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HE210 test 3 Questions And Answers 100%
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Introduction: 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
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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.
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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 from 34.9% in 1990 to 28.2% in 2013 (National Center for Health
Statistics [NCHS], 2015, Table 109).
The Federal Government and the Provision of Health Services. - answer✔Many federal agencies are
involved in the delivery of personal and community health serti0055 vices. The U.S. Department of
Health and Human Services (DHHS) is the most important federal actor in health and health care. There
are two other federal agencies with major health services responsibilities: the Department of VAs and
Department of Defense (DOD). Other federal agencies with significant health-related responsibilities
include the Department of Agriculture (nutrition policy, meat and poultry inspection, food stamps), the
Environmental Protection Agency (EPA), and the Department of Labor (administering the Occupational
Safety and Health Act).
Department of Health and Human Services - answer✔The central, though not only, federal agency
responsible for health and health care in the United States is the DHHS. Its mission is "to enhance the
health and well-being of Americans by providing for effective health and human services and by
fostering sound, sustained advances in the sciences underlying medicine, public health, and social
services" (DHHS, 2015a). Through 11 operating divisions, DHHS administers more than 115 health-
