Governments Role in U.S. Health Care

Chapter 4

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LEARNING OBJECTIVES

The student will be able to:

Describe five government organizations and their roles in health care.

Explain the importance of the National Association of County and City Health Officials in health care.

Analyze the integration of the collaboration of the Department of Homeland Security and the Federal Emergency Management Agency and its importance to disaster management.

Describe the role of the National Institutes of Health in healthcare research.

Discuss the U.S. Food and Drug Administrations regulatory responsibility in health care.

Evaluate the role of the Centers for Medicare and Medicaid Services in health care.

DID YOU KNOW THAT?

Social regulation focuses on actions such as those in the healthcare industry that impact an individuals safety or well-being.

The U.S. Surgeon General is the chief health educator in the United States.

The Food and Drug Administration is responsible for accrediting and inspecting mammography facilities.

Over the last several years, there has been a trend to regionalize local health departments in order to maximize population services.

The Department of Homeland Security is responsible for ensuring that all government levels have an emergency preparedness plan for catastrophic events.

INTRODUCTION

During the Depression and World War II the United States had no funds to start a universal healthcare programan issue that had been discussed for years. As a result, a private sector system was developed that did not provide healthcare services to all citizens. However, the governments role of providing healthcare coverage evolved as a regulatory body to ensure that the elderly and poor were able to receive health care. The passage of the Social Security Act of 1935 and the establishment of the Medicaid and Medicare programs in 1965 mandated the governments increased role in providing healthcare coverage. Also, the State Childrens Health Insurance Program (SCHIP), now the Childrens Health Insurance Program, established in 1997 and reauthorized by the Affordable Care Act (ACA) through 2019 with extended funding through 2015, continues to expand the governments role in childrens health care (CHIP, 2013). In addition to the reauthorization of the SCHIP program, the ACA has increased government interaction with the healthcare system by developing several of the government initiatives that focus on increasing the ability of individuals to make informed decisions about their health care.

In these instances, the government increased accessibility to health care as well as provided financing for health care to certain targeted populations. This chapter will focus on the different roles the federal, state, and local governments play in the U.S. healthcare system. This chapter will also highlight different government programs and regulations that focus on monitoring how health care is provided.

HISTORY OF THE ROLE OF GOVERNMENT IN HEALTH CARE

Social regulation focuses on organizations actions, such as those in the healthcare industry, that impact an individuals safety. Social regulations focus on protecting individuals as employees and consumers (Carroll & Buchholtz, 2009). These types of regulations are common in the U.S. healthcare system. The healthcare industry claims it is the most regulated industry in the world. It is important to mention that government regulations aside, there are nongovernmental regulations of U.S. health care by accrediting bodies such as the Joint Commission, which began over 80 years ago and accredits over 20,000 healthcare organizations (The Joint Commission, 2013). However, regulatory oversight is mainly handled at the federal, state, and local government levels.

U.S. GOVERNMENT AGENCIES

Regulatory healthcare power is shared among federal and state governments. State governments have a dominant role of regulating constituents in their jurisdiction. To assure success in this regulatory process, state governments also developed local government levels to provide direct services to constituents and regulate their geographic region. Their legal authority is derived from legislatures that establish the legal framework for their authority (Jonas, 2003).

Important Federal Government Agencies

Many federal agencies are responsible for a sector of healthcare. The U.S. Department of Health and Human Services (HHS) is the most important federal agency. HHS collaborates with state and local governments because many HHS services are provided at those levels. There are 11 operating divisions: the Centers for Disease Control and Prevention (CDC), Administration for Community Living (ACL), National Institutes of Health (NIH), Agency for Toxic Substances and Disease Registry (ATSDR), Indian Health Service (IHS), the Health Resources and Services Administration (HRSA), the Agency for Healthcare Research and Quality (AHRQ), the Substance Abuse and Mental Health Services Administration (SAMHSA), the U.S. Food and Drug Administration (FDA), Administration for Children and Families (ACF), and the Centers for Medicare and Medicaid Services (CMS). Each of these agencies will be discussed individually (HHS, 2013).

Centers for Disease Control and Prevention (CDC)

Established in 1946 and headquartered in Atlanta, Georgia, the CDCs mission is to protect health and promote quality of life through the prevention and control of disease, injury, and disability. The CDC has created four health goals that focus on (1) healthy people in healthy places, (2) preparing people for emerging health threats, (3) positive international health, and (4) healthy people at all stages of their life. To achieve these goals, the CDC focuses on six areas: health impact, customer focus, public health research, leadership, globalization, and accountability. On the CDC website, they provide information on disease, healthy living, emergency preparedness, injury prevention, environmental health, workplace safety, data and statistics, and global health. They also provide specific information for traveler, infant and children, pregnancies, and state and tribal associations (CDC, 2013).

Administration for Community Living (ACL)

All Americansincluding people with disabilities and older adultsshould be able to live at home with the supports they need, participating in communities that value their contributions. To help meet these needs, the HHS created a new organization, the ACL.

Established in 2012, the ACL brings together the efforts and achievements of the Administration on Aging, the Administration on Intellectual and Developmental Disabilities, and the HHS Office on Disability to serve as the federal agency responsible for increasing access to community supports, while focusing attention and resources on the unique needs of older Americans and people with disabilities across the lifespan.

The ACL mission is to maximize the independence, well being, and health of older adults, people with disabilities across the lifespan, and their families and caregivers (ACL, 2013).

Agency for Toxic Substances and Disease Registry (ATSDR)

Established in 1985, headquartered in Atlanta, Georgia, and authorized by the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA; more commonly known as the Superfund law), ATSDR is responsible for finding and cleaning the most dangerous hazardous waste sites in the country. ATSDRs mission is to protect the public against harmful exposures and disease-related exposures to toxic substances. ATSDR is the lead federal public health agency responsible for determining human health effects associated with toxic exposures, preventing continued exposures, and mitigating associated human health risks. ATSDR is administered organizationally with the CDC. The ATSDR has 10 regional offices within the Environmental Protection Agency (EPA) across the country (ATSDR, 2013).

National Institutes of Health (NIH)

Established in 1930 and headquartered in Bethesda, Maryland, this agency is the primary federal agency for research toward preventing and curing disease worldwide. Its mission is the pursuit of knowledge about the nature and behavior of living systems and the application of that knowledge to extend healthy life and reduce the burdens of illness and disability. They have 27 institutes and centers that focus on different diseases and conditions including cancer, ophthalmology, heart and lung and blood, genes, aging, alcoholism and drug abuse, infectious diseases, chronic diseases, childrens diseases, and mental health. Although they have sponsored external research, they also have a large internal research program (NIH, 2013).

The Health Resources and Services Administration (HRSA)

Created in 1982 and headquartered in Rockville, Maryland, the HRSA is the primary federal agency for improving access to healthcare services for people in every state who are uninsured, isolated, or medically vulnerable. They have six bureaus: primary health care, health professions, healthcare systems, maternal and child, the HIV/AIDS bureau, and the Bureau of Clinician Recruitment and Service. HRSA provides funding to grantees that provide health care to those vulnerable populations. They also oversee organ, bone marrow, and cord blood donation; support programs against bioterrorism; and maintain databases that protect against healthcare malpractice and healthcare waste, fraud, and abuse. Tens of millions of Americans get affordable health care and other help through HRSAs 100-plus programs and more than 3,000 grantees (HRSA, 2013).

The Agency for Healthcare Research and Quality (AHRQ)

Created in 1989 and headquartered in Rockville, Maryland, the agencys mission is to improve the quality, safety, efficiency, and effectiveness of health care for all U.S. citizens. AHRQs cutting edge research helps people make more informed decisions and improve the quality of healthcare services. AHRQ focuses on the following areas of research: healthcare costs and utilization, information technology, disaster preparedness, medication safety, healthcare consumerism, prevention of illness, and special needs populations (AHRQ, 2013). There is a Coalition for Health Services Research (CHSR), an organization of volunteers who advocate for the AHRQ. It is comprised of more than 250 nonprofit organizations that support the AHRQ. They send letters to Congress encouraging more funds for research (CHSR, 2013).

Indian Health Service (IHS)

Established in 1921 and headquartered in Rockville, Maryland, the mission of IHS is to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level. It is also their mission to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native people. They are also responsible to promote their communities and cultures and to honor and protect the inherent sovereign rights of these people. The IHS provides a comprehensive health service delivery system for approximately 1.9 million American Indians and Alaska Natives who belong to 566 federally recognized tribes (IHS, 2013).

The Substance Abuse and Mental Health Services Administration (SAMHSA)

Established in 1992, the SAMHSA is the main federal agency for improving access to quality substance abuse and mental health services in the United States by working with state, community, and private organizations. SAMHSA is the umbrella agency for mental health and substance abuse services, which includes the Center for Mental Health Services (CMHS), the Center for Substance Abuse Prevention (CSAP), and the Center for Substance Abuse Treatment (CSAT). The Center for Behavioral Health Statistics and Quality (CBHSQ) is responsible for data collection, analysis, and dissemination of critical health data to assist policymakers, providers, and the public for the use in making informed decisions regarding the prevention and treatment of mental and substance use disorders (SAMHSA, 2013).

U.S. Food and Drug Administration (FDA)

Established in 1906 as a result of the Federal Food, Drug, and Cosmetic Act, the FDA is responsible for ensuring that the following products are safe: food, human and veterinary products, biologic products, medical devices, cosmetics, and electronic products. The FDA is also responsible for ensuring that product information is accurate. The following is a summary of FDA responsibility for each category:

1. Food: The FDA ensures that labeling of food has accurate information. Also, they regulate the safety of all food except poultry and meat. They also oversee bottled water.

2. Veterinary products: The FDA has oversight of the production of livestock feed, pet food, and veterinary drugs and devices.

3. Human drugs: The FDA has regulatory oversight of both prescription and over-the-counter (OTC) drug development and labeling, which includes the manufacturing standards for these drug products.

4. Medical devices: The FDA has the authority for premarket approval for any new devices as well as developing standards for their manufacturing and performance. They also must track reports of any malfunction of these devices.

5. Cosmetics: The FDA oversees both the safety and labeling of cosmetic products.

6. Electronic products: The FDA must develop and regulate standards for microwaves, television receivers, and diagnostic equipment such as X-ray equipment, laser products, ultrasonic therapy equipment, and sunla

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