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Health care services in the United States can be divided into at least two discreet provider groups: public health and private health. A third group, special populations and special disorders, are discussed.

Public Health Care Services

The public health services sector is an organized function of the federal government and is supported by tax dollars from its citizens. It is organized and managed by a cabinet-level executive with an emphasis toward the prevention of disease, promotion of health, reporting and control of communicable diseases, responsibility for environmental factors such as air and water quality that affect the public's health, and collection and analysis of vital event data to provide indicators of the public's health.

The public health service has undergone numerous revisions as it has matured, but as of 1995 the essential public health services included monitoring health status to identify and solve community problems; diagnosing and investigating health problems and health hazards in the community; informing, educating, and empowering people about health issues; mobilizing community partnerships and actions to identify and solve health problems; developing policies and plans that support individual and community health efforts; enforcing laws and regulations that promote health and ensure safety; linking people to needed personal health services and assuring the provision of health services when otherwise unavailable; assuring a competent public health and personal health services workforce; evaluating effectiveness, accessibility, and quality of personal and population-based health services; and researching for new insights and innovative solutions to public health problems.

These activities and services are provided within the public health agencies as follows: Centers for Disease Control (CDC), Food and Drug Administration (FDA), Health Resources and Services Administration (HRSA), National Institutes for Health (NIH), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Indian Health Service (IHS), and the Agency for Health Care Policy and Research (AHCPR). Although the public health service may directly deliver some primary care services, the focus is not on service delivery, but on shaping the nation's public health system to promote health and to prevent disease.

Although these organizations are under the umbrella of the U.S. Department of Health and Human Services (DHHS), other ministry-level health functions in the system provide health care services. For example, the U.S. Department of Defense (DOD) administers health services for active duty military personnel and their dependents and for military retirees. As well, the Department of Veterans Affairs (DVA) provides services to military veterans in a nationwide system of hospitals, clinics, and nursing homes. The U.S. Department of Justice (DOJ) manages the correctional health services in the country's prisons; the Drug Enforcement Agency (DEA) within the Department of Justice governs the use of narcotic prescription drugs; the [Page 508]U.S. Department of Agriculture (USDA) administers the Women, Infants, and Children (WIC) nutritional program. WIC does not provide direct health services but is closely linked to programs that assist low-income recipients.

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