trading 175
CHAPTER 12
Feedback and Control 179
12.1 Looking at Markets through Models 179
12.1.1 Internal World 179
12.1.2 Strategies as Generalized Filters 180
12.1.3 Implicit Market Regimes 181
12.1.4 Persistence of Regimes 183
12.2 Fitness Feedback Control 184
12.2.1 Measures of Fitness 186
12.3 Robustness of Strategies 192
12.4 Efficiency of Control 193
12.4.1 Triggering Control 193
12.4.2 Measuring Efficiency of Control 194
12.4.3 Test Results 196
12.4.4 Optimizing Control Parameters 197
CHAPTER 13
Simple Swarm Systems 199
13.1 Switching Strategies 199
13.1.1 Switching between Regimes 200
13.1.2 Switching within the Same Regime 200
13.1.3 Mechanics of Switching and Transaction Costs 205
13.2 Strategy Neighborhoods 206
13.3 Choice of a Simple Individual from a Population 208
13.4 Additive Swarm System 210
13.4.1 Example of an Additive Swarm 211
13.5 Maximizing Swarm System 214
13.5.1 Example of a Maximizing Swarm 215
13.6 Global Performance Feedback Control 216
CHAPTER 14
Implementing Swarm Systems 219
14.1 Setting Up the Swarm Strategy Set 220
14.2 Running the Swarm 220
CHAPTER 15
Swarm Systems with Learning 223
15.1 Reinforcement Learning 224
15.2 Swarm Efficiency 224
15.3 Behavior Exploitation by the Swarm 225
15.4 Exploring New Behaviors 227
15.5 Lamark among the Machines 227
PART THREE
Optimizing Execution
CHAPTER 16
Analysis of Trading Costs 231
16.1 No Free Lunch 231
16.2 Slippage 232
16.3 Intraday Seasonality of Liquidity 233
16.4 Models of Market Impact 234
16.4.1 Reaction to Aggression 235
16.4.2 Limits to Openness 235
CHAPTER 17
Estimating Algorithmic Execution Tools 237
17.1 Basic Algorithmic Execution Tools 237
17.2 Estimation of Algorithmic Execution
Methodologies 240
17.2.1 A Simulation Engine for Algos 240
17.2.2 Using Execution Algo Results in Model
Estimation 241
17.2.3 Joint Testing of Models and Algos 242
PART FOUR
Practical Implementation
CHAPTER 18
Overview of a Scalable Architecture 247
18.1 ECNs and Translation 247
18.2 Aggregation and Disaggregation 249
18.3 Order Management 250
18.4 Controls 250
18.5 Decisions 251
18.6 Middle and Back Office 251
18.7 Recovery 252
CHAPTER 19
Principal Design Patterns 253
19.1 Language-Agnostic Domain Model 253
19.2 Solving Tasks in Adapted Languages 254
19.3 Communicating between Components 257
19.3.1 Messaging Bus 258
19.3.2 Remote Procedure Calls 259
19.4 Distributed Computing and Modularity 260
19.5 Parallel Processing 262
19.6 Garbage Collection and Memory Control 263
CHAPTER 20
Data Persistence 265
20.1 Business-Critical Data 265
20.2 Object Persistence and Cached Memory 267
20.3 Databases and Their Usage 269
CHAPTER 21
Fault Tolerance and Recovery Mechanisms 273
21.1 Situations of Stress 273
21.1.1 Communication Breakdown 273
21.1.2 External Systems Breakdown 274
21.1.3 Trades Busted at the ECN Level 275
21.1.4 Give-Up Errors Causing Credit Line Problems 276
21.1.5 Internal Systems Breakdown 277
21.1.6 Planned Maintenance and Upgrades 277
21.2 A Jam of Logs Is Better Than a Logjam of Errors 277
21.3 Virtual Machine and Network Monitoring 278
CHAPTER 22
Computational Efficiency 281
22.1 CPU Spikes 281
22.2 Recursive Computation of Model Signals
and Performance 282
22.3 Numeric Efficiency 285
CHAPTER 23
Connectivity to Electronic Commerce Networks 291
23.1 Adaptors 291
23.2 The Translation Layer 292
23.2.1 Orders: FIX 292
23.2.2 Specific ECNs 293
23.2.3 Price Sources: FAST 293
23.3 Dealing with Latency 294
23.3.1 External Constraints and Co-Location 294
23.3.2 Avoid Being Short the Latency Option 295
23.3.3 Synchronization under Constraints 296
23.3.4 Improving Internal Latency 297
CHAPTER 24
The Aggregation and Disaggregation Layer 299
24.1 Quotes Filtering and Book Aggregation 300
24.1.1 Filtering Quotes 300
24.1.2 Synthetic Order Book 301
24.2 Orders Aggregation and Fills Disaggregation 301
24.2.1 Aggregating Positions and Orders 301
24.2.2 Fills Disaggregation 303
24.2.3 Book Transfers and Middle Office 303
CHAPTER 25
The OMS Layer 305
25.1 Order Management as a Recursive Controller 305
25.1.1 Management of Positions 307
25.1.2 Management of Resting Orders 307
25.1.3 Algorithmic Orders 308
25.2 Control under Stress 309
25.3 Designing a Flexible OMS 310
CHAPTER 26
The Human Control Layer 311
26.1 Dashboard and Smart Scheduler 311
26.1.1 Parameter Control 311
26.1.2 Scheduled Flattening of Exposure 312
26.2 Manual Orders Aggregator 313
26.2.1 Representing a Trader by an Agent 313
26.2.2 Writing a Trading Screen 314
26.2.3 Monitoring Aggregated Streams 314
26.3 Position and P & L Monitor 314
26.3.1 Real-Time Exposure Monitor 315
26.3.2 Displaying Equity Curves 315
26.3.3 Online Trade Statistics and Fitnesses 315
26.3.4 Trades Visualization Module 317
CHAPTER 27
The Risk Management Layer 319
27.1 Risky Business 319
27.2 Automated Risk Management 320
27.3 Manual Risk Control and the Panic Button 320
CHAPTER 28
The Core Engine Layer 323
28.1 Architecture 323
28.2 Simulation and Recovery 325
CHAPTER 29
Some Practical Implementation Aspects 327
29.1 Architecture for Build and Patch Releases 327
29.1.1 Testing of Code before a Release 327
29.1.2 Versioning of Code and Builds 328
29.1.3 Persistence of State during Version Releases 328
29.2 Hardware Considerations 329
29.2.1 Bottleneck Analysis 329
29.2.2 The Edge of Technology 330
Appendix
Auxiliary LISP Functions 333
Bibliography 341
Index 351
Gerald F. Kominski, PhD, is professor, Department of Health Policy and Management in the UCLA Fielding School of Public Health, and director of UCLA Center for Health Policy Research. He is co-developer of the California Simulation of Insurance Markets (CalSIM) model currently being used to estimate eligibility and enrollment in health insurance exchanges in California and Hawaii.