Medicare and medicaid, although similar, are very different. They both have
many benefits, as well as downfalls. HIPAA also brings its own set of pros and
cons.
What is medicare? "Medicare is federal health insurance for people 65 or
older, some younger people with disabilities, people with End-Stage Renal
Disease." (medicare.gov). Although this health coverage helps pay for medical
costs, it does not cover everything, and unfortunately it typically does not
cover long-term care. One benefit of medicare is the assistance it offers our
elders, which significantly reduces out of pocket medical costs. Another
benefit of medicare is the increase in medical standards that come along with
it, "With the creation of Medicaid and Medicare, Congress created a set of
standards for hospital enrollment in the programs. As time went on, the
government became more involved in overseeing these standards and now
requires public reporting on things such as hospital infection rates and
readmissions." (Scott, 2021). Another benefit of medicare is the assistance it
offers patients with ESRD. Treatment for ESRD is expensive, and having
medicare helps to offset the costs of treatment, and helps patients continue
with life-saving interventions, such as dialysis. Unfortunately, medicare also
has cons. One con is that not all elders fall into category that classifies them as
"low-income", and therefore don't always qualify for all the coverage
medicare has available. Some individuals that qualify for medicare may not
qualify for medicare part D, which covers prescription medications. Not
having this coverage available may cause our elders to be non-compliant with
their medications in order to save the very small income they receive from
social security. They may choose eating that week over their medications.
Another con of medicare is the cost to administer it, "In 2020, Medicare
spending was projected to be $858.5 billion. That number isn’t expected to get
smaller, with CMS estimating that it will increase to over $1 trillion by the end
of the decade." (Scott, 2021).
What is medicaid? "Medicaid provides health coverage to millions of
Americans, including eligible low-income adults, children, pregnant women,
elderly adults and people with disabilities. Medicaid is administered by states,
according to federal requirements. The program is funded jointly by states and
the federal government." (Medicaid | Medicaid, 2022). One advantage of
medicaid is the security it brings low-income individuals, pregnant moms, and
others security regarding their health. It brings a sense of confidence that if
they were to be admitted to the hospital or need to see their PCP, they would
not be as financially burdened by the medical costs they may incur, and be
more apt to seek medical treatment for themselves rather than ignore it for fear
of inability to pay. Another benefit of medicaid is low or no cost prescriptions.
Having prescriptions available to an individual at low or no cost will help them
adhere to their treatment plan, as they don't have to make a choice between
paying for their medications instead of food or a utility bill. Disadvantages of
medicaid can be lower quality health care due to not all providers accepting
medicaid; sometimes medicaid has issues with reimbursing providers for
services, making it risky for the provider to accept that insurance. Another
disadvantage of medicaid can also be stigma; there is a certain stigma
associated with utilizing medicaid benefits, and individuals may feel ashamed
or embarrassed, which should not be the case.
What is HIPAA? "The Health Insurance Portability and Accountability Act of
1996 (HIPAA) is a federal law that required the creation of national standards
to protect sensitive patient health information from being disclosed without
the patient's consent or knowledge." (Health Insurance Portability and
Accountability Act of 1996 (HIPAA) | CDC, 2018). Benefits of HIPAA
include: protection for the individual regarding their private health
information. A patients health information should be limited to medical
providers that require it to care for their patient, no one else. Having
confidence in the confidentiality of your healthcare helps you to be more open
about your health, and seek treatment when needed. This also increases
patient/provider loyalty. Another benefit of HIPAA is it assists in allowing the
patient to have more control over their healthcare; the patient chooses with
who and when their private health information is shared, and when they would
like information to remain confidential. This also goes back to patient/provider
loyalty. Challenges of HIPPA include: more security breaches, especially the
more we continue to expand in regards to technology, and virtual healthcare;
there are higher chances of PHI being leaked or information stolen. Another
challenge of HIPAA is untrained or subtrained personnel not following
HIPAA guidelines/policy, leading to a breach in PHI. There needs to be
regular training regarding HIPAA, and mock situations to help personnel stay
in compliance. "While hackers are behind some of the most damaging data
breaches, internal While hackers are behind some of the most damaging data
breaches, internal actors are actually a greater threat to organizational
cybersecurity are actually a greater threat to organizational cybersecurity"
(Vasquez, 2021)
References
Health Insurance Portability and Accountability Act of 1996 (HIPAA) | CDC.
(2018). Cdc.Gov.
https://www.cdc.gov/phlp/publications/topic/hipaa.html#:%7E:text=The%20
Health%20Insurance%20Portability%20and,the%20patient’s%20consent%2
0or%20knowledge.
Medicaid | Medicaid. (2022). Medicaid.Gov.
https://www.medicaid.gov/medicaid/index.html
Scott, S. (2021, September 13). The Surprising Pros and Cons of Medicare.
HealthMarkets.
https://www.healthmarkets.com/resources/medicare/surprising-pros-cons-
medicare/
Vasquez, J. (2021, September 29). What are the Top Challenges to HIPAA
Compliance? Liquid Web. https://www.liquidweb.com/blog/hipaa-
compliance/
