The Nature Of Health Care Regulation
The pervasive nature of health care regulation stems from the fundamental concerns that are at stake. Most observers acknowledge that some form of oversight is needed when factors as essential as life and health are involved. Even those who are especially suspicious of heavy-handed government bureaucracy see a public interest in some form of external supervision of this field. Policy debates, for the most part, swirl not around whether oversight should exist but, instead, around the way it should be structured.
However, the present regulatory structure is neither uniform nor consistent. A broad range of regulatory bodies and programs apply in different ways to various aspects of the industry. Health care regulations are developed and enforced by all levels of governmentfederal, state, and localand also by a large assortment of private organizations. At times, they operate without coordination.
Healthcare Packages Under Consideration
Most Democrats in Congress, like the president, supported universal healthcare coverage for all Americans offered through various insurance providers and many coverage options. Many saw a low-cost, government-funded healthcare option as important to include.
Under the multi-option scenario, Americans satisfied with their present insurance could opt to keep their coverage. Americans dissatisfied or without coverage could opt for government-funded coverage.
As this idea spread, Republicans complained that the free-market competition offered by a lower-cost public-sector plan would cause private-sector insurance companies to cut their services, lose customers, and inhibit profitability to the extent that many would be forced to go entirely out of business.
Many progressive liberals and Democrats believed strongly that the only fair, just U.S. healthcare delivery system would be a single-payer system, such as Medicare, in which only low-cost, government-funded healthcare coverage is provided to all Americans on an equal basis. Here’s how the public responded to the debate.
New Laws And Regulations
For every new law or regulation, new or updated, policies must be created and be disseminated to staff. There are regularly changing provisions within the Affordable Care Act, other federal healthcare requirements, state laws and regulations, CMS Conditions of Participation, Joint Commission Standards, and other accreditation requirements. This makes it difficult to ensure that proper polices are not only created, but are efficiently communicated to the employees. As such, the legacy policy management systems for maintaining polices are no longer viable and can place the organization at risk. It is difficult just keeping up with every new law or regulation update, as well as, ensuring policies and procedures are effectively rolled out to employees is also just as complicated.
With the rapid pace of new and updated laws and regulations that providers must address, the task of ensuring that policies and procedures are up-to-date, available, and effectively communicated throughout the organization can be very difficult. This is where more state of the art policy management software can assist.
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Why Healthcare Policy Is Important
Healthcare policy is important because it helps establish guidelines that benefit patients, healthcare organizations, and our healthcare system. Having protocols in place can help prevent human error and poor communication around medical decisions.
For nurses and health administrators, understanding and following policies can help ensure that you deliver the best care to patients while using your knowledge to help inform future policies. On a broader level, when patients take the time to understand healthcare policy, they learn more about their rights.
About Government Health Care Programs For Parents And Children
If you live under the poverty line and require health care services, you may be eligible to receive benefits through the Medicaid program.
Individuals who may qualify for Medicaid include the following:
- Low-income parents and their children
- Pregnant women
- Medically needy individuals
However, to enroll in Medicaid and receive long-term health care through the program, you must meet specific requirements stipulated by the federal government.
In addition, private sector health care providers will often work in accordance with the Medicaid program to ensure equal coverage to individuals who are receiving health care through this government-sponsored program.
Low-income individuals who are younger than 18 years of age and do not have a primary source of insurance may qualify to receive health care through the Childrens Health Insurance Program .
For instance, if your total household income exceeds the maximum eligibility stipulated by Medicaid, you may enroll your children in CHIP in order to ensure that they will receive the health coverage that they need.
Furthermore, if you have previously qualified for Medicaid benefits, you can combine the benefits provided by CHIP alongside your existing health care plan.
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Other Benefits Of Systematic Assessment Of Health Impacts
The committee concluded that HIA has at least three important benefits in addition to the obvious implications for improved policy-making and promotion and protection of health that would result from the systematic assessment of the health consequences of policies, programs, projects, and plans:
The collaborations hold great potential for enhancing societyâs ability to prevent disease and promote public health. Furthermore, the active engagement of representatives of communities whose health stands to be affected by proposed policies, programs, projects, and plans is an essential component of democratic decision-making. Public engagement may also enhance understanding of the pathways through which policies, programs, projects, and plans may affect health and could promote actions that contribute to the reduction of health disparities. For example, the engagement of community members in HIA may lead to greater awareness of the impact of community resources on health and result in actions to improve community environments. Finally, systematic assessment of health consequences will give community groups a practical mechanism for increasing accountability of policy-makers and developers in the public and private sectors.
The Future Of Healthcare Policy
Healthcare policy is important on a macro and micro level. It affects our whole society, as well as each community and facility where care is administered. If youre looking to make an impact in healthcare and want to be an advocate for change, check out USAHS graduate degrees to find a career path thats right for you.
The University of St. Augustine for Health Sciences offers Master of Science in Nursing , Doctor of Nursing Practice , and Post-Graduate Nursing Certificates designed for working nurses. Our degrees are offered online, with optional on-campus immersions* . Role specialties include Family Nurse Practitioner , Nurse Educator,** and Nurse Executive. The MSN has several options to accelerate your time to degree completion. Earn your advanced nursing degree while keeping your work and life in balance.
USAHS offers a Master of Health Administration program designed for working healthcare professionals who want to improve systems of finance, informatics, operations, policy, and other key functions of healthcare organizations. The program is taught online, with optional on-campus immersion weekends and an optional internship. Whether you choose the traditional or accelerated track you will gain real-life experience and expand your professional network. During your capstone project, you will work with an industry mentor.
*The FNP track includes two required hands-on clinical intensives as part of the curriculum.
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Why Is Public Health Important
Most of us rarely think about these roles until a crisis, such as a devastating hurricane, captures our attention. But public health officialsmany of whom may hold public health degreeswork on a daily basis to keep people healthy and safe, locally and around the world, by preventing disease and injury.
Public health initiatives such as vaccinations, family planning, motor vehicle safety laws, and clean air and water policies have increased life expectancy in the U.S. by nearly 30 years.*
What Can You Learn In A Public Health Degree Program
Whether you pursue your education on campus or online, public health degrees provide students with a solid foundation in issues that impact population health and healthcare systems, including environmental health, disease prevention, health informatics, global health, ethics, and behavioral and cultural issues.
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Goal: Improve Health Care
High-quality health care helps prevent diseases and improve quality of life. Healthy People 2030 focuses on improving health care quality and making sure all people get the health care services they need.
Helping health care providers communicate more effectively can help improve health and well-being. Strategies to make sure health care providers are aware of treatment guidelines and recommended services are also key to improving health.
Some people dont get the health care services they need because they dont have health insurance or live too far away from providers who offer them. Interventions to increase access to health care services like lowering costs, improving insurance coverage, and increasing use of telehealth can help more people get the care they need.
Strategic Goals & Objectives
Agencies establish a variety of organizational goals to drive progress toward key outcomes for the American people. Long-term strategic goals articulate clear statements of what the agency wants to achieve to advance its mission and address relevant national problems, needs, challenges and opportunities. Strategic objectives define the outcome or management impact the agency is trying to achieve, and also include the agency’s role. Each strategic objective is tracked through a suite of performance goals, indicators and other evidence..
HHS developed the Strategic Plan with contributions from each of the Departments Operating and Staff Divisions as well as coordination with Congress, the Office of Management and Budget and other stakeholders. The process emphasized creating alignment between the long-range Strategic Plan and annual GPRA reporting in the Departments Congressional Budget Justifications and Annual Performance Plan. It also included the Departments Priority Goal establishment focused on quarterly data-driven reviews with HHS senior staff and counselors to monitor progress on achieving these key performance goals. These, in combination with efforts to improve the outcomes of services, research, and administration, support the Departments collaboration with health care organizations and professionals across governmental, nongovernmental, and private partners.
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Health Care Directives In Manitoba
What is the purpose of a Health Care Directive?
As a Manitoba citizen you have the right to accept or refuse medical treatment at any time. The Health Care Directives Act allows you to express your wishes about the amount and type of health care and treatment you want to receive should you become unable to speak or otherwise communicate this yourself. It also allows you to give another person the power to make medical decisions for you should you ever be unable to make them yourself.
Why should I fill out a form?
Due to accident or illness, you may become unable to say or show what treatment you would like, and under what conditions. If you have signed a directive, those close to you and the health care professionals treating you are relieved of the burden of guessing what your wishes might be.
How do I make a Health Care Directive?
Who do I talk to about these decisions?
It is strongly recommended you talk to your doctor before completing the directive. This will ensure your instructions are clear and easily understood by those who provide treatment. Your choices should then be clearly typed or printed.
What is a proxy?
Who do I choose as my proxy?
The choices you make in a directive are very personal. The person you choose to represent you should be close friends or relatives who are willing to accept this responsibility. You should discuss your wishes openly and in detail with them. It is wise to name more than one proxy in case one is not available when needed.
About Government Health Care Programs For Seniors
If you are older than 65 years of age and receive Social Security benefits due to a disability, you can enroll in the Medicare program offered by the government and gain access to health care coverage.
Moreover, seniors suffering from an end-stage renal disease are also qualified to receive benefits through the Medicare program.
Furthermore, with your Medicare benefits, you will receive basic health coverage and be entitled to preventative care options as well.
However, prescription drugs are generally not covered by the Medicare program.
If you need to obtain medications for a health condition, you will need to receive benefits from a private insurer, as well to receive supplement coverage from your Medicare benefits.
Seniors may also qualify for health care benefits provided through the Medicaid health care program.
Benefits under the Medicaid program include acute and chronic health care, as well as long-term institutional care for individuals who are no longer capable of taking care of themselves.
To determine your eligibility for the Medicaid program, you will need to meet certain criteria outlined by the government.
Moreover, the income requirements for Medicaid eligibility may differ from one state to another.
Thus, you will need to consult state-specific regulations in order to make sure that you are eligible to receive these benefits.
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Pros Of Government Healthcare
Iconic American consumer advocate Ralph Nader summed up the positives of government-funded healthcare from the patient’s perspective:
- Free choice of doctor and hospital
- No bills, no co-pays, no deductibles
- No exclusions for pre-existing conditions you are insured from the day you are born
- No bankruptcies due to medical bills
- No deaths due to lack of health insurance
- Cheaper. Simpler. More affordable
- Save taxpayers billions a year in bloated corporate administrative and executive compensation costs, .
Other important positives of government-funded healthcare include:
- 47 millions Americans lacked healthcare insurance coverage as of the 2008 presidential campaign season. Soaring unemployment since then caused the ranks of the uninsured to swell past 50 million in mid-2009. Mercifully, government-funded healthcare provided access to medical services for all uninsured, and lower costs of government healthcare caused insurance coverage to be significantly more accessible to millions of individuals and businesses.
- Doctors and other medical professionals can now focus on patient care and no longer need to spend hundreds of wasted hours annually dealing with insurance companies. Patients, too, no longer need to fritter inordinate amounts of time haggling with insurance companies.
Court Challenges: Chaoulli V Quebec And Cambie Surgeries Corporation V British Columbia
In the early 2000s, a Quebec doctor and patient challenged Quebec’s provisions that prohibited residents of the province from obtaining private health insurance for services that were covered by the provincial health insurance plan.23 Such insurance would be used to pay for a service obtained from a physician who works outside the provincial health insurance plan, enabling individuals to obtain health care services faster than in the provincially insured system.
The plaintiffs in Chaoulli v. Quebec argued that the prohibition on private insurance was contrary to sections of the Canadian Charter of Rights and Freedoms 24 and the Quebec Charter of Human Rights and Freedoms .25 Ultimately, the Supreme Court of Canada determined that the prohibition was contrary to the Quebec Charter.26 Since the decision was not based on the Canadian Charter of Rights and Freedoms, the decision had no application outside Quebec.
A similar case has been before the courts in British Columbia for the past decade. In Cambie Surgeries, the plaintiffs are challenging provisions in British Columbia’s Medicare Protection Act 27 that
- prohibit the purchase of private insurance for services that are insured under the provincial plan
- restrict medical practitioners from what is referred to as dual practice and
- prohibit a non-participating practitioner from charging patients amounts greater than those that would be reimbursed by the provincial health insurance plan.
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Consequences Of The Regulatory System
Despite the complicated and inefficient nature of its oversight, American health care has flourished over the past hundred years. Rather than hindering its progress, the complex system of regulation, for all of its flaws, may actually have served to support and nurture the overall enterprise.
Consider, for example, the public confidence that is engendered in the competence of physicians through licensure requirements and in the safety and efficacy of prescription drugs through the FDA approval process. These programs enhanced overall respect for major elements of the health care system and greatly expanded markets for the goods and services that they provide. Regulatory programs that include major funding components, such as Medicare and research support administered by the National Institutes of Health , serve an additional role of creating a financial base for key sectors of the industry.
Viewing the system in this way may help to provide perspective for those who have to navigate it. It is also important to consider the underlying nature of the system, with both its positive and negative elements, in evaluating proposals for reform.
A more thorough presentation of the regulatory structure of the health care industry and the themes that drive it can be found in my book.
Office Of The National Coordinator For Health Information Technology
Former President George W. Bush created the ONC in 2004 and the office was written into legislation by the HITECH Act. The ONC’s purpose is to promote a national health IT infrastructure and oversee its development. This includes policy coordination, strategic planning for the adoption of health IT and health information exchanges , establishing the Nationwide Health Information Network and promoting a national health IT infrastructure.
The ONC aims to achieve its ultimate goal, promoting a national health IT infrastructure, by improving the quality of healthcare while reducing costs improving the coordination of care and information among hospitals, labs, physicians and other healthcare organizations ensuring that personal health records remain secure and promoting the early detection, prevention and management of chronic illnesses.
Continue Reading About US Department of Health and Human Services
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Promote Healthy Communities And Healthy Behavior
Promoting healthy communities and healthy behaviors means activities that improve health in a population, such as investing in healthy families engaging communities to change policy, systems or environments to promote positive health or prevent adverse health providing information and education about healthy communities or population health status and addressing issues of health equity, health disparities, and the social determinants of health.
Assure An Adequate Local Public Health Infrastructure
Assuring an adequate local public health infrastructure means maintaining the basic capacities foundational to a well-functioning public health system such as data analysis and utilization health planning partnership development and community mobilization policy development, analysis and decision support communication and public health research, evaluation and quality improvement.
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