Health Law and Ethics in the United States - Essay Example

? Healthcare Regulatory Agencies 14th, September, Health Law and Ethics Introduction United d is arguably one of the industrialized democracies that do not provide health care for all of its citizens. Healthcare in US is in the hands of various legal entities with major health care facilities owned and controlled by the private sector. The government has taken over health insurance sector and met healthcare spending through programs such as Medicare, Medicaid, TRICARE, children health insurance, and Veterans Health Administration. Statistics reveal that millions of Americans remain uninsured every year. For instance, in the year 2010, CDC reported that over 21.3 % of the population between 18 to 64 years in the US was uninsured with 64.2 % under private insurance (CDC, 2012). Despite spending more on health care than any other state, US is still lagging behind in the kind of services its citizens receive. Unlike many industrialized nations, the US has a high mortality rate and a low life expectancy depicting poor health care services. The citizens have tried severally to push for reforms that would contain healthcare escalating prices, quality of healthcare services, inequality of treatment, and ways to reduce fraud in this sector. This paper will discuss the role of government regulatory agencies in the healthcare sector, the laws and regulations in healthcare, and its effects. Role of Governmental Regulatory Agencies Healthcare regulation plays a crucial role in healthcare industry and healthcare insurance. The Government of the US through the department of health and human services (HHS) has formed various agencies to protect and regulate public health at every level. The first role that the agencies play is to enable the government subsidizes healthcare costs to certain individuals. Medicare is one agency that dealing with social insurance services. It is administered by the US government since 1965 and guarantees access to health to persons over 65 years and above. Younger persons with disabilities, kidney failure, and amyotropic lateral sclerosis also qualify for Medicare. Medicare program caters for the cost of health care but does not cover all medical expenses especially long-term care costs. A patient under this program has four options as provided by the program. While, Part A covers hospital care, part B takes care of outpatient services. On the other hand, part C allows an individual to have a private health coverage paid by the government while part D covers for prescriptions of the patient. Medicare agency has to spread the financial risk associated with sickness across society to protect everyone and thus it differs in its activities compared to other insurers. Every year Medicare provides health services to millions of Americans meeting about half the cost of healthcare services for the enrollees (“Medline Plus,” 2012) Secondly, government agencies play an important role in protecting low-income earners and families and ensuring that they receive quality medical care. The government of US achieves this through Medicaid. States and the federal government jointly fund the program. Any legal permanent resident of the US has a right to enroll including their children, individuals with low incomes and certain disabilities. Poverty is not enough to qualify since one must prove that they are short of assets. The program operates in a way that enrollees are in a private health plan that receives a fixed monthly premium form the state. Medicaid also operates through other programs such as Children’s health Insurance program (CHIP). Thirdly, other agencies have the task of ensuring compliance to the Health Insurance Portability and Accountability Act (HIPAA). HIPAA is a body in healthcare that enables the department to improve on effectiveness and efficiency, cutting the cost while providing better medical care at the same time. This agency has two components. The first regulates the administrative provisions in that it addresses the security and privacy of health data. It requires establishment of national standards for electronic healthcare in the US healthcare systems. The second part protects health insurance coverage for persons who loose or change their jobs. Fourthly, the role of governmental regulatory agencies is to examine public health and warn of possible health threats including infectious diseases. The government achieves this through Centre for Disease Control and Prevention (CDC), which monitors birth defects, disabilities, diseases and conditions, and emergency preparedness. The agency is also concerned with environmental health, vaccines, and workplace safety. In addition, the government controls safety and effectiveness of the countries drug through Food and Drug administration Act (FDA) for both animals and humankind. FDA has a task to regulate food safety, cosmetics, medical devices, food additives, and restaurant inspection. Effects of Government Regulatory Agencies on Health Care Industry First, government regulatory agencies formulate laws that have prevented monopoly in the healthcare industry. Although federal laws prohibit mergers and laws that may that may substantially lessen or reduce competition for businesses, at times health insurance mergers need approval from more than one insurance regulator. For instance, California health insurance merger need approval form Department of Managed Health Care and from the Department of Insurance. However, each state adopts differing options to curb monopolizing the health industry. Secondly, regulatory agencies have worked to add value to services received by clients. The government agencies run various surveys that evaluate the kind of services received by Americans in the healthcare sector and what can be done to better the services. For instance, a survey by the Centre for disease and control can reveal the number of persons opting to have private insurance and their reasons for this. The government can address this issue to influence the service and support from the larger group. Thirdly, government regulatory agencies have led to escalating prices in the healthcare industry. With this, kind of a set up reforms in the health care sector to control costs has not yielded much. Costs continue to go up but the quality of the services received by Americans does not go up with the same magnitude. Reducing long-term costs is such an issue and the government has the option of increasing its role in the industry or encouraging market based models to encourage competition, which can reduce prices. Most of the government spending on healthcare agencies goes to administrative purposes other than to provide healthcare to Americans. This can explain the poor services received by patients. Additionally, the rise in chronic diseases and a higher expectancy rate seem to escalate the costs as the government reaches out for the older generation. However, there is hope to the rising costs as White House reports in that US insurers are being held accountable for their actions. The new health care law prevents insurers form raising rates without accountability or transparency (Sebelius, 2012). Examples of Laws and Regulations in the Healthcare Industry The first regulation faced by the healthcare industry is restrictions as to who should join government healthcare agencies. For instance, only persons over the age of 65 years old or younger persons with disabilities should enroll with Medicare. Additionally, only poor persons with a limited amount of assets or children under 19 years of age qualify to join Medicaid. Failure to comply with the above entry points means that certain persons cannot access government sponsored health care systems. Access to healthcare is important and it requires gaining entry into the system, locating a convenient place for the needed services, and finding a trustworthy provider (Robert, 2006). Therefore, existence of such entry points to Medicare and Medicaid paves way to a discriminatory system where some people cannot access health care. In addition, this regulation results in many uninsured persons and thus less likely to receive medical care, likely have a low life expectancy, or likely to have poor health status. Secondly, there exist disparities in the type of diseases the government can cover under the insurance programs. According to Michael, “the Patient Protection and Affordable Care Act has grand ambitions: to provide insurance coverage to more than 30 million currently uninsured Americans, to slow increases in health care costs, to reorganize the health care delivery system, and to improve the quality of care provided to all” (Michael, 2011). This Act is good but does not fit in oral health, physical health, and eye health Impacts of Laws and Regulations On Healthcare Service Providers Regulations on the healthcare sector play a key role in determining the quality of services received by the patients. Most of the healthcare industry in the US is manned by the private sector, which means that any law geared towards progress will influence the health industry as a whole. For instance, the restrictive laws preventing Americans to join government sponsored health services subject members of the public to exploitation by the private sector. The government sponsors a few persons to have services in the private sector but this is not enough to see the change needed in the health industry. Lack of government interventions in the larger part of the population leaves the providers an opportunity to exploit the public. This has also created a great disparity in the kind of services offered by the private sector to different persons of different social class. It has also created discrimination on the minority groups and some ethnic groups. Although they understand the importance of primary care to patients, they can only provide it to persons who can meet the costs. For instance, when treating at a Medicare Centre, I have found myself treating patients in a discriminatory manner in accordance to their ability to pay. For instance, some diseases like cancer require an earlier detection and treatment to prevent spreading. This marks the difference with the person in a community who has money to pay for screening or one that the government has waived some costs. Such persons are in a position to afford early screening and hence curability of the disease. Conclusion Healthcare industry in the US is currently unreliable because many people do not receive timely care needed. Although primary care to health plays a crucial role, there are fewer students interested in the job every year. The numerous regulations by the government appear as the hindrance to better healthcare crucial to all American citizens. The government need to adopt critical reforms to match the huge bills the government spends on this sector to the services provided. References “CDC.” (2012). Health Insurance Coverage,” Retrieved from, http://www.cdc.gov/nchs/fastats/hinsure.htm “Medline Plus,” (2012). “Medicare,” Retrieved from, http://www.nlm.nih.gov/medlineplus/medicare.html Michael, S. (2011). “US Health Care Reform and the Future of Dentistry,” American Journal of Public Health, 101(10), 1841-1844 Robert, S. (2006). “Home health care services: management and effectiveness in changing times,” Journal of Health and Human Services Administration, 28(3.4), 433-464 Sebelius, K. (2012). “The Health Care Law is Saving Americans Money,” White House, Retrieved from, http://www.whitehouse.gov/blog/2012/09/11/health-care-law-saving-americans-money Read More