Health Insurance Portability and Accountability Act (HIPPA),
Medicaid, and Medicare have had a significant impact on the
healthcare industry of the United States of America. These elements
have given rise to both benefits as well as challenges in the healthcare
domain when it comes to decision-making. They have impacted a
diverse range of stakeholders that exist in the healthcare landscape,
such as customers, healthcare professionals, and healthcare
organizations. The Privacy Rules of HIPPA mainly focus on the use as
well as disclosure of the health information (protected health
information) of individuals. It acts as a major guideline that enables
healthcare organizations to handle sensitive and confidential
information of patients so that they can be safeguarded from
malicious parties (Centers for Disease Control and Prevention, 2018).
Some of the key benefits associated with Medicare include better
management of the cost relating to health care and extended support
to individuals to pay for inpatient and outpatient care settings in the
healthcare domain. It offers ample flexibility to beneficiaries to make
necessary changes relating to their health insurance coverage which
ultimately influences their quality of health (Gonzalez et al., 2021).
The main benefits of Medicaid include the provision of a broad range
of healthcare services for vulnerable individuals, such as physician
services, home health services, etc., along with optional benefits like
case management and prescription drugs.
However, HIPPA, Medicaid, and Medicare also give rise to a host of
challenges in terms of the decision-making process. For instance, in
the highly unpredictable and dynamic cyber domain, the risk relating
to violation of HIPPA guidelines intensifies. Some of the most
common reasons that lead to the violation of the HIPPA Act include
malware and ransomware attacks, employee email phishing attacks,
inappropriate disposal of medical records, and snooping of medical
records (Gonzalez et al., 2021). One of the major challenges
associated with Medicare is the complex enrollment process,
especially for beneficiaries. For instance, there exists a high level of
uncertainty for new entrants relating to the decisions that they make
while choosing insurance plans that suit their exact health needs.
Similarly, Medicaid also presents several challenges when it comes to
decision-making in the healthcare domain. One of the key challenges
is a high degree of instability relating to the eligibility and enrollment
of candidates. Similarly, the arrangement relating to coverage and
care and the development of robust payment incentives is also a
major challenge area. Thus, designing Medicaid contracts is a major
challenge that affects the decision-making process.
References
Centers for Disease Control and Prevention. (2018, September 14).
Health Insurance Portability and accountability act of 1996 (HIPAA).
Centers for Disease Control and Prevention. Retrieved May 11, 2022,
from https://www.cdc.gov/phlp/publications/topic/hipaa.html
Gonzalez, L., Polivka-West, L., & Polivka, L. (2021). Failures of
regulation and policy in Medicaid-managed long-term care and
Medicare Advantage. Public Policy & Aging Report, 31(2), 57-61.
