The Role of Government in Health Care

Introduction

The government plays a central role in shaping health care in the United States through legislation, funding, regulation, and direct service provision. Understanding this role is essential for both health-care professionals and consumers to participate in policy development and advocacy.

History of Government Involvement in Health Care

Early Health-Care Legislation

• Origins: Early health-care decisions were made by monarchs, religious authorities, or experts, evolving into laws based on repeated judgments.

• Development of Laws: U.S. health-care laws initially focused on individual and property rights, later incorporating principles from health-care leaders such as Hippocrates, Dorothea Dix, Clara Barton, and Florence Nightingale.

• Standards of Practice: Standards based on scientific evidence became the foundation for consumer protection laws in health care.

• Early Legal Issues: Included definitions of health for slaves, methods of care delivery, and the role of caretakers, who were often family members or self-taught individuals.

• First Hospital: The first hospital for the poor was established in Philadelphia in 1750.

Development of Hospitals and Nursing Schools

• Bellevue Hospital School of Nursing (1873): Established in New York, promoting Nightingale principles.

• American Red Cross (1881): Founded by Clara Barton, focusing on community health.

• Professionalization: Formation of the American Medical Association, philanthropic support, and the establishment of nursing codes of ethics.

• Licensure: By 1903, state licensure was required for nursing practice; the National League for Nursing (NLN) and American Nurses Association (ANA) were established.

• Hospital-Centered Care: Hospitals became primary centers for care, with specialization and the creation of service units (medical, surgical, obstetrical).

• Hill-Burton Act (1946): Provided grants for hospital construction.

• Modern Nursing Education: Shifted to college and university settings, with standardized national competence exams for licensure.

Multidisciplinary Health-Care Team

Team Composition and Goals

• Members: Doctors, nurses, laboratory and radiology technicians, social workers, and others.

• Goals: Ensure optimal physical, social, and mental well-being through comprehensive care.

• Communication: The plan of care is a key tool for communication among team members and with patients/families.

• Standards of Care: Developed by professional organizations to ensure quality.

Nurse Practice Acts

Scope and Regulation

• Definition: State-established laws defining the scope and limitations of nursing practice.

• Variation: Each state has its own act; nurses must know the laws of the states where they practice.

• Nursing Licensure Compact (NLC): Allows nurses to practice in multiple states with one license (as of 2020, 34 states participate).

Patient’s Bill of Rights

Consumer Protections and Responsibilities

• Consumer Bill of Rights (2009): Emphasizes fairness, problem resolution, and patient involvement.

• Key Rights:

  • Choice of providers

  • Access to emergency services

  • Participation in treatment decisions

  • Respect and nondiscrimination

  • Confidentiality

  • Resources for complaints and appeals

• Informed Consent: Patients must receive understandable information about procedures; nurses often witness consent.

• State and Federal Laws: Minnesota was the first state to enact a Bill of Rights for Patients (1973); the Affordable Care Act (2010) expanded patient protections.

The Patient Care Partnership (AHA, 2003)

• High-quality care, clean and safe environment, involvement in care, privacy, and assistance with billing and insurance are emphasized.

• Patients are encouraged to communicate openly and participate in decision-making.

Accreditation and Quality Assurance

Hospital Accreditation

• Purpose: Accreditation ensures hospitals meet predetermined standards of care.

• Joint Commission Criteria: Includes infection control, medication management, care provision, patient rights, emergency management, human resources, information management, leadership, life safety, medical staff, nursing, performance improvement, and record-keeping.

• Funding: Non-accredited hospitals may not receive state or federal funding.

Government Structure and Health Care

Federal, State, and Local Roles

• Constitutional Basis: Article 1, Section 8 empowers the federal government to promote general welfare, including health.

• Direct Services: Provided to specific groups (e.g., Native Americans, military, prisoners), and through public health clinics.

• Financing: Government funds health education, Medicare, Medicaid, Social Security, and research grants.

• Information: Agencies like NIH and CDC collect and publish health data.

• Policy Setting: USDHHS oversees most health-care legislation; specialized agencies address environmental and occupational health.

Key Federal Legislation

Additional info: Table includes selected highlights; see full text for more legislation.

Health-Care Delivery Systems and Costs

Rising Costs and Cost Containment

• Increasing Costs: Health-care costs have risen steadily, threatening the sustainability of public programs like Medicare and Medicaid.

• Cost Controls: Focus on national health goals, resource use, prescription costs, and changing population needs.

• Managed Care: Organizations like MCOs, HMOs, and PPOs aim to standardize and control costs.

Private Health Insurance

• Premiums: Rising costs lead to higher insurance premiums, affecting employers and consumers.

• Economic Impact: Employers may pass costs to consumers, increasing the cost of living.

Health Promotion and Self-Care

Prevention and Early Intervention

• Healthy People 2030: National initiative focusing on prevention and wellness.

• Human Genome Project: Advances in genetics may help predict and prevent chronic diseases.

Resurgence of Self-Care

• Historical Roots: Self-care, midwifery, and lay practitioners were common in the 18th and 19th centuries.

• Nursing Theories: Dorothy Orem (self-care model), Martha Rogers (holistic care), Jean Watson (nurse-patient relationship).

• Modern Trends: Self-care guides, nutrition, and exercise classes are widely used; complementary and alternative medicine (CAM) is increasingly integrated.

• Community Outreach: Programs target local needs for screening and education; culturally competent care is emphasized in training.

Global Health

International Organizations

• United Nations (UN): Formed in 1945 to promote human rights, peace, and social advancement.

• World Health Organization (WHO): Established in 1946 to set global health policies and research agendas.

Political Influence and Advocacy

Political Action Committees (PACs)

• Role: PACs influence legislation by supporting lawmakers who advocate for health-care issues.

• Nursing Involvement: Nurses participate in PACs, serve as elected officials, and advocate for patient and professional needs.

Key Terms and Definitions

• Accreditation: Recognition that an institution meets specific standards of care.

• Scope of Practice: Legal limitations and customary skills defined for a profession.

• Informed Consent: Patient's right to receive information and agree to procedures.

• Medicare: Insurance program for elderly and disabled, funded by payroll deductions.

• Medicaid: Needs-based program for low-income individuals.

• Managed Care Organization (MCO): Controls health-care costs through standardization.

• Health Maintenance Organization (HMO): Provides care for prepaid members.

• Preferred Provider Organization (PPO): Contracts with providers for care at agreed rates.

Sample Table: Federal Legislation Related to Health Care

Review Questions (with Answers)

• The “Plan of Care” for a multidisciplinary health-care team is:

  • A. a tool for communication between health-care providers concerning a patient/client/family.

  • B. a description of standards of care for a client.

  • D. a compilation of goals or needs of a client and planned approach to meet those goals.

• Which of the following is true of the Nurse Practice Act:

  • B. defines the scope of practice of a nurse within one state.

  • C. may include a multistate licensing agreement.

  • D. defines the functions and limitations of nursing actions.

• The functions of the U.S. Department of Health and Human Services (USDHHS) include:

  • A. operating clinics for poor/indigent patients.

  • B. writing most health-care legislation.

  • C. overseeing Healthy People 2030 document.

• Political action committees (PACs) influence health care by:

  • B. supporting legislators who vote on health-care policies.

Summary of Key Points

• The U.S. government’s role in health care is established in the Constitution and expanded through federal and state laws.

• Standards of practice and accreditation ensure quality and safety in health care.

• Major legislation has shaped the structure, funding, and delivery of health care.

• Cost containment, health promotion, and self-care are central to current and future reforms.

• Political advocacy and global cooperation are essential for ongoing improvement in health care.