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Now in its fourth edition, this book defines and illustrates the application of effectiveness, efficiency, and equity criteria for evaluating health services system performance. It integrates the theories, issues, approaches, and methods of health services research, providing an excellent framework for understanding health services systems and change. The authors take a broad and integrative look at the role of public health and personal care services in enhancing community well-being. This edition has been revised and updated throughout and includes the following new features:

• Two new discussions have been added on the nature of the health policymaking process and problems in health policy research.
• The section on populations at risk has been expanded to reflect recent literature on equity disparities related to predisposing, enabling, and need-related characteristics.
• The discussion of realized access has been revised to emphasize the mutable factors shown to contribute to disparities in health and in access to health services (such as insurance and education).
• Information about the Patient Protection and Affordable Care Act has been incorporated throughout the text
• Pay for performance, accountable care organizations, and medical homes are introduced as newer payment and care delivery models designed to improve the efficiency and quality of health services in the United States.
• The book concludes with a comprehensive new case study illustrating the application and integration of the three perspectives of health services research in evaluating a recent policy change.