Question

What are the three roles of the U.S. government in the health care system and in health insurance? Provide some examples of the influence the Federal government has on private health insurance.

Answer 1

Ans) The government is a major financier of healthcare delivery through the Medicare and Medicaid programs – more than 45% of the $ in the system is public $ - 4 roles in financing health care: 1) fund its own health care providers (i.e. VA Hospital) 2) fund health services thru grants to state & local govts. 3) fund medical education & researchconducted by private & non-profit entities 4) fund government insurance programswhich pay providers to deliver health care services (Medicaid, Medicare, SCHIP) - the government determines eligibility criteria as to who can receive services under these programs; it also determines the reimbursement rates that providers will receive for rendering services to Medicaid and Medicare patients.

2.The government also regulates the healthcare industry through licensing of personnel, healthcare establishments and health care products - licensing of physicians to certificates of need for new hospitals to approval of new pharmaceutical drugs – regulation also includes environmental health.

3.The government also designs and implements health policy – provides the policy/legal/regulatory framework for the financing & delivery of health care affecting cost, access, & quality.

4.Govt. may also be more than the payerbut also serve as the providerdirectly delivering health care services to specific patient populations such as veterans, Native Americans, & the indigent – when govt. is the direct provider of personal health services, it largely breaks out along these lines: At fed. level, it is population-specific - provided to specific categories of persons such as veterans & Native Americans.At state level, it is disease-specific - mentally ill, TB At local level, it is largely class-centered - indigent care

5.Govt. also funds & directs much medical research (i.e. NIH, CDC)

6.Responsible for public health priorities and programs - Emerson’s “Basic Six”services of public health at state & local level: vital statistics, public health labs, communicable disease control, environmental health, maternal & child health, and public health education – consensus with private health care sector that these services are appropriate for state & local govt. involvement/delivery.

- The federal government plays an important role in regulating the financing of the system, which is effected through mandatory health insurance (MHI) and other social insurance; ensuring the quality and safety of pharmaceuticals and medical devices; overseeing public health initiatives; and promoting research.

- Three levels of government are collectively responsible for providing universal health care: federal; state and territory; and local. The federal government mainly provides funding and indirect support to the states and health professions, subsidizing primary care providers through the Medicare.