One of the most important medical-legal doctrine is the Healthcare Insurance Portability and
Accountability Act (HIPAA), which protects all of the patients identifying factors from being
disclosed to or discussed with those outside of the patient’s direct care (Legal, n.d.). This law
ensures that patients are granted privacy which in turn makes them trust their practitioners more,
creating an honest, trusting communication stream between the patient and health care team.
Healthcare workers, such as nurses, who do not abide by HIPAA are subject to termination and
legal interventions such as fines, penalties, or jail time (Legal, n.d.).
a a a a a a a a a a a a a a Medicare is a program that provides financial aid to members of the retirement
community (65+) or disabled individuals, regardless of their income or worth (Medicare, n.d.).
Beginning in 1965 this program began to provide insurance coverage for doctors appointments,
hospital insurance, and prescription insurance at little to no cost (Medicare, n.d.). Medicaid is
similar in the fact that it is a program, also enacted in 1965, that provides insurance coverage to
low income families or individuals with disabilities (Medicare, n.d.). These programs are especially
important in providing vulnerable populations with access to healthcare. Without these programs
many elders, young mothers and their children, as well as the disabled would not be able to go to
doctors appointments, physical therapy, or their home health care. Although these programs are
highly beneficial in providing access to healthcare, they do not come without a cost, a financial
burden (Medicare, n.d.). For many years government figures and hospital administration have
noticed the financial burden these programs place on both the government as well as the hospital
systems. As more and more people begin to reach retirement age, with more and more chronic
illnesses, there is hardly enough supply to meet the demand of this generation. In 2008 the
government spent $600 billion dollars on these programs alone, to provide care to these patients,
and this number is expected to keep climbing (Medicare, n.d.). Another challenge with these
systems is the financial burden it also places on acute care hospitals and skilled nursing facilities.
Medicare uses a value based program to reimburse healthcare facilities for the patient care
provided. This means that these facilities receive payment based on the quality of care the patient
received in the hospital (CMS, n.d.). For example, facilities do not receive reimbursement for care
received as a result of a pressure ulcer acquired during admission. Therefore, healthcare facilities
find themselves with increased spending due to not receiving payback from Medicare (CMS, nd.).
CMS' value-based programs. CMS. (n.d.). Retrieved May 22, 2022, from
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-
Instruments/Value-Based-Programs/Value-Based-Programs#:~:text=Value-
based%20programs%20reward%20health%20care%20providers%20with%20incentive,
our%20three-part%20aim%3A%20Why%20are%20value-
based%20programs%20important%3F
Legal Information Institute. (n.d.). 42 U.S. Code § 1320D–6 - wrongful disclosure of
individually identifiable health information. Legal Information Institute. Retrieved May
22, 2022, from https://www.law.cornell.edu/uscode/text/42/1320d-6
Medicare and Medicaid funding challenges. Concord Coalition. (n.d.). Retrieved May 20,
2022, from https://www.concordcoalition.org/medicare-and-medicaid-funding-
challenges
