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Experiences from the United States (US)

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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