Lesson 4 Discussion with students
1 st students post
What are the three roles of the U.S. government in the health care system and in health insurance?
“The government has three roles in health care: to pass laws that ensure fair competition and protect the public; to provide health care services; and to pay for services”. Slide 29. Congress passed a law to protect and serve the public, called Federal Food, Drug, also known as the (FDA). This law was intended to protect and promote public health.
In order, to protect the people, as well as the public, laws are created to ensure fairness with company or market competition. Laws were passed by Congress and Presidents. The Sherman Anti-Trust Act of 1890 was created to prohibit trade and monopolization. To maintain security of this, act another act was created to close any gaps that the Clayton Act may have left open. Clayton Act addresses “price-fixing”, pricing of goods and services.
To fund public medical facilities such as clinics and hospitals or nonprofit facilities, such as rehabilitation facilities, acute care general hospitals, specialty hospitals, nursing homes, public health centers, the government funds programs, grants, and ERISA. Operated delivery systems, such as the Veterans Health Administration, TRICARE, and Indian Health Service are self- contained systems that operate facilities and have government-employed providers
There are multiple public health care services that are operated, delivered and paid for by the government funded programs, grants and ERISA, the Employee Retirement Income Security Act of 1974, which regulates employer self-funded health plans. Government provides and pays health care services and health care organizations, by either directly or indirectly. Indirectly by the form of a contract with an insurance agency, or directly federally- and state-supported hospitals, clinics, health centers, doctors, and other services. Some programs include two large Federal payment programs, Medicare and Medicaid. Slide 13.
2nd students discussion
The government is a major financier of healthcare delivery through the Medicare and Medicaid programs. The major roles the U.S government play in the health care system are 1) fund its own health care providers 2) fund health services thru grants to state & local govts. 3) fund medical education & research conducted by private & non-profit entities 4) fund government insurance programs which pay providers to deliver health care services (Medicaid, Medicare, SCHIP) - the government determines eligibility criteria as to who can receive services under these programs; it also determines the reimbursement rates that providers will receive for rendering services to Medicaid and Medicare patients. The government also regulates the healthcare industry through licensing of personnel, healthcare establishments and health care products - licensing of physicians to certificates of need for new hospitals to approval of new pharmaceutical drugs – regulation also includes environmental health. The government also designs and implements health policy ,provides the policy/legal/regulatory framework for the financing & delivery of health care affecting cost, access, & quality.
Most employer plans cover workers and their dependents, and the majority offer a choice of several plans.Both employers and employees typically contribute to premiums; much less frequently, premiums are fully covered by the employer. The Affordable Care Act introduced a federal marketplace, HealthCare.gov, for purchasing individual primary health insurance or dental coverage through private plans.
References:
https://www.commonwealthfund.org/international-health-policy-center/countries/united-states