U.S. Government Reimbursement Policies For Healthcare Providers Essay

Expectations

Initial Post:

Due: Friday, November 13
Length: A minimum of 250 words, not including references
Citations: At least 2 scholarly reference in APA 7th ed from within the last 5 years

As a consequence of the taxpayer’s revolt that began in California and spread across the country, sharp cutbacks in federal aid to subnational levels of government, and the economic recession, state and local governments are being forced to cope with dramatically reduced resources. Nevertheless, spending for health remains big business in state and local governments today. More than one of every six dollars states spend (16.9percent) are devoted to health, slightly more than the share of the federal budget devoted to health (13 percent). Local governments spend 7.8 percent of their overall expenditures for health purposes, a proportion roughly equal to that of transportation, public safety, and natural resources and more than spending for public welfare. Recognizing that resources are shrinking at a time when responsibilities are expanding, Drew Altman and Douglas Morgan have a particular interest as officers at The Robert Wood Johnson Foundation in developing policy approaches to this difficult equation that spare the most vulnerable population segments of society. Altman, an assistant vice-president at the foundation, is a political scientist by training (Ph.D., Massachusetts Institute of Technology) and former health official in the Carter administration. U.S. Government Reimbursement Policies For Healthcare Providers Essay  Morgan, a senior program officer at the foundation who holds a master’s degree in public administration from New York University, was formerly the City of Newark’s director of public health. Two decades ago, Altman and Morgan would have been in the forefront of the Great Society, believing as they do in a strong central government. Now, realists that they are, Altman and Morgan are struggling, along with many others, to strike new balances, build new alliances, and make tough decisions in the face of limited resources. As they underscore, these judgments will involve incremental changes rather than fundamental funding reallocations or policy shifts. Despite the incremental nature of the shifts, though, it is unlikely that ever again will state and local governments be cast so easily as the adversaries of the poor—they now represent a vast resource to people without means. U.S. Government Reimbursement Policies For Healthcare Providers Essay

TOPICS
PUBLIC HEALTHMEDICAIDCOSTS AND SPENDINGCHILDREN’S HEALTHDISEASESHEALTH SERVICESBLOCK GRANTSWELLNESSORGANIZATION OF CARECLINICAL CARE
Though responsibility for health care in the United States is, in unique fashion, both a public and private affair, in recent years, government—and most especially the federal government—has emerged as perhaps the single most important force shaping our health care system. This development has drawn attention to Washington and to what policymakers there are doing in health. Yet, as in other domestic policy areas, government’s role in health is shared. No level of government—federal, state, or local—has its own entirely autonomous sphere of action, and all three levels interact in shaping policy, in financing and delivering health care, and in running programs. Students of intergovernmental relations are familiar with Morton Grodzin’s now somewhat hackneyed metaphor for this state of affairs. The balance of government roles and responsibilities in America, he observed, looks much more like a marble cake than a layer cake with a clear separation of roles and functions. U.S. Government Reimbursement Policies For Healthcare Providers Essay

However, despite the current preoccupation with events in Washington, increasingly we are seeing a rediscovery of the importance of the role of state and local governments in the health care field. Whether the issue is Medicaid, hazardous wastes, chemical spills, state rate setting or certificate-of-need, homeless persons on the streets of major cities, or lead paint poisoning, more and more attention is being focused on what state and local governments are doing in health. Several developments have spurred this apparent rediscovery of the state and local role, but three appear to be most noteworthy. U.S. Government Reimbursement Policies For Healthcare Providers Essay

First, through his New Federalism initiatives, President Reagan has stimulated a fresh debate about the respective roles of each level of government in health as well as in other fields. This so-called New Federalism would substantially reshuffle the relationship between federal-state-local government, significantly expanding the role of the states in the governance and financing of domestic programs. President Reagan’s initiative has renewed awareness of important differences between liberals and conservatives on the respective roles of federal and state government— with liberals in recent years fearful of the motivations and capacities of state government, and conservatives equally fearful of any expansion of the federal purse or presence. The fate of the Medicaid program, among others, has been a hot issue in this larger debate. U.S. Government Reimbursement Policies For Healthcare Providers Essay

Second, these are hard times for state and local governments. The tax revolt that began with Proposition 13, recent cutbacks in federal aid, and the nationwide economic recession have placed a severe burden on state and local governments. Their fiscal plight and their efforts to cope are receiving increasing attention, much of which has concentrated on the health area where state and local governments have been grappling with the problem of how to trim expenditures while still maintaining services and programs. U.S. Government Reimbursement Policies For Healthcare Providers Essay

Third, and perhaps most important, in a period of belt-tightening and retrenchment at all levels, both the general public and professionals in the health care field are concerned that these cutbacks might threaten the nation’s health. Over the past twenty years, this country has made truly significant gains in access to health care and in health. For example, the poor in the U.S. now see a physician and receive hospital care at least as often as the nonpoor, and such health status measures as mortality and morbidity and infant mortality have shown steady improvement. 2 Though the evidence is not yet in one year or the other, there is now concern that the cutbacks that are being made threaten these gains. It is a concern that focuses not just on Washington, where broad financing and policy decisions are made, but at the state and local level as well, where the consequences of decisions are most visible and where services are actually delivered. U.S. Government Reimbursement Policies For Healthcare Providers Essay

Thus, for philosophical, economic, and health care reasons, the role of state and local government in health is emerging both as an issue for professionals in the field and as a significant public issue as well.

The public officials who are the object of this attention face two broad challenges. The first is how to adapt, in the short term, to federal cutbacks and the pressures of today’s economy. In today’s economic climate, what choices and tradeoffs should state and local governments make in the health area?  U.S. Government Reimbursement Policies For Healthcare Providers Essay The second challenge involves the long-term role of state and local government in health. The fundamental question is whether state and local governments should refocus what they do in the health care field. Specifically, should more resources be invested in personal medical care or in public health, and what specific investments should be made in each area? Underlying these questions are historically difficult issues involving the role of the public and private sectors in health; the role of the different levels of government; and the adequacy of our knowledge base and the capacity of our political system for making tradeoff and priority decisions of this kind. The articles that follow address these challenges as well as these underlying concerns. As background, in this article we describe where things currently stand with regard to the state and local role in health. U.S. Government Reimbursement Policies For Healthcare Providers Essay

THE EVOLUTION OF THE STATE AND LOCAL ROLE
Broadly speaking, the health-related activities of state and local government are: traditional public health, including health monitoring, sanitation, and disease control; the financing and delivery of personal health services including Medicaid, mental health, and direct delivery through public hospitals and health departments; environmental protection, including protection against man-made environmental and occupational hazards; and the regulation of the providers of medical care through certificate-of-need and state rate setting as well as licensing and other functions. Though we will not deal with these equally or comprehensively, a selective look at the history is useful in thinking about future roles and choices. U.S. Government Reimbursement Policies For Healthcare Providers Essay

State and local government involvement in public health began with the great epidemics of the late eighteenth and early nineteenth centuries. The first of these, the yellow fever epidemic in Philadelphia, struck in 1793, and epidemics of cholera, small pox, and yellow fever were frequent occurrences over the next fifty years. 3 Initially, government responded to these epidemics by instituting quarantine measures and efforts to improve community sanitation. Generally these were directed by physicians appointed by the city or state government. Today we know that the causes of these epidemics were in large part social and economic. Counted among them were a rapidly growing and fast moving population; the urbanization of the Eastern seaboard which resulted in overcrowding, bad housing, inadequate sanitary facilities, polluted water supplies, and contaminated food; and the rapid expansion of the West, resulting in similar conditions on a smaller scale in new Western towns and communities. 4 However, the importance of these factors was not well understood in the early nineteenth century. Even when England and other countries were beginning to address these problems effectively, government in the United States was slow to respond. Due partly to the epidemics in Philadelphia, the nation’s capitol was moved from that city to Washington, D.C. in 1800. U.S. Government Reimbursement Policies For Healthcare Providers Essay