The document discusses the role of government in the U.S. healthcare system across federal, state, and local levels. It notes that while the U.S. government is less involved than other countries, it still plays roles in regulating healthcare through over 130,000 pages of rules, financing care for groups like the poor and elderly through programs like Medicare and Medicaid, and providing some direct services. It also describes the activities of different government agencies and levels, and concludes that the lack of a national health plan has necessitated government involvement in both direct care and regulation.

1. HLT-2100: Introduction
to the Healthcare
Industry
Chapters 4-6

2. Chapter 4
 U.S. Government less involved than any
other industrialized country in the world
(p.117)
 Why?
 “Government control and interference”
 Medicare & Medicaid Rules-more than
130,000 pages of rules
 Meeting regulatory demands (of all relevant
agencies) requires up to 1 hr of paperwork
for every 1 hour of patient care (p. 117)
 Burden of clinical documentation and clerical
duties

3. Chapter 4
 Certain areas of the healthcare delivery
system that are not dominated by the
private sector:
◦ Care of sick poor
◦ Mentally ill
◦ Special
◦ Distant population groups ex: Native
Americans
◦ Elderly
◦ Infectious disease control & other personal
public health services

4. Chapter 4
 Should government be the healthcare
provider of last resort or does it have a
greater responsibility?
 Pauper stigma
 Question of role of government in
healthcare has still not been answered
definitively in the U.S.

5. Chapter 4
 Constitutional basis for the federal
government’s health authority is found in the
powers to tax and spend to provide for the
general welfare (p. 123)
 Separation of powers
 Legislative Branch: create laws to safeguard
the public’s health from clean water to
protecting the health of workers
 Which roles and entities can deliver services
to which persons under what conditions and
requirements

6. Chapter 4
 Judiciary: handles disputes related to
healthcare services such as malpractice,
practicing medicine without a license, etc
 Executive: delivers healthcare services,
drafts and enforces provider/payer
regulations and administers financing
programs

7. Chapter 4
Federal Level: Provision of Personal Health
Services:
-Uniformed services & families
-Native Americans
-Military veterans
State Level:
-for specific diseases ex: mental illness or TB
Local Level:
-poor
All Levels: prisoners

8. Chapter 4
Community Health Services:
-all levels supply “public health” services
-examples: pure water, sanitary sewage
disposal, food and drug inspection &
Regulation, communicable disease control,
vital statistics, environmental regulation &
protection, and public health laboratory work
-Shared work with private sector Ex:public
health education, American Cancer Society,
AHA

9. Chater 4
Health Services Financing
Gov’t Participates in financing in 3 ways:
 Pays for operation of own programs (both
personal and community)
 Through grants and contracts to
nongovernmental agencies, biomedical
research or medical education
 Medicare and Medicaid

10. Chapter 4
Health Services Financing
Gov’t Participates in financing in 3 ways:
 Pays for operation of own programs (both
personal and community)
 Through grants and contracts to
nongovernmental agencies, biomedical
research or medical education
 Medicare and Medicaid

11. Chapter 4
Personal and Community Health Services:
 Federal agencies, DHHS, VA, DOD
 DHHS: 11 operating divisions
 Variety of functions: regulation, direct
provision of personal and community
health services, financial support for
health services through grants/contracts,
and biomedical research

12. Chapter 4
Role of State:
 Mental illness
 Medicaid Operations
 SHAs: personal health, environmental,
resources, laboratory, general admin & services,
and funds to local health programs
 Health Statistics-collection and analysis of vital
and health statistics (births, deaths, marriages,
divorces, reportable diseases
 Licensing: for individual practitioners-set
minimum standards for qualification, facilities,
apply standards and determine operation

13. Chapter 4
Local health Department (LHD):
 Unit of either state or local gov’t focusing
exclusively on a “substate,” county, city,
town, parish or village
 Activities: adult immunizations, infectious
disease surveillance, child immunizations,
TB screening/treatment, inspection of
food services, school daycare inspections

14. Chater 4
Summary:
 Lack of a national health plan has forced the US
gov’t to step in and care for general population
and to create state and federal regulations for
the protection of the public
(environment/occupational hazard exposures,
finances, and provides services, research)
 Healthcare providers feel that gov’t is too
involved and try to limit the influence
 Book discusses that the proper role of the gov’t
cannot properly defined until the role of the
private health services provider sector is
redefined.