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Federal, State, and Local Governments in Provision of Healthcare in the US

The government on all levels is a major stakeholder in healthcare and is responsible for its provision on the public sector. Federal, state, and local governments are involved in the creation of specific laws, regulations, and policies regarding healthcare.

Federal Government

The federal government has overseen the creation of national health insurance programs like Medicaid, Medicare, and CHIP to provide medical services to certain populations. Federal government also manages the medical services of active military personnel and veterans, through TRICARE and the VHA, the latter of which is the largest healthcare system in the US. Native Americans are covered by the Indian Health Service, which provides medical services to members of federally recognized tribes. Federal government also supplies funds for medical research at institutions such as the CDC and certain universities. Recent federal legislation (e.g. the Affordable Care Act) have removed some healthcare barriers, such as restrictions due to preexisting conditions, and expanded coverage overall.

State Government

State governments are involved in the provision of healthcare via health planning; the regulation of health facilities and manpower; health professions development; the development and regulation of emergency medical services; and the collection, analysis, and publication of health statistics (Altman & Morgan, 1983). Individual states are also responsible for operating their own Medicaid program within federal regulations while at the same time developing their own judgment over who is eligible for the program and the benefits received. They are also capable of developing healthcare programs and initiatives unique to that state. States are likewise in charge of regulating health insurance via overseeing state insurance departments and developing insurance laws and budgets. In addition, states are responsible for running state owned and operated community hospitals.

Local Government

Local governments operate more on a city and/or county level and are concerned with maintaining public health. For instance, the Public Health Department of Seattle and King County is concerned with matters such as immunizations, prevention of communicable disease, reproductive health, environmental health services, emergency medical services, and healthy eating. Local governments are also responsible for the operation of locally owned and operated community hospitals.

Government Roles in Healthcare

Government.PNG

Roles and Structures of Healthcare Organizations

Hospitals have a complex organizational structure with divisions and hierarchies. The direction, control, and governance of the hospital are divided among three influential entities: the board of trustees, administration, and medical staff (Young, Kroth, & Sultz, 2018). Operating divisions which consist of information, therapeutic, diagnostic, support, and other services represent the more functional areas of the hospital.

The organizational structure a hospital can be represented as a pyramid:

Structure.PNG

Board of Trustees

The board of trustees is most responsible for safeguarding the quality of care patients receive and developing the organization’s mission and strategic plans. Hospital trustees oversee the appropriate use and allocation of resources and are in charge of the overall financial wellbeing of the organization. Members of the board of trustees are also assigned with hiring and monitoring the CEO and are involved in the accreditation and credentialing process (Price, 2018).

Administration

Hospital administrators coordinate all of the departments within the organization to ensure operations are efficient and that departments operate as a whole. Roles within the hospital administration include:
 

  • Chief Executive Officer (CEO)

    • Leader of the administration department and oversees staff, public relations, and economic operations

  • Chief Operating Officer (COO)

    • Manages the operation of particular hospital departments

  • Chief Financial Officer (CFO)

    • Oversees financial activities of the hospital

  • Chief Nursing Officer (CNO)

    • Directs nursing services of the hospital

  • Chief Information Officer (CIO)

    • Manages healthcare IT infrastructure

  • Chief Medical Information Officer (CMIO)

    • Manages the EHR and designs healthcare IT systems

Medical Staff

The medical staff is a group comprised of medical doctors and other medical professionals of at both the doctoral level and midlevel. The president or chief of staff is the liaison between the hospital administration and members of the medical staff (Young, Kroth, & Sultz, 2018). Duties of members of the medical staff include:

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  • Managing and evaluating the quality of medical services

  • Directing training programs and maintaining accredditation

  • Suggesting the designation of doctors to the medical staff through the board of trustees

Operational Divisions

Operating divisions are another vital component of the hospital organization structure and are central to patient care and the smooth running of the establishment. These divisions can include nursing, admissions, business, pharmacy, rehabilitation, nutrition, laboratories, imaging, hotel, transportation, and other services.

References:

Altman, D. E., & Morgan, D. H. (1983). The role of state and local government in health. Health Affairs, 2(4). doi: https://doi.org/10.1377/hlthaff.2.4.7


Price, N. (2018, January 31). Roles & responsibilities of a board of directors for a hospital. Retrieved from https://www.boardeffect.com/blog/roles-responsibilities-board-directors-hospital/.


Spath, P. (2013). Fundamentals of health care quality management. Forest Grove, OR: Brown-Spath & Associates.


Young, K. M., Kroth, P. J., & Sultz, H. A. (2018). Sultz & Youngs health care USA: understanding its organization and delivery. Burlington, MA: Jones & Bartlett Learning.
 

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