SOLUTION: SNHU Improve Health Insurance Policy Discussion

Running head: GLOBAL HEALTH AND DIVERSITY
Global Health and Diversity
Bianco Bernard
Southern New Hampshire University
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GLOBAL HEALTH AND DIVERSITY
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Global Health and Diversity
Milestone One
Introduction
Healthcare is one of the critical industries that needs government intervention. The
government must regulate several industry procedures to ensure that consumers who are the
patient are protected and provided with quality services. The Healthcare industry has faced
several advancements based on scientific and technological progress. To improve the treatment
process, a healthcare professional should have adequate information about the patient. This
resulted in healthcare information records. The government intervention was based on protecting
patient information from being accessed by a third party. The government created the Health
Insurance Portability and Accountability Act (HIPAA) of 1996 as a policy to regulate how
healthcare facilities use and store patient information (Moore & Frye, 2019). The Act was passed
by the 104th congress and signed by President Clinton. The policy created national standards for
information protection and provided more control to patients on deciding how the information
should be handled. Another vital element of the project is the provision of boundaries on the use
and release of health records. Health information can only be disclosed with the knowledge and
consent of the patient. In the policy, patient information is referred to as protected health
information. Therefore, the main purpose is to ensure a continuous flow of necessary information
and patient data protection. This ensures a provision of quality services and an increase in trust
level between patient and health care professions.
Rationale
The policy has a positive impact on both patients, healthcare organizations, and
healthcare professions. From its enactment to law, the policy has helped improve efficiency in
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the healthcare industry, ensure information is protected, and streamline most healthcare
functions. Also, it is evident that the policy is flexible enough to accommodate advancement in
the industry. For example, the policy plays a significant role in the Electronic Health Record.
Also, the government has integrated the Act to help in determining the reimbursement level. The
Act has also played a major role in improving the patient-doctor relationship, which is critical for
the treatment process (Cohen & Mello, 2018). A patient gains confidence that the information
provided is private and provides critical information that helps a doctor address the problems the
patient is facing. Therefore, the HIPAA Act has created a significant milestone for the industry.
The compliance is also based on protecting health information, upholding integration and
confidentiality, protecting against the unlawful use of patient information, guarantee compliance,
and protecting patient information from any threat such as cybersecurity breach.
Development
The policy was introduced by President Clinton’s administration. The Act aimed to
improve accountability and portability of medical cover. The portability can be noted by the shift
of an employee from one company to another, where the HIPAA Act ensured that the medical
cover was also shifted. Employees with pre-existing health conditions were required t create and
use medical saving accounts. Two years after the Act was introduced, the government
recommended further improvement on patient information security. In 1999, the Act prohibited
healthcare facilities from disclosing information to unauthorized individuals. The HIPAA
Privacy Rule was introduced in 2003, and the compliance became effective on April 21, 2005,
and any non-compliance party was subjected to financial penalties by April 21, 2006 (Moore &
Frye, 2019). The enforcement rule was introduced in 2006, which gave the Department of Health
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and Human Service power to investigate complaints raised against covered entities and evaluate
the fine necessary.
Stakeholders
The stakeholders in HIPAA Act can be categorized as primary stakeholders and
secondary stakeholders. Primary stakeholder includes employees, employers, payors,
researchers, health facilities, clinicians, caregivers, families, and patient. Secondary stakeholders
include legislators, policymakers, consultants, distributors, suppliers, and vendors. The
stakeholders are determined by the level of impact and how they are affected by the policy
implantation. The level of influence is determined by privacy included, data security, and
funding.
Milestone Two
Evaluation
Strengths
The HIPAA Act’s strength is based on the impact that the policy has created in the
industry. Most of the benefits noted from its implementation are for patients. For healthcare
facilities, HIPAA has helped in the transition from traditional paper records to electronic records.
Thus, it has helped to improve efficiency, quality of care, and protection of health information.
The policy ensures that patients are signed in the same hymn sheet, which ensures that health
professionals have adequate information for the treatment. The policy also ensures that there is
no discrimination (Kafali et al., 2017). The policy ensures patients can file a complaint and
complaint investigated through proper channels. Any lack of compliance will cause facilities to
face penalties, which will affect their revenue. This ensures that health facilities are working
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towards the guideline provided. The policy is also flexible since it has adequately included most
of the advancement in the industry.
The establishment rule also plays a major role since it ensures that health patients’
information is subjected to strict control. The information protected by the establishment role
includes information disclosed to health providers, information stored by health facilities,
information disclosed to health plans. Patients can also get a copy of their information whenever
they need it. This process helps to check errors that might exist in the records and request for
correction. Patients can also seek treatment from new facilities with the information obtained.
This reduces the cost associated with the testing process. Before the introduction of the policy,
health care facilities had no legal requirements to release copies of information. Therefore,
HIPAA Act has helped improve the quality of care and ensure that health facilities are more
accountable (Wang, 2019). Accountability in the industry is important since it ensures
sustainability in the industry. This has made HIPAA Act to be considered one of the major
milestones made in the healthcare industry.
Weaknesses
The policy does not have major limitations. However, most healthcare facilities have
faced financial troubles attributed to the policy. The penalties associated with the policy are high.
For example, based on the level of negligence, non-compliance penalties can range from 100 to
50000 dollars per record. The maximum penalty per record is at 1.5 million dollars for identical
provision violations. It is also costly to implement a system that ensures data protection in a
facility. With an increase in cyber breaches associated with health facilities, the information
system implementation requires significant budget allocation.
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There is also a monopoly when deciding the level of fine. This is because only the USA
department of Health and Human Service determines the level of fine. Also, the government
agent analyzes the breach. The patient is not involved in the fine process despite being the owner
of the violated information. Lastly, the automation of claims is not regulated by the HIPAA. This
makes it hard for a patient to self-pay since the claim is sent without consent. The privacy rule
should mandate health facilities and health professionals to obtain patient consent prior to
submitting a claim to the insurance company (Chen & Benusa, 2017). Through this, a patient can
have the right to self-pay or decide the claim he or she wants to submit.
Needs
HIPAA can be classified as a utilitarianism theory since it aims at improving healthcare
services for most people in the population. The theory is achieved by protecting patients’
information, keeping data private, giving the patient the right to access information, and
notifying the right authority in case of a breach. Information is protected by limiting the number
of people with access and the ability to view and amend the information. This ensures a high
confidentiality level in the industry. The policy also requires the relevant parties to be informed
in case of a breach. This is important since it ensures that the stakeholders have the information
need to implement procedures necessary to mitigate the risks. For example, in July 2020, 36 data
breaches were reported by HIPAA-covered entities in 21 states (Alder, 2020). The breach
affected more than 1.3 million people. The provision of such information is crucial for
addressing current and future risks. Provision of such information helps people to change their
financial information such as pin and password, which can reduce the risk of fraud. Patients also
have a right to request copies of their health information. This can help in creating an
intervention action to improve their treatment.
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Unintended Impacts
HIPAA still costs healthcare provides millions to maintain the high standard associated
with the policy. This cost also includes the compliance cost and time spent developing and
implementing policies for a facility. Another unintended consequence is an increase in
administration requirements. The policy also affects the reimbursement whereby health care
facilities are evaluated based on their compliance. Low-level compliance can lead to facilities
receiving less amount than they expected. This ends up hurting the budget allocation in such
facilities. The HIPAA also increases the process or reimbursement, which makes it hard for
facilities to create a specific timeframe. There is also the issue on reputation damage especially
for facilities subjected to HIPAA compliance.
Milestone 3
Introduction
There is a HIPPA Law in New Mexico that can help evaluate the effectiveness in which
population can be addressed. HIPPA Law, while doing an assessment, impacts the overall
targeted population. In New Mexico, there are certain areas where several improvements in
HIPPA can make an overall better policy. This policy can be recommended in specific ways to
help in improving the HIPPA Law. HIPPA Law, in certain ways, can be beneficial or might be
opposed to the policy.
Efficacy
Health Insurance and Portability Act (HIPAA) is a US legislation founded in 1966
focused on providing safety to protected health information (PHI). Under HIPPA, there are
many, including the Safe Harbor Rule, among the many incorporated legislations. The Safe
Harbor Rule aims at protecting the facilities and professionals that operate in the medical sector
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from any liabilities under certain circumstances. It helps in reducing the liability in the event that
reflects good faith. Additionally, it also elaborates that health information that fails to identify an
individual and lacks a reasonable basis that that particular information can be used to identify an
individual should not be considered identifiable health information (Malin, Benitez, & Masys,
2011). The Safe Harbor Rule is useful in HIPPA as it aids in guiding how and where the rules of
privacy are applicable in protecting personal.
In my observation, there are magnificent laws for privacy accompanied by HIPAA that
must be used in human service organizations. For personal data, it can be hard to keep it private
in this world of technology; therefore, HIPAA establishment is a great step. A great purpose is
served by HIPAA because it safeguards the privacy of a patient. Although several establishments
were contrary to HIPAA, for the patient’s best interest and the rights of their privacy, it is
significant to put into effect the HIPAA rules. It is significant to implement severe punishments
for the workers who violate the HIPAA laws because it might become the reason for humiliation
if the patient’s private information was disclosed to further people.
Key Areas of Improvement
In HIPAA, there are certain regulatory gaps that must be focused on with the intention of
adapting to the current era. There was no advanced technology upon the establishment of
HIPAA. This legislation was aimed at accountability, privacy, and portability. Security must be
addressed further because of technology’s existing landscape. With HIPAA, the major issue is
that upon its establishment, it was meant for holding providers answerable over the data of the
patients (Davis, 2019). Throughout that period, many were concerned that there would be
discrimination grounded on health for citizens in the job market. It seems at this time that there
was a little assumption of the way the technology would affect the policy advancing.
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The systems of health technology in 1996 highlighted accounting and billing, but not
highlighting protection against the information of health. With the intention of protecting health
information and staying ahead of the curves of increasing security threats, it is significant to
advance the technology of health information. The field of healthcare would benefit from tasking
agencies with the data safety oversight and the security for making up for any inadequacies that
the policy has not considered.
Policy Improvement
The policy’s security aspect requires improvement. With the intention of improving this
policy for adapting to the health technology’s existing landscape as best as possible, there is a
need for removing the dirt from current legislation of HIPAA, along with making it clear that
responsible, appropriate use of data is good and must be encouraged (Davis, 2019). To improve
this policy, the top approach is a broad start prior to focusing on specifics. Catching up to the
curve of technology would be best prior to concentrate on particular sorts of breaches.
A data security agency can be used for overseeing data security and privacy. These
agencies need to be licensed and inspected for having the capability of handling the that is
trusted. The data of healthcare is eye-catching to hackers as they can use this information for
financial gain. An agency that is newly licensed must concentrate on making financial data
secured, along with keeping it separate from the patient’s health information or clinical data.
Keeping these secure and separate could assist in making health data a less attractive target for
hackers. The data would be unable to be unified and would be fragmented (Davis, 2019).
Advocate for or Against the Policy
HIPAA is sustained by many individuals; however, it is not supported by several
organizations, and people did. The industry of health care, in the beginning, was contrary to
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HIPAA and did not accept the HIPAA-stated guidelines. “Health care providers, health care
organizations, and, to some extent, health plans thought of the proposed HIPAA rules as just
another federal mandate that would cost the industry billions of dollars to implement and
monitor” (Herold & Beaver, 2003). With the rules and regulations of HIPAA, the industry of
health care is continually having problems; however, with HIPAA, more establishments are
concentrating on the progressive features that are provided by HIPAA rather than concentrating
on adverse matters. Although for several organizations, it can be difficult to recognize HIPAA;
these organizations are researching it, and with the intention of serving better to their patients,
they are approaching the standings to better handle the HIPAA.
Conclusion
There is a HIPPA Law in New Mexico that can assist in evaluating the effectiveness in
which population can be addressed. Health Insurance and Portability Act (HIPAA) is a US
legislation founded in 1966 focused on providing safety to protected health information (PHI). In
HIPAA, there are certain regulatory gaps that must be focused on with the intention of adapting
to the current era. The policy’s security aspect requires improvement. HIPAA is sustained by
many individuals; however, it is not supported by several organizations, and people did.
Testimony
One of the most readily felt impacts of HIPAA is the creation of standard codes that are
used by billers. The codes used include International Classification of Diseases, Current
Procedural Terminology, and Image result for HCPCS codes meaning Healthcare Common
Procedure Coding System codes. These codes make it easier for healthcare professionals to read
and understand. Another important aspect includes an increase in patient power in terms of
control, setting necessary boundaries for the use and release of patient information, establishing
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appropriate safeguards for information protection, and holding violators accountable. Patients are
also well aware of how their information will be used and have a right to obtain the copy
whenever they want.
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References
Alder, S. (2020). July 2020 Healthcare Data Breach Report. Retrieved February 10, 2021, from
https://www.hipaajournal.com/july-2020-healthcare-data-breachreport/#:~:text=There%20were%2026%20data%20breaches,had%20some%20business%
20associate%20involvement.
Chen, J. Q., & Benusa, A. (2017). HIPAA security compliance challenges: The case for small
healthcare providers. International Journal of Healthcare Management, 10(2), 135-146.
Cohen, I. G., & Mello, M. M. (2018). HIPAA and protecting health information in the 21st
century. Jama, 320(3), 231-232.
Davis, J. (2019, August 13). Healthcare Needs More than HIPAA, Legislation to Improve
Security. Retrieved from https://healthitsecurity.com/news/healthcare-needs-more-thanhipaa-legislation-to-improve-security
Herold, R., & Beaver, K. (2003). The practical guide to HIPAA privacy and security compliance.
CRC Press.
Kafali, Ö., Jones, J., Petruso, M., Williams, L., & Singh, M. P. (2017, May). How good is a
security policy against real breaches? A HIPAA case study. In 2017 IEEE/ACM 39th
International Conference on Software Engineering (ICSE) (pp. 530-540). IEEE.
Malin, B., Benitez, K., & Masys, D. (2011). Never too old for anonymity: a statistical standard
for demographic data sharing via the HIPAA Privacy Rule. Journal of the American
Medical Informatics Association, 18(1), 3-10
Moore, W., & Frye, S. (2019). Review of HIPAA, part 1: history, protected health information,
and privacy and security rules. Journal of nuclear medicine technology, 47(4), 269-272.
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Wang, C. (2019). The Strengths, Weaknesses, Opportunities, and Threats Analysis of Big Data
Analytics in Healthcare. International Journal of Big Data and Analytics in Healthcare
(IJBDAH), 4(1), 1-14.

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