Paper Example on Government Regulates Healthcare to Ensure Integrity and Improve Service Delivery

Introduction

Government regulation plays a significant role in ensuring integrity in all sectors of its economy. The healthcare sector is one of the most affected because it is the one that deals with human life. Therefore, the government, together with other stakeholders like the CDC, have over the years developed policies that aim to improve service delivery in the health care sector. One of the most significant regulation to be enacted by the government is the Health Insurance Portability and Accountability Act (HIPAA). HIPAA was a bill proposed by Kennedy and Kassebaum, both politicians serving Massachusetts and Kansas respectively, and ascended to by President Bill Clinton in 1996, forming a new age in the way healthcare information was protected by healthcare officials (Luxton, Kayl, & Mishkind, 2012). The law affected several aspects of healthcare, including healthcare insurance, the handling of personal information by healthcare personnel, administrative requirements, and tax concerns. Overall the bill has five sections concerning the integrity of the healthcare system.

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HIPAA Specifications

HIPAA was created when there was a need to modernize the healthcare sector in the United States. The modernization process involved the use of technology to store patient information. As such, there was a need for the government to intervene and develop a national framework that would determine how personal and private information from patients would be handled and also set regulations on how the healthcare sector and its staff were to conduct their business. The titles of the legislation affected both the health care consumer, provider and any third party that provides health care plans in collaboration with health care institutions or the government.

The first article of the legislation affected the consumer and how the consumer accesses health care services and how certain health care policies looked out for the quality of service delivered to the consumer. Article I was created to ensure that health care providers did not exempt the benefits of group coverage in the event of a late payment or lack of prior cover by an individual. Additionally, the article created limitations for the restrictions by allowing the consumer to reduce the exclusion period depending on the amount of time the individual has been under credible coverage or the number of days that would constitute a significant break from coverage. Credible coverage means that one is under any of the nationally recognized covers like Medicaid and Medicare, while a significant break constituted more than 63 days without any coverage. The main aim of this legislation was to help the consumer receive better and assured care by allowing better access to care. At the same time, the law allowed the employer to charge a premium based on the lifestyle of the individual. For example, persons with a smoking habit were charged more premiums because of the risk they place on their health. Therefore, their premiums were set a little higher to cover the increased risk. The new legislation required the removal of hidden clauses that excluded coverage from accidents, leading to the loss of lives because of hidden exclusionary clauses in prior healthcare plans.

While the first article was concerned about the coverage of healthcare and access by the consumer, the second one was concerned about the safety of the information provided by the consumer and the administrative capacity of healthcare professionals in managing the vital data presented to them while, at the same time, providing quality care. Tittle two is concerned with the protection of healthcare information and dictates the several crimes related to information disclosure and the penalties related to such offenses. The main aim of the second title is to improve the efficiency of the system by stealing issue related to the protection and sharing of healthcare information. The privacy rule affects all the entities that handle healthcare information, including healthcare insurance providers, healthcare professional and the institution as well. The HIPAA privacy rule has set aside the regulations for what is to be considered as protected healthcare information (PHI). PHI is defined as any form of healthcare and personal information that is provided by the consumer to either the insurer, healthcare giver, or any other third party that can be directly linked to the specific consumer. In as much as this information is private, upon suspicion of cases of child abuse, the holders of PHI are required to submit patient information to the relevant authorities for investigation (Solove, 2013). The case should have slid grounds for suspicion for the information to be disclosed. Additionally, upon request by the consumer or any other authorized entity holding the information, it is required to be released within 30 of the initial requests. This legislation is concerned with the sharing of healthcare information across the board, as well as the administrative requirements for healthcare providers. Healthcare professionals are under the law required to keep the consumers' information private even to family members unless instructed to do so by the consumer.

HIPAA Amendments and Monitoring

Over the years, HIPAA has been updated to cover areas that had presented difficulties for both the healthcare sector and law enforcement. Some of the amendment to the legislation came as recently as 2013 when it was affected by the Omnibus rule that touched on the privacy provisions of the Health Information Technology for Economic and Clinical Health Act (Solove, 2013). Under the new privacy provisions, businesses associated with healthcare consumers under HIPAA were included under the proception clause as a means of reducing the breach of information by unauthorized personnel. At the same time, the new amendment set regulation that revoked the withholding of personal information in the event of a natural disaster because emergency service needs the information to be effective in delivering services and alleviating the impacts of the disaster (Richards, 2009). The new amendments are focused on improving the level of privacy while, at the same time, allowing reasonable use of healthcare information among authorized personnel to affect the best form of service delivery to the consumer.

To ensure that the requirements of HIPAA are met, the national government has put the enforcement of the regulation to the US Department of Health and Human Services (HHS). HHS is tasked with the duty to ensure that the healthcare service provided to the citizen is of good quality and effective (Wilkes, 2014). Additionally, the safety of the consumer and his or her information is a concern for the HHS. Working with the department of public health and social services, the HHS has a wide scope that covers healthcare for the entire population, making it the best department to oversee the delivery of healthcare services on the country.

References

Luxton, D. D., Kayl, R. A., & Mishkind, M. C. (2012). mHealth data security: The need for HIPAA-compliant standardization. Telemedicine and e-Health, 18(4), 284-288.

Richards, M. M. (2009). Electronic medical records: Confidentiality issues in the time of HIPAA. Professional Psychology: Research and Practice, 40(6), 550.

Solove, D. J. (2013). HIPAA turns 10: analyzing the past, present, and future impact. Retrieved from: http://bok.ahima.org/doc?oid=106325#.XO60UtRLiM8Wilkes, J. J. (2014). The creation of HIPAA culture: Prioritizing privacy paranoia over patient care. BYU L. Rev., 1213.