HIPAA and Health Law: Policy, Politics & Resource Allocation

Introduction to Health Law and Organizational Policy

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 has had a significant impact on healthcare organizational policies. This paper examines that impact by addressing several key review questions covering the nature of health law, the distinction between legislative and organizational policies, political influences on policymaking, the role of regulatory agencies, resource allocation, and the contributions of stakeholders and interest groups.

Health law can be conceptualized in several ways. It may be viewed as entailing not just the law on financing and delivery of healthcare, but also all related areas of study associated with the link between health and law. Simply put, healthcare law focuses on judicial, executive, and legislative rules and guidelines that regulate the healthcare industry. That industry includes healthcare facilities, systems, healthcare practitioners, medical device manufacturers, pharmaceutical companies, and private and public insurers. Each of these stakeholders functions within several different and interrelated legislative frameworks (WCL.edu, 2016).

Health policies are the strategies, actions, plans, or decisions taken to attain specific healthcare goals within a given population. A well-drafted health policy clearly defines the vision of policymakers — a clear definition helps establish targets and reference points for the future. A good health policy also prioritizes and assigns roles and responsibilities to different stakeholders, and helps build consensus among all parties concerned (WHO, 2016). A health policy is meant to serve as a vehicle for innovation and for the discussion of specific issues within the healthcare system. It is intended to improve communications among healthcare professionals, policymakers, legislators, and researchers involved in the development, implementation, and analysis of health systems and healthcare reforms (healthpolicyjrnl, 2015).

Legislative vs. Organizational Healthcare Policies

Legislative Policies

A legislative policy is a set of actions undertaken by a lawmaking body in order to achieve an envisioned health outcome (Cherry & Trotter Betts, 2005). The general healthcare system — including both the private and public sectors, as well as the political pressures that influence the system — is governed by the policymaking process. All public, and to some extent private sector, health-related policies originate from federal, state, or local court rulings, regulations, or legislation, which shape the provision of healthcare services.

The policymaking process accommodates a range of settings, from open systems that encourage contributions by citizens to closed-door systems that involve only small groups of policymakers. The setting, the nature of the issue at hand, and the intended impact of the health policy all affect the final character of the policy (Thurber, 1996).

Organizational Policies

Many NGOs, as well as private and public healthcare institutions, use procedures and policies to demonstrate regulatory and legal compliance and to achieve their operational goals. The official mandates of many such institutions may originate from federal regulatory agencies. Healthcare institutions may also form policies and procedures to meet the contractual requirements of their financiers. Large and medium-sized healthcare institutions typically have compliance officers who continuously monitor the implementation of these procedures and policies.

For instance, a hospital or any other facility that houses patients may have a general management mandate for patient safety. That facility might establish specific rules — for example, requiring two staff members to move a patient from one bed to another. An institution dealing with a different area of healthcare may require different procedures and policies to meet its unique regulatory requirements. A radiology department, for example, might need to develop a comprehensive system that captures the receipt, storage, utilization, movement, and subsequent disposal of radioactive substances.

Healthcare providers may also develop policies to guide employee conduct. In the literature, a policy has been defined as a set guide that instructs staff on what to do in a particular scenario. Such a guide not only influences employee conduct but also creates a framework to support decision-making.

Healthcare institutions should always update their procedures and policies whenever new innovations, inventions, devices, patient protocols, or technologies are adopted. Policies should also be continuously monitored to ensure that employees conduct themselves in accordance with the best practices in the industry (Bianca, 2016).

Influence of Politics on Healthcare Policies

As health issues move through the stages of the policymaking process, many factors can affect the outcome, including the preferences of legislators, Special Interest Groups (SIGs), organizations, and other powerful actors (Longest, 2006). These stakeholders do not necessarily share the same perspective and often have different — and usually competing — interests. The process is frequently further complicated by the partisan agendas of the country's two major political parties, the Republicans and the Democrats. The party holding the majority often has the final say in this complex process (Abood, 2007).

Politics influence who receives what, how, and when across many dimensions of daily life. As some scholars have defined it, politics is the process through which scarce resources are authoritatively allocated (Kalisch & Kalisch, 1982, p. 31). Health policy decision-making is inherently political: whenever individuals participate in any decision-making process, they influence who gets what within the healthcare system. SIGs and powerful stakeholders employ problem-solving, critical thinking, conflict management, communication, and negotiation skills to achieve their desired outcomes in the policymaking process (Cherry & Trotter Betts, 2005; Kalisch & Kalisch, 1982).