Technology is a two-edged sword. Rarely is this as clear as it is in the realm of health care. Technology allows doctors to test their patients for genetic defects—and then to turn around and spread the results throughout the world via the Internet. (1) For someone in need of treatment, that’s good news. But for someone in search of a job or an insurance policy, the tidings can be all bad.
Last week a corollary (推论) to the patients bill of rights now before Congress: a right to medical privacy. Beginning in 2002, under rules set to become law in February, patients would be able to stipulate the conditions under which their personal medical data could be divulged. They would be able to examine their records and make corrections. They could learn who else had seen the information. (2) Improper use of records by a caregiver or insurer could result in both civil and criminal penalties. The plan was said to be an unprecedented step toward putting Americans back in control of their own medical records.
(3) While the administration billed the rules as an attempt to strike a balance between the needs of consumers and those of the health-care industry, neither doctors nor insurance companies were happy. The doctors said the rules could actually erode privacy, pointing to a provision allowing managed-care plans to use personal information without consent if the purpose was “health-care operations”. That, physicians said, was a loophole (漏洞) through which Health Maintenance Organizations and other insurers could pry (窥探) into the doctor-patient relationship, in the name of assessing the quality of care. Meanwhile, the insurers protested that the rules would make them vulnerable to lawsuits.
They were especially disturbed by a provision holding them liable for privacy breaches (违背) by “business partners” such as lawyers and accountants. Both groups agreed that privacy protections would drive up the cost of health care by at least an additional $3.8 billion, and maybe much more, over the next five years. (4) They also complained about the increased level of federal scrutiny required by the new rules’ enforcement rules.
One aim of the rules is to reassure patients about confidentiality, thereby encouraging them to be open with their doctors. (5) Today various cancers and sexually transmitted diseases can go untreated because patients are afraid of embarrassment or of losing insurance coverage. The fear is real: an official noted that a January poll by Princeton Survey Research Associates found that one in six U.S. adults had at some time done something unusual to conceal medical information, such as paying cash for services.
