Introduction Regulation of healthcare in America continues to be a divisive topic. The regulatory process is complex, impacting healthcare payers, providers, and consumers. Polar views on market dynamics and the right to healthcare contribute to the quagmire. Healthcare regulations thus far have been made in piecemeal fashion. As the issues of cost, quality, and access to care grow with the aging of the U.S. citizenry, Federal change may be in store.
? Regulation and Policy - Differences Regulation and policy are different. According to the Merriam-Webster?s dictionary, a policy is a high-level overall plan embracing the general goals and acceptable procedures especially of a governmental body and a regulation is a rule or order issued by an executive authority or regulatory agency of a government and having the force of law.The former is designed to facilitate decision-making and the latter is designed to control and govern the decisions.
? Need for Regulation and Policy Regulations are needed for three primary purposes: (1) to promote adherence to standards, (2) to manage and simplify market complexity, and (3) to fill gaps due to private sector inaction.
First, regulations and policies are used to control behavior of certain groups and hold them accountable to set standards. This control is especially necessary in a capitalist market, where the interests of business and consumers conflict. In the case of pharmaceuticals, manufacturers are held to high manufacturing standards. For healthcare providers, association-set standards of care and medical guidelines establish treatment protocols. For insurers and sites of care, Federal, State, and industry-affiliated organizations monitor facilities and processes. Without regulation, variation would naturally exist.
Second, complexity and competing interests invite regulation. The complexity of players in the U.S. healthcare system and the myriad insurance provisions and financing sources led government to simplify Medicare, for example. Medicare recipients...