The government’s role in healthcare has many different facets, as regulator, purchaser of care,
provider of health services, sponsor of applied research and demonstrations and the education and
training programs for healthcare professionals (Corrigan et al, p 58) It also manages licensure,
structure, or competency requirements for hospitals. The government also regulates the
requirements for Medicare and Medicaid and the integral part of the clinical management process
of Veterans Health Administration, Department of Défense and Tricare (Corrigan et al, p 59) The
impact to the different health organizations may be due to the regulations and if the organization
has achieved higher performance in the quality standards, then that organization may receive
bonuses or payments based on diagnosis.
I think that health insurance impacts healthcare delivery in terms of quantity not quality. In my
field of pharmacy, depending on what insurance a person has is what is covered on their
formulary. Those with the state aid or Medicaid may not have the medication list (formulary) to
choose from that someone with commercial insurance may cover. Then there are those with
Medicare that must deal with the 'donut hole" causing medication cost to go through the roof and
medication adherence to be affected due to patients not being able to afford their medication. If a
patient has a special diagnosis that requires a specialty medication that also may be prohibitive in
getting the medication.
I think that we can reduce the number of uninsured people by making it available - Having the
resources to go and get information for those that are unemployed or may not have the means to
get insurance. If you have a younger adult that is just out on their own, it is not learned in school
about oh by the way - you need health insurance. There are also barriers such as transportation
and costs and geographic area. The knowledge is also a key. Those that are employed get the
information from the organization they are involved in Strengthening the resources for those that
need the help or need the knowledge on how to find insurance might point them in the right
direction.
What is the government's role in healthcare? How does the government impact healthcare
organizations? I have been in healthcare for the past 30 years. One of the most helpful regulations
that has been brought about by the government is the HIPPA law. Most of us feel that our health
information is private and should be protected. That is why there is a federal law that sets rules for
health care providers and health insurance companies about who can look at and receive our
health information. This law, called the Health Insurance Portability and Accountability Act of 1996
(HIPAA), gives you rights over your health information, including the right to get a copy of your
information, make sure it is correct, and know who has seen it. (hhs.gov). Also, the
implementation of Affordable care act. Which helps make affordable health insurance available to
more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs
for households with incomes between 100% and 400% of the poverty level.
(/www.healthcare.gov/glossary/affordable-care-act/). By these 2 laws being implemented by the
government allows correct information be given to people that need your information and
protects your privacy. The Government also passed the law of the Affordable Care act which helps
those who do not have insurance get insurance. However, the government still needs programs
that are affordable to people that are unable to obtain insurance from an employer. It allows a
person to get treatment regardless of their ability to pay. There are incentives given to healthcare
organization to accept and keep patients on the profile. For example, for every 1 person that is
treated with no insurance the system will be given a higher pay reimbursement. Or may get better
payment on a bill of those without insurance.
How does health insurance impact healthcare delivery? However, there are a few insurances that
offer a low month premium to people, but do not cover a lot of expenses. I have had a patient
that needed a particular medication but it was not on the insurance formulary. We tried several of
the medication that were on the formulary, however did not control the disease. The formulary
had only a certain number of medications to choose from, so to help the patient, we had to write
script for something that was not the best medication for them. Thus, not giving the best care, but
it was the only medication that the patient could afford. This happens a lot, and unfortunately
then the patient must be on multiple medication rather than just the one.
How can we reduce the number of uninsured people while maximizing quality and access and
minimizing costs? I think that if we can cut cost of treatment and medication and healthcare in
general will help with costs. Maybe have more clinics available with quality care and more
volunteers? Have services at a set amount for cost. All premiums be a set amount and then all
drug and testing be a set amount. I am not sure how to go about doing all this. It sounds good on
paper, but how to regulate it is another thing.
www.healthcare.gov/glossary/affordable-care-act/).
/www.hhs.gov/hipaa/index.html
Corrigan et al (2003) Leadership by Example: The Role of Government with Healthcare, National
Academy of Sciences
