Explain The Structure Of The Health Care System

Structure of the health care system and how it works?

In every health-care system, a product/service is offered to a consumer at a price. This includes the American health-care system. Transactions coming from different entities are controlled by rules and they all expected to obey the law of the United States.

The regulators and policy makers, payers, providers, suppliers and consumers are all part of the American health-care system. Each entity has its roles which at times overlap with other entities such as a consumer can also be the payer.

Regulators and policy makers

The federal government is the major regulator and policy maker in the American health-care system. The federal and state governments are made up of the executive, legislative

In addition, HHS is one of the biggest regulator in this system.

Agencies within Department of Health and Human Services (HHS) consist of the Centres for Medicare and Medicaid Services (CMS) which involve the public Medicare and Medicaid programmes, the Children’s Health Insurance Program (CHIP), Agency for Healthcare Research and Quality (AHRQ), the Centres for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA) and the National Institutes of Health (NIH).

The Veterans Health Administration (VHA) is managed by the Office of Veterans Affairs (VA). The main aim of the VA is to provide health-care to military veterans. Unlike the other agencies, the VA is federal agency independent of HHS. Moreover, the Department of Defence is responsible to provide health-care to active duty military including their families through

Even though the federal government is the most powerful regulator, state governments have been successful in introducing new moves in the health-care system that go beyond federal order for health-care policy. For instance, in 2006 Massachusetts introduced health insurance coverage for its citizens.

Payers

Payers are the entities that finance the cost of the American health-care system. These are the public sector which is made up of the federal government, state and local governments and the private sector including the private insurers and business and the person’s own funds (out-of-pocket). These payers purchase health-care services from providers.

Public purchasers include federal and state agencies.

Medicare is the largest public purchaser. It covers Americans aged 65 and older, citizens with a disability and those with end-stage renal disease. State governments with the help of the federal government, purchase health-care services through Medicaid and CHIP. Both programmes cover poor mothers and their children. In addition, Medicaid also provides coverage for disabled adults, low-income families or individuals in paying for long-term care services who used up all their own income and assets and the low-income