Respond to two of your classmates, contrasting and comparing the benefits and challenges.
There are many benefits of Medicare, Medicaid, and HIPAA. The most prevalent third-party payers in healthcare are insurance companies and Medicare and Medicaid offered by the government. The creation of these government programs changed “healthcare from a privilege to a right” for Americans (Nowicki, 2022). Those who qualify for Medicare are those 65 years of age and older in addition to those who are younger than 65 with disabilities. A challenge with Medicare is the growing costs, especially with the baby boomer generation growing older. Spending is projected to exceed one trillion dollars by 2023. In order to meet the needs of Medicare beneficiaries, tax contributions will need to be increased (Nowicki, 2022).
Medicaid was created for those who are “medically indigent” people who are unable to pay healthcare costs (Nowicki, 2022). Originally, those who were eligible for the program were associated to being federal assistance programs (ie. AFDC and SSI), but children, infants, and pregnant women of low-income were also deemed eligible in 1986. Optional benefits offered through Medicaid , such as drug prescriptions or PT/OT, are state specific (Nowicki, 2022).
The creation of Medicare and Medicaid has positively changed the lives of many and continues to do so. It goes without saying that the main benefit of Medicare and Medicaid is that it gives those who may otherwise be unable to afford or obtain healthcare the opportunity to do so (Nowicki, 2022). Data has revealed that one in three people are enrolled in Medicare or Medicaid. Since the initiation of these government programs, more people have access to healthcare, which can be attributed to the increase in life expectancy rate since the creation of Medicare and Medicaid. One study also showed that children who were enrolled in Medicaid develop into healthier young adults versus those who are not in the program (Leonard, 2015).
Another benefit of Medicaid is that the program assists with long-term care costs. This is imperative as 1 in 4 adults will require care in a nursing home at some time. Alternatively, a challenge to this is that people only qualify for long-term care assistance through Medicare if all of their assets have been used up. This may be difficult for many as they their need for long-term care may have not been planned or they have loved ones whom they support.
However, Medicare will pay for short-term admissions (ie. following a fall), but lacks other benefits such as support from social services (Leonard, 2015). From a personal standpoint, I have seen many people who require long-term care after being admitted to the hospital and have to wait a lengthy amount of time prior to be accepted for long-term Medicaid assistance (Miller & Stroud, 2015). I find this factor to be concerning as not only are these patients experiencing a delay in care (ie. if they require certain services the hospital may not provide) and/or are using hospital resources that could be better utilized (ie. holding a bed as the ED is overflowing with patients in need of a bed on a unit) as they await long-term care approval. I think it would be beneficial if this aspect were readdressed in hopes of decreasing spending as a patient extending their length of stay can be costly, especially if they are medically cleared for discharge (Nowicki, 2022).
The creation of HIPAA has set standards in place to protect patient’s health information. With HIPAA, not only is private health information protected, but it has given patients the legal right to view their medical records. A benefit of HIPAA is that compliance is monitored to ensure health information remains protected and that patients are able to access their PHI. For example, organizations should have specific policies in procedures in place in order to properly dispose of PHI in order to reduce the risk of a breach (Nowicki, 2022). Although, a challenge related to HIPAA is that if there are offenses, such as disclosing health information of a patient, the penalties aren’t only costly, but they may also include time in prison (“HIPAA Violations”, n.d.).
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