Abstract: All levels of government have an economic and social interest in
health. In the United States, Federal, state and local government are involved
in the development of health policy, funding health care, and maintaining or
improving public health. Federal, State and most municipalities also engage in
delivery of health services. As with the private sector, government is
grappling with accelerating health care costs, increasing service demands
generated by an aging and more chronically ill society, and accumulating
evidence that American health outcomes are not commensurate with the resources
invested. Unlike the private sector, attempts to improve value in health care
– whether through legislation in Congress or regulation or program design in
the Executive branch – are subject to the full intensity of the partisan
political process. In order to engage effectively with government in health
system transformation, an understanding of both the civic processes and the
political dynamics is necessary. This chapter provides an overview of the major
governmental roles in health care as formally structured and identifies points
of influence in the political process.