HE210 COMPREHENSIVE EXAM 2026
QUESTIONS AND ANSWERS 100% CORRECT
◉ THE HEALTH CARE FUNCTIONS OF GOVERNMENT: The
Constitutional Basis of Governmental Authority in Health Care. .
Answer: It is argued that a very significant role for government in health
care delivery is justified by the amount of money government spends on
it. This says nothing about the calls for major reforms that could be
undertaken by no agency other than government that echo down to us
from the early 1930s and resonate in many voices today. But such a role
has a constitutional basis as well. To understand government operations
in the health care delivery system, it is to understand the structure of the
government itself. 1 A basic principle of the U.S. Constitution is that
sovereign power is to be shared between the federal and state
governments, a principle called federalism . At its heart, the U.S.
Constitution is an agreement among the original 13 states to delegate
some of their inherent powers to a federal government, on behalf, not of
themselves as separately sovereign entities, but of, as the Preamble to
the Constitution says, "the people of the United States." As part of this
agreement, in the Tenth Amendment to the Constitution, the states
explicitly reserved to themselves the rest of the power: "The powers not
delegated to the United States by the Constitution, nor prohibited by it to
the states, are reserved to the states respectively, or to the people."
Because it is not explicitly mentioned in the Constitution, among the
powers reserved to the states is the "police power." It is the latter that
forms the basis of the states' role in health (Mustard, 1945, pp. 17- 21).
As Grad (2005) points out: In the states, government authority to
regulate for the protection of public health and to provide health services
,is based on the "police power"—that is, the power to provide for the
health, safety, and welfare of the people. It is not necessary that this
power be expressly stated, because it is a plenary power that every sove
◉ The Legislative Branch . Answer: At each level of government,
federal, state, and local, the three branches of government have
responsibility and authority for health and health services. Legislatures
create the laws that establish the means to safeguard the public's health,
in matters ranging from the assurance of a pure water supply to
protecting the health of workers in their places of employment. The
legislatures also enact the legal framework within which the health care
delivery system functions, determining which individuals and
institutions are authorized to deliver what services to which persons
under what conditions and requirements. In the past, legislatures have
imposed certain requirements for planning and development on the
system, although in most jurisdictions that function has been minimized
or has disappeared entirely. If the government is to participate in health
care financing (see Chapter 5), directly deliver services, or support
research efforts, the legislature must first establish the legal authority for
those programs.
◉ The Judiciary . Answer: The judiciary generally supports the work of
the other two branches of government. The judicial branches at the three
levels of government have important powers relating to health and
health services. In the criminal law arena, working in concert with the
law enforcement arms of the executive branches, under the authority
granted to them by their respective legislatures, they can try
apprehended transgressors of the criminal law and determine
punishment for those successfully prosecuted. For example, although it
,is a state legislature that creates the licensing law for physicians and the
executive branch that administers it, it is the judicial system that
determines the guilt or innocence of a person charged with "practicing
medicine without a license." The criminal justice system also plays a
vital role in safeguarding the public's health. For example, it enforces
sanitary protection and pollution control legislation, with criminal
sanctions if necessary. In the civil arena, the judicial system handles
disputes arising from the provision of health services, for example,
through the process of malpractice litigation. The judicial system
adjudicates contract cases arising from health care system disputes, such
as those between providers or patients, on one side, and a third-party
payer on the other. It protects the rights of individuals under the due
process and equal protection clauses of the Fifth and Fourteenth
Amendments to the Constitution. Together, then, the judicial and
executive branches form the civil and criminal justice systems, at the
federal, state, and local levels.
◉ The Executive Branch . Answer: In common parlance, the term
government in health care refers to the executive branch that delivers
health care services, drafts and enforces provider/payer regulations, and
administers financing programs, not the legislature that creates the
programs or regulatory authority, nor the courts that settle disputes
arising under the laws and adjudicates violations of them. Therefore, in
the remainder of this chapter the term government refers to the executive
branch of government.
◉ Provision of Personal Health Services . Answer: Government at all
levels is the major provider of the traditional community-wide "public
health" services, such as pure water supply and sanitary sewage disposal,
, food and drug inspection and regulation, communicable disease control
(e.g., immunization and the control of sexually transmitted diseases),
vital statistics, environmental regulation and protection, and public
health laboratory work. Certain community health activities are shared
with the private sector. For example, in public health education,
voluntary agencies such as the American Cancer Society and the
American Heart Association are important participants. Private refuse
companies do much of the solid waste collection and, in certain states,
supply the water. Private organizations such as the Sierra Club and the
Natural Resources Defense Council are active in environmental
protection. Private institutions also play a vital role in health sciences
education and research.
◉ Health Services Financing . Answer: As will be described in more
detail in Chapter 5, government participates in the financing system in
three ways. First, it pays for the operation of its own programs, both
personal and community. It does this directly, for example, through the
federal government's Veterans Affairs (VAs) hospital system or a
municipal hospital serving primarily the poor. It also does this indirectly,
for example, through the federal government's provision of grants to
state governments to help pay for personal care in state mental hospitals
and for the operation of the state's public health agencies at the
community level. The states, in turn, indirectly support local
governmental public health activities by providing money for that
purpose. Second, through grants and contracts to nongovernmental
agencies (and, in certain cases, other governmental agencies),
governments support other types of health-related programs, for
example, in biomedical research and medical education. Third, and this
is by far the major role of government in financing, under such programs
QUESTIONS AND ANSWERS 100% CORRECT
◉ THE HEALTH CARE FUNCTIONS OF GOVERNMENT: The
Constitutional Basis of Governmental Authority in Health Care. .
Answer: It is argued that a very significant role for government in health
care delivery is justified by the amount of money government spends on
it. This says nothing about the calls for major reforms that could be
undertaken by no agency other than government that echo down to us
from the early 1930s and resonate in many voices today. But such a role
has a constitutional basis as well. To understand government operations
in the health care delivery system, it is to understand the structure of the
government itself. 1 A basic principle of the U.S. Constitution is that
sovereign power is to be shared between the federal and state
governments, a principle called federalism . At its heart, the U.S.
Constitution is an agreement among the original 13 states to delegate
some of their inherent powers to a federal government, on behalf, not of
themselves as separately sovereign entities, but of, as the Preamble to
the Constitution says, "the people of the United States." As part of this
agreement, in the Tenth Amendment to the Constitution, the states
explicitly reserved to themselves the rest of the power: "The powers not
delegated to the United States by the Constitution, nor prohibited by it to
the states, are reserved to the states respectively, or to the people."
Because it is not explicitly mentioned in the Constitution, among the
powers reserved to the states is the "police power." It is the latter that
forms the basis of the states' role in health (Mustard, 1945, pp. 17- 21).
As Grad (2005) points out: In the states, government authority to
regulate for the protection of public health and to provide health services
,is based on the "police power"—that is, the power to provide for the
health, safety, and welfare of the people. It is not necessary that this
power be expressly stated, because it is a plenary power that every sove
◉ The Legislative Branch . Answer: At each level of government,
federal, state, and local, the three branches of government have
responsibility and authority for health and health services. Legislatures
create the laws that establish the means to safeguard the public's health,
in matters ranging from the assurance of a pure water supply to
protecting the health of workers in their places of employment. The
legislatures also enact the legal framework within which the health care
delivery system functions, determining which individuals and
institutions are authorized to deliver what services to which persons
under what conditions and requirements. In the past, legislatures have
imposed certain requirements for planning and development on the
system, although in most jurisdictions that function has been minimized
or has disappeared entirely. If the government is to participate in health
care financing (see Chapter 5), directly deliver services, or support
research efforts, the legislature must first establish the legal authority for
those programs.
◉ The Judiciary . Answer: The judiciary generally supports the work of
the other two branches of government. The judicial branches at the three
levels of government have important powers relating to health and
health services. In the criminal law arena, working in concert with the
law enforcement arms of the executive branches, under the authority
granted to them by their respective legislatures, they can try
apprehended transgressors of the criminal law and determine
punishment for those successfully prosecuted. For example, although it
,is a state legislature that creates the licensing law for physicians and the
executive branch that administers it, it is the judicial system that
determines the guilt or innocence of a person charged with "practicing
medicine without a license." The criminal justice system also plays a
vital role in safeguarding the public's health. For example, it enforces
sanitary protection and pollution control legislation, with criminal
sanctions if necessary. In the civil arena, the judicial system handles
disputes arising from the provision of health services, for example,
through the process of malpractice litigation. The judicial system
adjudicates contract cases arising from health care system disputes, such
as those between providers or patients, on one side, and a third-party
payer on the other. It protects the rights of individuals under the due
process and equal protection clauses of the Fifth and Fourteenth
Amendments to the Constitution. Together, then, the judicial and
executive branches form the civil and criminal justice systems, at the
federal, state, and local levels.
◉ The Executive Branch . Answer: In common parlance, the term
government in health care refers to the executive branch that delivers
health care services, drafts and enforces provider/payer regulations, and
administers financing programs, not the legislature that creates the
programs or regulatory authority, nor the courts that settle disputes
arising under the laws and adjudicates violations of them. Therefore, in
the remainder of this chapter the term government refers to the executive
branch of government.
◉ Provision of Personal Health Services . Answer: Government at all
levels is the major provider of the traditional community-wide "public
health" services, such as pure water supply and sanitary sewage disposal,
, food and drug inspection and regulation, communicable disease control
(e.g., immunization and the control of sexually transmitted diseases),
vital statistics, environmental regulation and protection, and public
health laboratory work. Certain community health activities are shared
with the private sector. For example, in public health education,
voluntary agencies such as the American Cancer Society and the
American Heart Association are important participants. Private refuse
companies do much of the solid waste collection and, in certain states,
supply the water. Private organizations such as the Sierra Club and the
Natural Resources Defense Council are active in environmental
protection. Private institutions also play a vital role in health sciences
education and research.
◉ Health Services Financing . Answer: As will be described in more
detail in Chapter 5, government participates in the financing system in
three ways. First, it pays for the operation of its own programs, both
personal and community. It does this directly, for example, through the
federal government's Veterans Affairs (VAs) hospital system or a
municipal hospital serving primarily the poor. It also does this indirectly,
for example, through the federal government's provision of grants to
state governments to help pay for personal care in state mental hospitals
and for the operation of the state's public health agencies at the
community level. The states, in turn, indirectly support local
governmental public health activities by providing money for that
purpose. Second, through grants and contracts to nongovernmental
agencies (and, in certain cases, other governmental agencies),
governments support other types of health-related programs, for
example, in biomedical research and medical education. Third, and this
is by far the major role of government in financing, under such programs
