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Chapter Basic Concepts of the U.S. Health Care Delivery System: Student Activity Workbook
Chapter 3
The Role of Government in Health Care
Nancy J. Niles
Introduction
As discussed in chapter one, during the Depression and World War II, the U.S. had no funds to start a universal health care program—an issue that had been discussed for years.
As a result, a private sector system was developed which did not provide health care services to all citizens.
The passage of the Social Security Act of 1935 and the establishment of Medicaid and Medicare programs in 1965 mandated government’s increased role in providing health care coverage.
Introduction
Also, the State Children’s Health Insurance Program (SCHIP), established in 1997, which continues to be reauthorized expands government’s role in children’s health care
In both instances, the government increased accessibility to health care
This chapter will focus on the different roles the federal, state and local government play in the U.S. health care system.
Noted Federal Government Agencies
Many federal agencies are responsible for a sector of healthcare.
The United States Department of Health and Human Services (HHS) is the most important federal agency. HHS collaborates with state and local governments because many of the services are provided at those levels.
Noted Federal Government Agencies
There are 11 Public Health Service operating divisions of the HHS:
the Centers for Disease Control and Prevention (CDC),
National Institutes of Health (NIH),
Agency for Toxic Substances and Disease Registry (ATSDR),
Indian Health Service (IHS),
The Health Resources and Services Administration (HRSA),
The Agency for Health care Research and Quality (AHRQ), the Substance Abuse and Mental Health Services Administration (SAMHSA);
and the Food and Drug Administration (FDA).
Centers for Disease Control and Prevention
Established in 1946, and headquartered in Atlanta, GA, the CDC’s mission is to protect health and promote quality of life through the prevention and control of disease, injury, and disability.
The CDC has created four health goals that focus on:
healthy people in healthy places,
preparing people for emerging health threats,
positive international health and
healthy people at all stages of their life.
Agency for Toxic Substances and Disease Registry (ATSDR)
1985: Atlanta, GA headquarters Administered with CDC.
Is responsible for finding and cleaning up the most dangerous hazardous waste sites in the country.
ATSDR’s mission is to protect the public against harmful exposures to toxic substances.
ATSDR is the lead federal public health agency responsible for determining human health effects associated with toxic exposures and mitigating associated human health risks.
National Institute of Health (NIH)
1930: headquartered in Bethesda, MD, is the primary federal agency for research towards preventing and curing disease.
They have 27 institutes and centers that focus on different diseases and conditions including cancer, eye, heart and lung and blood, genes, aging, alcoholism and drug abuse, infectious diseases, chronic diseases, children’s diseases and mental health.
Although they have sponsored external research, they also have a large internal research program .
The Health Resources and Services Administration (HRSA)
1982: headquartered in Rockville, MD, the HRSA is the primary federal agency for improving access to health care services for people who are uninsured, isolated or medically vulnerable in every state.
They have six bureaus: primary health care, health professions, health care systems, maternal and child, the HIV/AIDs bureau and the bureau of clinician recruitment and service
HRSA trains health professionals and improves systems of care in rural communities.
They oversee 650 community and migrant health centers plus 150 primary care programs for the homeless and residents of public housing. Service is provided to individuals with AIDS.
They also oversee organ, bone marrow and cord blood donation and support programs against bioterrorism.
The Health Resources and Services Administration (HRSA)
The Health Resources and Services Administration (HRSA)
1989: headquartered in Rockville, MD, the agency’s mission is to improve the quality, safety, efficiency, and effectiveness of health care for all U.S. citizens.
AHRQ's cutting edge research helps people make more informed decisions and improve the quality of health care services
The Agency for Health care Research and Quality (AHRQ)
There is a Coalition for Health Services Research that is a voluntary organization that is an advocacy group for the AHRQ. It is comprised of more than 250 non-profit organizations that support the AHRQ.
They send letters to Congress encouraging more funds for research.
Indian Health Services (IHS)
1921: headquartered in Rockville, MD, their mission is to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.
They are also responsible to promote their communities, and cultures and to honor and protect the inherent sovereign rights of these people
The Substance Abuse and Mental Health Services Administration (SAMHSA)
1992: the main federal agency for improving access to quality substance abuse and mental health services in the U.S by working with state, communities and private organizations.
SAMSHA is the umbrella agency for mental health and substance abuse services which includes the Center for Mental Health Services (CMHS), The Center for Substance Abuse Prevention (CSAP), and the Center for Substance Abuse Treatment (CSAT).
The Substance Abuse and Mental Health Services Administration (SAMHSA)
The Office of Applied Studies (OAS) is their focal point for data collection, analysis, and dissemination of critical health data to assist policymakers in developing mental health issues.
Food and Drug Administration (FDA)
1906: the FDA is responsible for ensuring that the following products are safe: food, human and veterinary products, biological products, medical devices, cosmetics and electronic products.
The agency monitors approximately $1 trillion worth of goods on an annual basis.
Administration on Aging (AOA)
1965: as part of the Older Americans Act (OAA), the AOA is one of the largest providers of home and community based care for older persons.
The AOA is a partnership of federal, state and local networks called the National Network on Aging which services seven million elderly and their caregivers in the U.S.
The Administration for Children and Families (ACF)
The Administration for Children and Families, which has 10 regional offices, is responsible for federal programs that promote the economic and social well-being of families, children, individuals and communities.
Their mission is to empower people to increase their own economic well-being, support communities that have a positive impact on the quality of life.
Center for Medicare and Medicaid Services (CMS)
The Center for Medicare and Medicaid Services was established when the Medicare and Medicare programs were signed into law in 1965 by President Lyndon B.Johnson, as a result of the Social Security Act.
Medicaid was established for low income children, elderly, the blind and the disabled and linked with the Supplemental Security Income program (SSI).
In 1972, Medicare was extended to cover people under 65 with permanent disabilities.
Occupational Safety and Health Administration (OSHA)
1970: the Occupational Safety and Health Administration (OSHA) was established to govern the workplace environment to ensure that employees have a safe and healthy environment.
The Hazard Communication Standard (HCS) ensures that all hazardous chemicals are properly labeled and that companies are informed of these risks.
Occupational Safety and Health Administration (OSHA)
The Medical Waste Tracking Act requires medical waste disposal procedures to ensure there is no risk to employees and the environment.
The Occupational Exposure to Blood borne Pathogen Standard developed behavior standards for employees who deal with blood products such as wearing gloves and other equipment, disposal of blood collection materials, etc.
Surgeon General/U.S. Public Health Service
The Surgeon General is the U.S. chief health educator who provides information on how to improve U.S. health.
The U.S. Public Health Service Commissioned Corps consists of 6,000 public health professionals that are stationed within federal agencies and programs.
Department of Homeland Security (DHS)
The Department of Homeland Security (DHS) was established in 2002 as a result of the 2001 terrorist attack on the United States.
The Federal Emergency Management Agency (FEMA) which is responsible for managing catastrophic events was integrated into the DHS in 2003.
Together, they are responsible for coordinating efforts at all government levels to ensure emergency preparedness for any catastrophic events.
Department of Homeland Security (DHS)
DHS has also developed a National Incident Management System (NIMS) which provides a systematic, proactive approach to all levels of government and private sector agencies to collaborate to ensure there is a seamless plan to manage any major incidents.
Council of State and Territorial Epidemiologists (CSTE)
1992: headquartered in Atlanta, GA, the Council of State and Territorial Epidemiologists (CSTE) is a professional organization of over 1,000 public health epidemiologists that work in state and local health departments.
They provide technical assistance to ASTHO and to the CDC for research and policy issues.
State Health Department’s Role in Health care
The U.S. constitution gives state government the primary role in health care for their citizens Most states have several different agencies that are responsible for specific public health services.
There is usually a lead state agency with approximately twenty agencies that target aging, environment, alcoholism and abuse, etc.
State Health Department’s Role in Health Care
State health departments have the authority to collect health data, manage vital statistics, declare health emergencies and conduct health planning and formulate health policy.
Vital statistics collected include deaths, births, marriages, and health and disease status of their populations. These statistics are important to collect because they serve as a basis for funding.
State Health Department’s Role in Health Care
Most state agencies provide technical assistance to their local health departments in the following areas:
quality improvement,
data management,
public health law,
human resource management, and
policy development.
State Health Department’s Role in Health
States also provide prevention services in the following areas:
tobacco control and prevention,
obesity,
injury prevention,
HIV/AIDs,
diabetes, and
sexually transmitted diseases.
State agencies are funded primarily by federal sources (45%), with state resources (24%), Medicaid/Medicare (15%) with the remaining sources are fines and fees (4%), indirect federal funding (3%) and other minor sources (9%)
The Association of State and Territorial Health Officials (ASTHO)
The Association of State and Territorial Health Officials (ASTHO) is a not for profit organization that provides support for state and territorial health agencies.
They provide research, expertise and guidance for health policy issues.
The federal government looks to ASTHO for their expertise in developing health policy. They frequently testify in front of Congress regarding major health issues.
Local Health Department Role in Health Care
Local health departments are the government organization that provides most direct services to the population. There are approximately 3,000 local health departments across the U.S.
It is difficult to generalize what types of services are offered by local health departments because they do vary according to geographic location but most are involved in communicable disease control.
Local Health Department Role in Health Care
Local health departments receive funding from their state government and federal government direct funding.
Due to population size and coverage, local health department funding varies state to state.
Local Health Department Role in Health Care
Local sources are the greatest contributor to funding local health departments (29%), followed by state allocations (23%), and federal funding (13%).
As a result of continued lack of funding, more local health departments are collaborating with schools, community organizations, other local governmental organizations such as social services and health care providers to provide services
Regionalization of Local Health Departments
Over the last 10 years there has been a trend to regionalize local health departments in order to maximize service to their populations.
Counties normally providing health services separately have formed regional health departments which means that smaller local health departments unite as one operation to provide services within a geographic area.
Emergency Preparedness in Local Health Departments
As a result of the threat of bioterrorism to the United States, all local health departments’ roles have changed since September 11, 2001.
The Centers for Disease Control awarded funding to state health agencies to help the local health departments to develop plans for bioterrorism attacks.
Although bioterrorism is a new public health threat, emergency preparedness also includes responses to natural disasters or disease outbreaks.
Emergency Preparedness in Local Health Departments
The Centers for Disease Control has developed a checklist to guide local health departments when a disaster occurs.
Assess the situation – The local health department has to assess the capability of the community and itself to respond quickly to a threat. It is also important to assess the impact of the threat.
Emergency Preparedness in Local Health Departments
Epidemiological capability and laboratory analyses: Local health departments should have a surveillance component in place to track susceptible populations and access to laboratory services as needed.
Communication: Communication protocols need to be in place for key health and medical agencies.
Emergency Preparedness in Local Health Departments
Community reassurance: Address requests for assistance and information.
Clinical interventions: Depending on the type of disaster, interventions must readily available to provide to the population.
Coordination of Health care systems: Coordinate with federal and state on-site assistance.
Emergency Preparedness in Local Health Departments
Workforce training: It is vital that all workers involved in the disaster plan be trained. Volunteers also need to be trained so they understand the hierarchy of implementing a disaster plan.
Special populations: Address the needs of the elderly, disabled and young children.
Legal issues: Stay apprised of any legal issues.
The National Association for County and City Health Officials (NACCHO)
1993: NACCHO is the advocacy organization for local health departments. They provide support to nearly 3,000 member local health departments which include city, county, district, metro and tribal agencies.
They are staffed by nearly 100 physician and public health experts and a 32 member Board of Directors.
The National Association for County and City Health Officials (NACCHO)
The NACCHO also developed standards and defined the role of local health department’s activities (see Table 3-1).
Other frequent local contributors to public health activities include social service agencies, elementary and secondary public schools, housing departments, fire and police departments, parks and recreation, libraries, waste management and water and sewer authorities.
Public Health Accreditation Board (PHAB)
The PHAB was established as a nonprofit organization to administer the voluntary, national accreditation program for state and local health departments based on the recommendations of the steering committee of the Exploring Accreditation project.
The development process will allow sufficient time for the creation of a successful program to include:
Development of standards and metrics for state and local health departments,
Creation of an assessment process for applicants,
Public Health Accreditation Board (PHAB)
Establishment of a process to determine recognition/approval of existing state-based accreditation programs,
Implementation of a pilot testing phase for state and local public health departments.
Voluntary standards have been developed and are in the process of receiving public comments.
Summary of Chapter 3
The government plays an important role in the quality of the U.S. health care system.
The federal government provides funding for state and local government programs.
Federal health care regulations are implemented at the state and local level and are enforced at these levels.
Summary of Chapter 3
More local health departments are working with local organizations to provide services such as immunizations, education and prevention.
NACCHO and ASTHO are important support organizations for both state and local governments.
They support them by providing policy expertise, technical advice and lobby at the federal level for appropriate funding and regulations.
