Question

What are some forms of regulation in the healthcare industry? Provide detailed explanation for each.

Answer 1

Ans) Some regulatory agencies that protect and regulate public health are:

- The Centers for Medicare and Medicaid (CMS) oversee most of the regulations related directly to the health care system. CMS provides government-subsidized medical coverage through a number of programs:

• Medicare for the elderly and disabled
• Medicaid for lower-income individuals and families
• State Children’s Health Insurance Program (SCHIP) for health insurance coverage for children under 19

- CMS is also responsible for ensuring compliance to the Health Insurance Portability and Accountability Act (HIPAA). HIPAA, which works to reduce costs while protecting patients and providing better medical care, is a major piece of health care regulation and was instituted to improve the efficiency and effectiveness of the health care system.

- The Agency for Healthcare Research and Quality (AHRQ) is another agency that falls under the U.S. Department of Health & Human Services (HHS). It conducts research aimed at improving the quality of health care, reducing costs and addressing patient safety and medical errors.

There are also several non-profit organizations that serve as watchdogs and accreditation institutions for health care in America:

• The Joint Commission on Accreditation of Health Care Organizations (JCAHO) works to ensure that health Care organizations provide quality care. JCAHO employs a system in which health care organizations are examined and then given a score of 1-100, with higher scores being better. These scores are important to health care organizations as they are a factor when determining reimbursement from Medicare.
• The National Committee for Quality Assurance (NCQA) ensures the quality of managed care plans. It was established in 1991 to provide standard and objective information about HMOs.

Other Public Health Regulation

In addition to the CMS programs, the HHS has many other regulatory departments that oversee other forms of public health regulation.

• The Centers for Disease Control and Prevention (CDC) in Atlanta examines public health and warns of possible health threats from infectious diseases. The CDC monitors birth defects, disabilities, diseases and conditions, emergency preparedness and response, environmental health, genetics and genomics, health promotion, injury and violence, travelers’ health, vaccines and immunizations and workplace safety and health. The CDC is currently working closely with national, local and international health organizations, including the World Health Organization, to control the transmission of the Ebola virus.
• The Food and Drug Administration (FDA) is the federal regulatory agency responsible for controlling the safety and effectiveness of the country’s drug supply for both humans and animals. The FDA regulates food safety, cosmetics, feed supply for animals, dietary supplements and biologics as well as the national blood supply, medical devices, food additives, product recalls and restaurant inspections.
• The United States Agency for Toxic Substances and Disease Registry (ATSDR) monitors and regulates the effects of hazardous materials on public health. The ATSDR responds to hazardous material threats, educates the public on HAZMAT risks and encourages community members and organizations participation.
• The Environmental Protection Agency (EPA), another federal agency, was created to protect human health and the environment through the writing and enforcing of regulations based on laws passed by Congress.

Essentially, all areas of health care, including but not limited to physicians, medical directors, health care computer technology companies, health care facilities and pharmaceutical companies, are subject to regulatory review and compliance. It is important that you recognize which regulations apply to you and seek clarification as needed in order to adequately comply with those regulations. Remember, the primary reason for health care regulation, while sometimes confusing, is to ensure that the care being provided by health care practitioners and health care facilities is safe and effective for all everyone who accesses the health care system.