Health Information System Standards


Medical insurance is very critical as it helps cover one against some of the unanticipated events that are likely to be experienced. This architectural schema will analyze the Medicare health insurance which is the insurance for the people who are aged above 65years. During this period of old age, one is usually exposed to some of the terminal illnesses as well as several renal diseases. Keeping accurate health information systems ensures that insurance companies have a track of some of their beneficiaries, and this helps insurance companies in making proper compensation plans as well as getting to know some of the medical histories of their clients. As such, this facilitates the process of budgeting and the appropriate allocations.


Medicare cover is a health insurance program that aims at providing health insurance for people who are aged 65 and above, those living with a disability at whichever age as well as people having the end-stage renal disease. As Kaiser Family Foundation (2010) states, the program has several plans which comprise of prescription drug plans (D); Medicare Advantage Plans (C), hospital/ hospice services (A) and the medical insurance (B). These plans help individuals obtain healthcare services that are quality. The benefit of Medicare insurance is that the government has dramatically subsidized it through taxes and general revenue, and therefore, those enrolled pay a small amount as premiums (Newhouse, 2010).

Additionally, the government places a limit, for example, on the Medicare Advantage plans of out of pocket costs when the care needed is expensive and regular to prevent individuals from excessive care costs. As aforementioned, the government pays for the insurance from taxes and general revenues, and due to the growing population of the elderly population, the spending is estimated to rise in the coming years (Newhouse, 2010). The overall healthcare costs are expected to grow higher than inflation owing to the improved and lengthened lifespan.


Discuss the current financial health and the future projection on the financial sustainability of Medicare.

Medicare is estimated to account for 15% of federal spending, and this figure is expected to rise to 18% in the next ten years (Kaiser Family Foundation, 2010). Currently, Medicare is facing challenges owing to the decreased ratio of employees to enrollees, rising care costs and a growing elderly population. The beneficiaries of the program must pay out of pocket such as co-insurance and deductibles especially in B and D which has no set limit, and there is a risk of exploitation (Newhouse, 2010). Additionally, the beneficiaries opt for supplementary insurance to enable them to obtain services that are not covered. Under the A and B parts, the government pays directly to the services providers using systems as such fee schedules while for C and D, Medicare pays the insurers a given amount per enrollee to provide coverage (Medicare Payment Advisory Commission, 2016).

Historically, Medicare spending has been on an upward trend, for instance, as from 1974 to 2009 the expenditure as a share of the GDP rose from 0.9% to 3.5% (Medicare Payment Advisory Commission, 2016). As of 2014, the Medicare program covered 54 Million people and accounted for 22% of healthcare spending. As Medicare Payment Advisory Commission (2016) mentions, Medicare payments stand at $702 billion which is an upward trend. Payments for parts A and B are $210 billion. In this regard, the current financial health of Medicare can be estimated using the Total and Per Capita Medicare spending which shows a total annual growth rate of 4.5%, Medicare spending as a share of GDP as well as estimating the solvency of the Medicare Hospital Insurance trust fund which caters for part A (Zarabozo & Harrison, 2009). This fund is generally affected by economic behavior which influences employment, taxes, and revenues. As it stands, the fund can only be depleted by 2026 (Medicare Payment Advisory Commission, 2016).

According to Zarabozo and Harrison (2009), a look at the future projections and sustainability of Medicare shows that Medicare spending will increase faster than the GDP. In the future, the increasing care costs due to complexities of illness and utilization rates might push spending higher relative to GDP growth (Zarabozo & Harrison, 2009). Moreover, the elderly population is increasing and as the years go by a majority of people will be in the eligible age bracket. In the next ten years, total spending is projected at $1.44 trillion by 2027 where Part A accounts for $555 billion, part B $685 billion and part D $195 billion (Medicare Payment Advisory Commission, 2016). Sustainability of the program is dependent on the economic growth over the years and the measure the government undertakes to enable funding and reduce pressure on the federal budgets.

Propose initiatives that the government might take as possibilities to preserve Medicare

Several measures can be used by the government to protect Medicare. One of the strategies is restructuring Medicare benefits or features within a given plan which will enable cost sharing for particular services. Rising the eligibility age can also help reduce spending and sustain the program (Medicare Payment Advisory Commission, 2016). The government can leverage the role of the plan in the health care market place to boost volume. For instance, the government can introduce models of care that effectively manage care that is of the high cost.

Moreover, changing Medicare from its structure of a benefit defined program to one that provides entitlement to government payment for the purchase of insurance can significantly help in sustaining the program. The government should also focus on public health initiatives that will help people adopt healthy lifestyles, and drastically reduce Medicare spending that is associated with lifestyle diseases such as obesity. Medicare can be preserved through taxation which is one method that helps in financing (Winter & Haux, 2011). The government can tax individuals who earn a higher income more to enable the continuity if this program.

Health Information Systems capture, stores as well as transmit the information that is directly related to the health of individuals or the organizations that work directly with the health sector. Medicare as one of the insurance companies is also affected by Healthcare Information Systems.

Health Information System Standards that are Required
Operational and Tactical Systems These are the systems that enhance the day-to-day operations of the critical systems that are directly linked to Medicare.

These systems need to meet the threshold as well as standards that have been established.

Clinical and Administrative Systems The clinical and administrative systems are critical components of the healthcare information systems. They enhance the operations of critical clinical procedures while at the same time provides for procedures for the regulatory systems. These systems should be in a position of being audited
Subject and task-based systems, for instance, EMR and the EHRs. Standards have been established for the effective and proper use of the EMR and EHRs. There is a need for ensuring that privacy of the EHR and EMR data is guaranteed. The standard helps protect the medical records from intrusion.
Financial systems It is one of the healthcare information systems which is critical, and this has to meet the regulatory and compliance standards as well as being easy to audit. Financial systems is among the features that will help in ensuring that the insurance companies regulate the medical returns that they make to hospitals.


Healthcare information systems assist the healthcare providers with means through which they can manage daily tasks as well as management of the information on patients. An insurance company shall also find these healthcare information systems as being critical and helpful in ensuring that they are on track with some of the renal diseases that are suffered by its clients that are insured and are under medical cover (Balgrosky et al., 2015). Medicare will use an integrated health information system which will help them in understanding some of the medication as well as formulate necessary budgets that will be critical and helpful to finance their other projects. The software solutions ensure that there is accuracy in the billing system while at the same time enhancing quality medical cover to all its clients who have established the effective policies.


It is evident that Medicare has dramatically improved access to health for those living with the end-stage renal disease, the aged and those with disabilities. Medicare program needs the government to undertake specific measures that will ensure its sustainability, especially with the growing elderly population. A panoramic look at the spending rate of this program shows that finances risk being depleted due to the growth of the economy which significantly determines the level of financing. Arguably, the government can raise taxes, restructure Medicare plans and invest in public health initiatives in a bid to preserve the program. Additionally, eligibility criteria can be altered to ensure individuals with most health needs benefit and the overall health status, access and disparity are taken care of.


Balgrosky, J. A., Brady, J. W., & Speaker, R. (2015). Essentials of health information systems and technology.

Kaiser Family Foundation. (2010). Medicare ata glance. Retrieved from

Medicare Payment Advisory Commission. (2016). Context of Medicare Payment Policy.In Report to Congress. Medicare Payment Policy. Washington: The Commission.

Newhouse, J. P. (2010). Assessing health reform’s impact on four key groups of Americans. Health Affairs29(9), 1714-1724. doi:10.1377/hlthaff.2010.0595

Winter, A., & Haux, R. (2011). Health information systems: Architectures and strategies. London: Springer.

Zarabozo, C., & Harrison, S. (2009). Payment policy and the growth of Medicare Advantage. Health Affairs28(1), w55-w67.

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