Law of Healthcare in America
The law of health-care administration in America is a mixture of federal, state, and local statutes, rules, and regulations. At the federal level, Congress passes a statute that is often enforced in the executive branch by an administrative agency. The US Department of Health and Human Services, composed of twelve administrative agencies, is the federal department that implements national health policy. It is important for actors within the health-care industry to be aware of the authority of and relationships between each body that regulates the industry. It is also important to be acquainted with the sources of potential liability of health-care professionals and institutions toward their patients. This article reviews the governmental structure of health-care regulation and a few sources of liability for actors in the health-care industry.
Keywords Administrative Agency; Administrative Law; Administrative Regulations; American Healthcare System; Common Law; Department of Health and Human Services; Healthcare; Healthcare Administration; Independent Contractor; Statutory Law
Health Care Management: Law of Healthcare Administration in America
Health care in the United States is a hot political topic that ignites much debate. The number of uninsured Americans is often cited as a problem for the country. The cost of medical insurance is generally rather high, in many cases prohibitively so, with many people forgoing the expense and suffering the crush of medical bills in the event of illness. The seemingly dire financial outlook for Medicare, the federal health-care program generally provided to those Americans receiving Social Security, is another cause for concern. While the Affordable Care Act of 2010 took some steps toward addressing these issues, it did not solve the problem. A universal health-care program is often discussed as a way to cure some of the ills of the American health-care system, but opponents of such a system often cite the attendant cost and presumably large tax increase necessary to fund such a program. They may also mention that the United States has some of the finest medical professionals in the world, and socialization would adversely affect the country's position as a leader in global medical innovation. The health-care debate also affects the doctors themselves, who may have difficulty receiving reimbursements from insurance companies and are often subject to their own large premiums for malpractice insurance. In the business world, individual companies are having trouble keeping pace with competition from lower-cost producers around the world, in part because of the high cost of providing health-care benefits for employees.
Each of the potential problems mentioned above impacts business because they impact almost every American. Every issue also involves law, but the law of health care is a vast subject. To try to reduce the subject to a manageable size, this article will first describe the sources of the laws that control the field of health care and then discuss a few legal topics related to the business of administering medical services, including the regulation of health-care institutions and the liability of health-care professionals and institutions.
The Structure of the Law
This discussion of the structure of the law in the United States is generally applicable to every area of US law and is therefore valuable for all those interested in the government regulation of conduct. Of the three general sources of law described below, each may apply in certain circumstances with more vigor or primacy than the others, and the relationship of each to one another is critical. While the description of law is keyed to the federal system, each state, as a separate governing authority, typically has an analogous structure to the federal system. While a discussion of the relationship between state and federal governments is beyond the scope of this article, as a general rule, federal law supersedes state law.
The three sources of law are common law, statutory law, and administrative law.
- Common law is judge-made law; it is derived from judicial decisions. When a court decides on an interpretation of a law, that interpretation is binding on lower courts in other cases with sufficiently similar facts.
- Statutory law is the body of laws, or statutes, that were passed by a legislature. Legislative action is the first step in the process. After Congress (or a state legislature) passes a law, it may be administered or enforced by an administrative agency, which is part of the executive branch of government.
- Administrative laws, or more appropriately administrative regulations, are rules passed or promulgated by an administrative agency. If Congress desires to enforce a statute with an agency, the statute itself creates that agency and empowers it to create regulations to enforce that law. The process by which Congress creates agencies, the degree of power and latitude those agencies have, the method by which the agency may create rules, and the judicial oversight of the process are all part of what is generally referred to as administrative law, which is largely governed by the Administrative Procedure Act (APA), passed by Congress in the 1940s. The body of rules produced by an agency is usually referred to as rules and regulations. The complete set of all of those rules and regulations from all federal agencies is contained in the Federal Register for public access.
Agencies typically have significant latitude to fulfill their congressional mandate. In other words, the agencies enjoy deference from the courts that agency rules and decisions should be upheld. That deference to agencies is called Chevron deference, named after the 1984 United States Supreme Court case of Chevron v. Natural Resources Defense Council. Parties seeking to challenge or appeal an administrative ruling are typically required to seek recourse within the agency itself before a court will hear the case. The important general point is that an agency regulation, once established according to the rules prescribed by the APA, has the effect of law, and in many cases an agency interpretation of that law will be respected by the courts, although courts retain the power to disagree with and overrule an agency decision or interpretation.
Agencies enforce their congressional mandate through internal legislative, judicial, and executive functions, the general arrangement of which is similar to the structure of the government at large. Accordingly, the agency has the authority to create rules (the legislative function), enforce those rules (the executive function) and adjudicate the cases (the judicial function). As mentioned, all of these activities occur within the executive branch of government, which is charged with the duty to enforce the law passed by Congress. The executive branch is organized into departments, with the heads of those departments forming the president's cabinet. A few examples of federal executive departments are the Departments of Defense, State, Justice, Education, Energy, and Homeland Security, as well as the Department of Health and Human Services (DHHS).
The Department of Health
The DHHS enforces most of the health-related laws passed by Congress. The secretary of the DHHS is the administrative head of the department and a cabinet-level adviser to the president. The DHHS is responsible for developing and implementing regulations that carry out the national health policy objectives and is the main source of regulations that affect the health-care industry. DHHS agencies include the Administration for Children and Families (ACF), which describes its mission as "to enhance the health and well-being of Americans by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services." The ACF lists five main goals: to "promote economic and social well-being for individuals, families and communities," to "promote healthy development and school readiness for...
(The entire section is 3567 words.)