Medicare is defined by Nowicki (2021) as a federally funded program
(1966) that provides health insurance to Americans at age 65.
Medicaid is defined by Nowicki (2021) as a program created by the
federal government, funded by the federal and state governments,
and administered by the state government, to provide free or low-
cost healthcare to low-income recipients. Collectively Medicaid and
Medicare have helped to bridge the gap in many healthcare
disparities regarding cost and access to healthcare and this also
helped to lessen the burden of medical expenses for many Americans.
Because the Medicaid program covers the spectrum regarding age it
has helped many underprivileged families who have members who
are under 65 gain access to healthcare services. Medicaid and
Medicare also provide guaranteed payments to providers.
Challenges regarding Medicare are that people are living longer the
cost of Medicare is increasing. Medicare is not an all-inclusive plan
and does not cover dental or vision. Medicare also does have
copayments and does not cover 100% of all medical costs, leaving an
often financially struggling person over 65 with the potential of
accruing healthcare costs that may become a burden or deter them
from accessing preventative care. Medicare also has different plan
options that can be confusing to people and can result in inadequate
coverage for the person’s individual medical needs. Although
Medicaid has guaranteed payments to providers, there is no
guaranteed timing of those payments to providers and therefore
some providers chose to not see patients with Medicaid coverage
(OCF, 2022). This may make it challenging for patients who have
Medicaid to find care. The number of people who are eligible for
Medicaid puts a strain on the shortages and or delays of care in
certain areas and as a result delays in care for not only people with
Medicaid but for all.
HIPAA is defined by Nowicki (2021) as the federal legislation from
1996 to improve the efficiency and effectiveness of the healthcare
industry by requiring covered healthcare entities to adopt
administrative simplification provisions including privacy and security.
HIPAA provides national standards and protection to the patient
regarding the wrongful disclosure of individually identifiable
healthcare information. HIPAA also enforces penalties if there is a
breach of security or confidentiality. HIPAA also allows for patients to
have access to their records which encourages patient involvement
and investment in their plans of care.
Some of the challenges to the healthcare industry that HIPAA creates
is the paperwork burden (SSG, 2022). Providers are already
challenged with staffing and time constraints and HIPAA’s paperwork
adds to this burden. HIPAA has also created a market for companies
and legal consultants to assist medical professionals to comply with
the laws and changing medical provisions (SSG, 2022). This too takes
providers away from providing patient care.
Reference
Nowicki, M. (2021). Introduction to the Financial Management of
Healthcare Organizations, Eighth Edition (Gateway to Healthcare
Management) (7th Ed.). Gateway to Healthcare Management.
Obama Care Facts. (2022). Do all doctors take Obamacare?
Obamacarefacts.Com. https://obamacarefacts.com/questions/do-all-
doctors-take-
obamacare/#:~:text=Most%20doctors%20will%20take%20most%20i
nsurance%20types%2C%20and,your%20plan%20and%20insurer%20
choice%20before%20you%20enroll.
SSG. (2022). What Are Some Pros & Cons of HIPAA? - Default Landing
Page - Strategic Services Group. ssgmi.com.
https://www.ssgmi.com/default-landing-page/What-Are-Some-
Pros--Cons-of-HIPAA-_AE141.html
