The U.S government plays a vital role in the healthcare sector given that it is responsible for maintaining a healthy country by ensuring that all Americans have full access to high-quality care services. The government has been influential in both the decline and growth throughout U.S. history. For instance, in 1872, the country had 178 hospitals, however, as at 1929; there were 6,665 hospitals in 1929, which represented a hospital bed increase from 35,604 to 907,133 within the period (Shi & Singh, 2014). During that time, the mantra that guided construction of hospitals in the region was that every bed built was subsequently filled (Shi & Singh, 2014. However, this kind of thinking has changed significantly over the years. There are key factors that facilitate the growth of hospitals, including scientific advances, development in professional nursing, increased medical information, growth in health insurance, advancement in specialized technology, as well as the government role. This paper explores the part of the government in decline and increases in the United States, mainly focusing on the roles of Medicaid and Medicare in-hospital growth as well as the Hill-Burton Act.
Hill-Burton Act
In the 1930s a large number of hospitals closed down in the U.S., a factor that was attributed to the Great Depression, which further threatened the closure of more hospitals. According to Chung, Gaynor, and Richards-Shubi (2017), approximately 663 closed between 1928 and 1937. The closure contributed to a severe hospital bed shortage in the U.S. after World War II. Further, hospital construction was minimal during the Great Depression, further exacerbating the problem of accessing quality care within the region ( Chung, Gaynor & Richards-Shubik, 2017) . The government at the time played a central role in influencing the decline of hospitals because it was responsible for making policies about healthcare as well as funding the sector. However, the government failed to provide adequate support to the industry contributing to its near collapse by paying more attention to the political aspects that affected the country, including war among others.
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In a bid to resolve the problem of the shortage of bed space, the government implemented the Hill-Burton Act. The Act is described as one of the most significant breakthroughs in the U.S. healthcare sector to date ( Chung, Gaynor & Richards-Shubik, 2017) . The Act facilitated the building of new community hospitals by providing states with federal grants to support the construction projects. In this context, the government encouraged the growth of new hospitals since the Act made it mandatory for states to upgrade and develop a health facility construction plans annually. The Act endorsed the concept of bed-to-population proportion, which acted as the basis as to which the grants distributed to each state were determined.
Medicaid and Medicare Programs
Apart from focusing on constructing more hospitals to meet the growing demand for healthcare services, the government also implemented Medicaid and Medicare programs to promote the affordability of care. The plans, which were established in 1965 by the U.S. government, aimed at helping citizens of all ages to access care, but mainly focused on individuals within the retirement age ( Centers for Medicare & Medicaid Services, 2018) . Although the two programs aimed at achieving similar objectives, they differ as far as access to care, benefit packages, and eligibility are concerned. While the Medicare program focuses on helping individuals requiring long-term care including the elderly, Medicaid is concerned with covering healthcare costs, particularly for individuals from poor backgrounds in the states. Moreover, the Medicare program is mainly created for individuals who are above the age of 65 years. However, the program is unique in that all individuals who fall under the stipulated age are covered irrespective of their income levels. Medicare is coordinated into four different packages, including hospitalization coverage, medical insurance, prescription drugs coverage, as well as private packages that pertain to both medical insurance and hospitalization packages.
On the other hand, the Medicaid program, which is divided into the federal and state Medicaid programs, focuses on helping low-income but qualified families and persons to access quality care by paying for long-term medical expenses, hospital stays doctor visits and custodial care among other services. Through the program, millions of Americans obtain health coverage, including people with disabilities, elderly adults, expectant women, children, and low-income adults. The federal and state governments jointly fund the program. Eligibility for the program is based on such factors as citizenship, disability, age, asset, and income. By February 2018, approximately 67.6 million U.S. citizens had access to Medicaid coverage ( Centers for Medicare & Medicaid Services, 2018) . In most cases, individuals who qualify for the program are provided with managed care plans that consist of a network of selected healthcare providers. The covered persons access to care for free from all the providers that accept the program.
The government has most influenced the growth of hospitals through the two programs, whereby the state Medicaid programs comprise the largest recipients of the federal spending. Although some voters regard the programs as flawed systems that are poorly managed, others consider them as a crucial social safety net. Despite the progress that these programs have shown in promoting access to care, particularly among the low-income families as well as such disadvantaged groups as the elderly and the disabled, the programs are presently facing significant pressure to cut down on their costs both at the federal and state levels. As at mid-2018, the Medicaid expansion proposal was rejected in 17 states although most states had expanded their programs starting 2014 under the requirements of the Affordable Care Act ( Centers for Medicare & Medicaid Services, 2018) .
In conclusion, the above analysis illustrates that the government's role is crucial in influencing the growth or decline of hospitals in the U.S. Policies or laws that favor the growth of the healthcare sector, such as the Affordable Care Act, Medicaid, Medicare, and the Hill-Burton Act among others are vital in influencing growth of hospitals. However, political factors such as reduced spending on healthcare largely affect the closure or decline of hospitals.
References
Centers for Medicare & Medicaid Services (CMS), HHS. (2018). Medicare Program; Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program. Final rule. Federal Register , 83 (73), 16440.
Chung, A. P., Gaynor, M., & Richards-Shubik, S. (2017). Subsidies and structure: the lasting impact of the Hill-Burton program on the hospital industry. Review of Economics and Statistics , 99 (5), 926-943.
McHugh, M. D., Berez, J., & Small, D. S. (2013). Hospitals with higher nurse staffing had lower odds of readmissions penalties than hospitals with lower staffing — Health Affairs , 32 (10), 1740-1747.
Shi, L., & Singh, D. A. (2014). Delivering Healthcare in America: A Systems Approach (6th ed.). Sudbury, MA: Jones and Bartlett Publishers.
