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HE210 Test 3 With Complete Solutions 100% Correct
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HE210 Test 3 With Complete Solutions 100% CorrectIntroduction: Government and the Health Care System - ANSWER In fact, in the United
States, government is less involved with the provision of health care (in contrast to the
payment for health services, with which it is heavily involved) than in any other
industrialized country in the world. The government's role in the U.S. health care system
has developed and expanded gradually over a long period of time. In his preface to
Stern's (1946) seminal book on governmental medical services in the 1940s, Smillie, one
of the first medical sociologists (as was Stern) and a noted public health authority of the
day, said: Our forefathers certainly had no concept of responsibility of the Federal
Government, nor of the state government, for health protection of the people. This was
solely a local governmental responsibility. When Benjamin Franklin wrote "Health is
Wealth" in the Farmers' Almanac, he was saying that health was a commodity to be
bought, to be sold, to be conserved, or to be wasted. But he considered that health
conservation was the responsibility of the individual, not of government. The local
community was responsible only for the protection of its citizens against the hazards of
community life. Thus government responsibility for health protection consisted of (a)
promotion of sanitation and (b) communicable disease control. The Federal
Constitution, as well as the Constitutions of most of the states, contains no reference or
intimation of a federal or state function in medical care. The care of the sick poor was a
local community responsibility from earliest pioneer days. This activity was assumed
first by voluntary philanthropy; later, it was transferred, and became an official
governmental obligation. (p. xiii) Nevertheless, the government at all levels— federal,
state, and local— now plays a major role in the U.S. health care system. Although it is
restricted compared wi
THE HEALTH CARE FUNCTIONS OF GOVERNMENT: The Constitutional Basis of
Governmental Authority in Health Care. - ANSWER It is argued that a very significant
role for government in health care delivery is justified by the amount of money
government spends on it. This says nothing about the calls for major reforms that could
be undertaken by no agency other than government that echo down to us from the early
1930s and resonate in many voices today. But such a role has a constitutional basis as
well. To understand government operations in the health care delivery system, it is to
understand the structure of the government itself. 1 A basic principle of the U.S.
Constitution is that sovereign power is to be shared between the federal and state
governments, a principle called federalism . At its heart, the U.S. Constitution is an
agreement among the original 13 states to delegate some of their inherent powers to a
federal government, on behalf, not of themselves as separately sovereign entities, but
of, as the Preamble to the Constitution says, "the people of the United States." As part of
this agreement, in the Tenth Amendment to the Constitution, the states explicitly
,reserved to themselves the rest of the power: "The powers not delegated to the United
States by the Constitution, nor prohibited by it to the states, are reserved to the states
respectively, or to the people." Because it is not explicitly mentioned in the Constitution,
among the powers reserved to the states is the "police power." It is the latter that forms
the basis of the states' role in health (Mustard, 1945, pp. 17- 21). As Grad (2005) points
out: In the states, government authority to regulate for the protection of public health
and to provide health services is based on the "police power"—that is, the power to
provide for the health, safety, and welfare of the people. It is not necessary that this
power be expressly stated, because it is a plenary power that every sove
The Legislative Branch - ANSWER At each level of government, federal, state, and local,
the three branches of government have responsibility and authority for health and
health services. Legislatures create the laws that establish the means to safeguard the
public's health, in matters ranging from the assurance of a pure water supply to
protecting the health of workers in their places of employment. The legislatures also
enact the legal framework within which the health care delivery system functions,
determining which individuals and institutions are authorized to deliver what services to
which persons under what conditions and requirements. In the past, legislatures have
imposed certain requirements for planning and development on the system, although in
most jurisdictions that function has been minimized or has disappeared entirely. If the
government is to participate in health care financing (see Chapter 5), directly deliver
services, or support research efforts, the legislature must first establish the legal
authority for those programs.
The Judiciary - ANSWER The judiciary generally supports the work of the other two
branches of government. The judicial branches at the three levels of government have
important powers relating to health and health services. In the criminal law arena,
working in concert with the law enforcement arms of the executive branches, under the
authority granted to them by their respective legislatures, they can try apprehended
transgressors of the criminal law and determine punishment for those successfully
prosecuted. For example, although it is a state legislature that creates the licensing law
for physicians and the executive branch that administers it, it is the judicial system that
determines the guilt or innocence of a person charged with "practicing medicine
without a license." The criminal justice system also plays a vital role in safeguarding the
public's health. For example, it enforces sanitary protection and pollution control
legislation, with criminal sanctions if necessary. In the civil arena, the judicial system
handles disputes arising from the provision of health services, for example, through the
process of malpractice litigation. The judicial system adjudicates contract cases arising
from health care system disputes, such as those between providers or patients, on one
side, and a third-party payer on the other. It protects the rights of individuals under the
due process and equal protection clauses of the Fifth and Fourteenth Amendments to
the Constitution. Together, then, the judicial and executive branches form the civil and
, criminal justice systems, at the federal, state, and local levels.
The Executive Branch - ANSWER In common parlance, the term government in health
care refers to the executive branch that delivers health care services, drafts and
enforces provider/payer regulations, and administers financing programs, not the
legislature that creates the programs or regulatory authority, nor the courts that settle
disputes arising under the laws and adjudicates violations of them. Therefore, in the
remainder of this chapter the term government refers to the executive branch of
government.
Provision of Personal Health Services - ANSWER Government at all levels is the major
provider of the traditional community-wide "public health" services, such as pure water
supply and sanitary sewage disposal, food and drug inspection and regulation,
communicable disease control (e.g., immunization and the control of sexually
transmitted diseases), vital statistics, environmental regulation and protection, and
public health laboratory work. Certain community health activities are shared with the
private sector. For example, in public health education, voluntary agencies such as the
American Cancer Society and the American Heart Association are important
participants. Private refuse companies do much of the solid waste collection and, in
certain states, supply the water. Private organizations such as the Sierra Club and the
Natural Resources Defense Council are active in environmental protection. Private
institutions also play a vital role in health sciences education and research.
Health Services Financing - ANSWER As will be described in more detail in Chapter 5,
government participates in the financing system in three ways. First, it pays for the
operation of its own programs, both personal and community. It does this directly, for
example, through the federal government's Veterans Affairs (VAs) hospital system or a
municipal hospital serving primarily the poor. It also does this indirectly, for example,
through the federal government's provision of grants to state governments to help pay
for personal care in state mental hospitals and for the operation of the state's public
health agencies at the community level. The states, in turn, indirectly support local
governmental public health activities by providing money for that purpose. Second,
through grants and contracts to nongovernmental agencies (and, in certain cases, other
governmental agencies), governments support other types of health-related programs,
for example, in biomedical research and medical education. Third, and this is by far the
major role of government in financing, under such programs as Medicare and Medicaid,
governments pay providers for the delivery of care to patients. As will be discussed in
greater detail in Chapter 5, federal, state, and local public funds accounted for about
43.4% of national health expenditures in 2013, up from 35.5% in 2000 and 32.6% in 1990.
Concomitantly, private business' contribution to the national health expenditures
dropped from 24.6% in 1990 to 20.9% in 2013, and the household contribution declined
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