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Experience from the United States of America
(US) may have some relevance for India since the two countries
share mixed health care delivery system. relevance for India in
many respects. More over the dominant American ethos is to favour
free enterprise and small government. Hence the health care policy
and regulatory environment for private HCIs in the US can give
some idea about what would be the most liberal boundary regulation
of health care institutions, elsewhere. Health care delivery
institutions in the US need license to operate. This institutional
licensing is in addition to the requirement of license to practice
by individual health care professionals. The respective state
hospital or health care facility licensing boards have to satisfy
that the health care institution meets the state building
standards as well as minimum standards for delivery of health
care. In addition, there are voluntary accreditation systems in
the US like the Joint Commission of Accreditation of Health Care
Organisations (JCAHO). Most states in the US have one or more
nonprofit health insurance organisations popularly called the Blue
Cross. . These plans were exempt from insurance regulatory laws.
In view of their nonprofit status, they also had tax exemption. In
return for these benefits the Blue Cross plans were expected to
serve the entire community and provide insurance plans affordable
by persons with moderate to low income. Their accounts and rate
structure could be examined by public bodies. The US Federal tax
code allows income tax exemption to employers for health insurance
coverage of employees. To reduce geographic imbalances in
availability of doctors, the US Federal government operated a
hospital construction and equipment grants program, popularly
called the Hill-Burton program from 1947 till 1973. This program
contributed to a small increase in the stock of short term general
hospitals, and most importantly helped reduce the imbalance in
distribution of hospital capacity across states. Capital grants
were provided to nonprofit and local body hospitals only. public
This might have contributed to a marginal reduction in share of
forprofit hospitals in the US, but the effect if any was small.
The program did help improve availability of physicians in
backward areas, through an increase in hospital stock of those
areas. Most American states have some kind of certificate of need
(CON) law to regulate expansion of hospitals and acquisition
expensive equipment by health care institutions. Although the
federal certificate of need program under the National Health
Planning and Resources Development Act has been discontinued, the
state certificate of need programs are continuing. To slow down
rapid increase in health care costs the US federal government has
been encouraging setting up of health maintenance organisations
(HMOs) which combine health insurance and health care provision
functions. There are many programs in US to improve quality of
health care. Some important initiatives by the federal government
include, (a) peer review organisations, and (b) development and
dissemination of clinical practice guidelines.
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