About | HeinOnline Law Journal Library | HeinOnline Law Journal Library | HeinOnline
LOG IN
LOG IN

17 Temp. Pol. & Civ. Rts. L. Rev. 605 (2007-2008)
A Taxonomy of American Health Care Regulation: Implications for Health Reform

handle is hein.journals/tempcr17 and id is 609 raw text is: A TAXONOMY OF AMERICAN HEALTH CARE REGULATION: IMPLICATIONS FOR HEALTH REFORM by ROBERT I. FIELD* INTRODUCTION Health care is one of America's largest industries and is among the most highly regulated. It represents sixteen percent of the economy, a number that is expected to rise to over twenty percent in the next decade.' All levels of government as well as numerous private organizations oversee aspects of this huge enterprise in ways that sometimes complement one another but often conflict. The result is a regulatory system of almost bewildering complexity. All proposals at both the state and federal levels to change the way health care is delivered and financed rely on regulatory structures to take effect. Therefore, any effort to reform the health care system has to be implemented through regulation. Regulation may include both government programs overseen by administrative agencies and private regulatory initiatives conducted through nonprofit organizations that issue guidelines and criteria for clinical behavior. Because of its central role in effectuating reform, a conceptual understanding of the nature of American health care regulation is essential to assessing the prospects of reform initiatives. Over the course of the past century, different paradigms of regulation have emerged that govern various aspects of the system.2 In none of them does a single regulatory authority function in isolation, and in all cases, regulators at various levels interact in a dynamic process. For reform to succeed, it will almost certainly have to fit into this model. This Article will present a taxonomy of health care regulation according to the roles of different regulatory authorities. The basis for the taxonomy will first be presented by defining the nature of regulation and briefly surveying the hjstorical sweep of regulatory programs. The taxonomy will then be applied to assess . A.B., 1974, magna cum laude, Harvard College; J.D., 1977, Columbia Law School; M.P.H., 1980, Harvard School of Public Health; Ph.D., 1987, Boston University. The author is Professor and Chair, Department of Health Policy and Public Health, University of the Sciences in Philadelphia. 1. Estimates for the total cost of health care in the United States are derived by the Centers for Medicare & Medicaid Services. See Centers for Medicare & Medicaid Services, National Health Expenditure Data, http://www.cms.hhs.gov/NationalHealthExpendData/ (last visited Apr. 15, 2008) (outlining up-to-date health care information and statistics); see also HENRY J. KAISER FAMILY FOUND., HEALTH CARE COSTS: A PRIMER 2 (2007), available at http://www.kff.org/insurance/uploadf7670.pdf (presenting a more complete analysis of the rising trend in health care costs). 2. See ROBERT I. FIELD, HEALTH CARE REGULATION IN AMERICA: COMPLEXITY, CONFRONTATION AND COMPROMISE 4 (2007) (noting that the evolution of health care regulation over the past century reflects the changing balance of the three core objectives of a well-functioning health care system: acceptable quality of care, widespread access to care, and affordable care). [6051

What Is HeinOnline?

HeinOnline is a subscription-based resource containing thousands of academic and legal journals from inception; complete coverage of government documents such as U.S. Statutes at Large, U.S. Code, Federal Register, Code of Federal Regulations, U.S. Reports, and much more. Documents are image-based, fully searchable PDFs with the authority of print combined with the accessibility of a user-friendly and powerful database. For more information, request a quote or trial for your organization below.



Short-term subscription options include 24 hours, 48 hours, or 1 week to HeinOnline.

Purchase Access

Contact us for annual subscription options:

Contact Us

Already a HeinOnline Subscriber?

Log In

profiles profiles most