The Covert Rationing Blog

Free Personal Records From Your Health Plan? Not So Free.

July 2nd, 2007 by DrRich

Personal health records are, generically speaking, a wonderful idea. It is vitally important for American patients, in the name of self-preservation, to collect all their personal health records in one place, where they can control them, access them at will, and share them with healthcare professionals of their choosing as they deem necessary. Maintaining one’s own health records, in one form or another, is an important prerequisite for surviving the American healthcare system.So is it a good thing that America’s Health Insurance Plans and the Blue Cross and Blue Shield Association are planning to provide free personal health records to their plan enrollees? DrRich agrees with the folks at Patient Privacy Rights, who think not.

These altruistic insurers intend to offer their enrollees an on-line, electronic health record. The health plans will “automatically” populate the records with claims data (i.e., the information the insurance plans already have), and then “encourage” patients to populate the records with additional health information that might be important to an individual’s health (and that the health plan might find it useful to know).

As Dr. Deborah C. Peel of Patient Privacy Rights points out, there are several things health plans stand to gain from this endeavor. Among these are:

· An immensely lucrative data base they control completely.

· A rich compilation of patient data with no state or federal laws to prevent them from using the information any way they please.

· The opportunity to data mine the new information consumers add to their PHRs for medical underwriting.

· A great new business opportunity they can sell the PHR data of millions of enrollees to employers, drug companies, and data brokers.

What do the patients get? Dr. Peel tells us this also:

· No control over who can use and access their PHRs in these databases.

· No way to know how many other corporations will have access to their PHRs.

· No legal way to stop their PHRs in this database from being accessed, used, and sold.

· The misleading impression that medical underwriting will stop. Consumers are led to believe that that their PHRs in this database will not be used for underwriting, but insurers ALWAYS share enrollees’ health data with the Medical Information Bureau, which in turn gives every other insurance company access to the diagnoses, claims, and costs the patient and his/her family have incurred over their lifetimes.

· The only “right” they get is to approve the transfer of their PHR to another insurer if they change jobs.

Dr. Peel goes on to say, “The last place on Earth where patients want to keep their complete medical records is in the hands of their insurers.”

DrRich agrees.

Insurers are in the business of collecting healthcare premiums, then not spending those premiums on enrollees’ healthcare. That’s their business model: whatever they don’t spend on healthcare, they get to keep. If health plans were ever to do otherwise - that is, if they were to spend one penny more on an enrollee’s healthcare than they absolutely must - they would be guilty of defrauding their shareholders. Defrauding shareholders (individuals who, after all, have placed their trust in these enterprises) is a very serious offense, and no health plan considering itself an ethical corporate entity would ever, ever do that.

Indeed it is this business model that has caused our American society to rely on health plans as a primary means of covertly rationing healthcare. We provide them a huge incentive (i.e., the business model just described) to conduct this covert rationing, a nasty job that somebody’s got to do.

Naturally, then, it must seem like a very good idea to the folks running such health plans to provide personal health records for their enrollees. By doing so they will have a means to “capture” private health information that they would otherwise not have access to, and will be able to use that information in any way they see fit, without apparent limitations. This information might often prove very useful to them as they strive to fulfill the rationing mission our society has deputized them to fulfill.

DrRich’s advice is: certainly, by all means, compile and maintain your personal health records. This is a vital step toward empowering yourself within our hostile healthcare system. Even do it electronically. But do it yourself, or through some other business entity in which you are the customer. Don’t give your insurer another potential weapon as they forage for new ways to covertly ration your healthcare.

Posted in Gekkonian Rationing

3 Responses to “Free Personal Records From Your Health Plan? Not So Free.”

1. Joseph LaMountain wrote on 07/3/07 at 10:26 am :

   The National Health Council is an umbrella organization with more than 100 members, including the nation’s leading nonprofit charity health groups (e.g. American Cancer Society, Epilepsy Foundation of America, Mental Health America, Alzheimer’s Association). We’re working to ensure that the 100 million Americans with a chronic disease or disability are aware of the tremendous benefits of electronic personal health records.

   Because insurance providers can pre-populate a PHR, theirs will be far more valuable than others that require a patient to enter all information manually. Research and empirical evidence clearly shows that patients will not enter all their own data. Think about it this way: Would you use electonic/online banking if you had to enter all your own transactions, fees and interest deposits? Health information is no different.

   From my understanding, AHIP standards for PHRs allow for patients to own and transport their data to another provider or PHR vendor. Patients may also protect their data and prevent others from accessing it, including their insurance provider. As for the “rich compilation of data” that insurance companies “receive,” many patient groups representatives see this as a tremendous attribute as it will allow for population-based research on rare conditions.

   Most patient groups see great value in this effort. That’s not to say that this proposed system is perfect, but what is?. Patients clearly see that the benefits of a portable, large-scale, pre-populated PHR system clearly outweigh the liabilities.

2. DrRich wrote on 07/12/07 at 10:19 am :

   I understand what you say, and on one level it makes sense. I do online banking and other online financial transactions all the time, and would be angry if I had to enter all the data myself.

   The difference here, as I see it, is that these financial institutions see me as their customer. On at least some level they want to keep me happy (or, at least, they care whether they p*ss me off so much that I’ll go elsewhere). Further, they want to encourage me to do as many transactions as they can, because they make money each time I do one.

   The health insurance companies, on the other hand, do not see patients as customers. Their customers are the human resources and benefits executives who decide which insurance products to offer to their employees. Enrollees (patients) themselves are risky - they tend to use health care services, which directly reduces profit to the insurance companies. Indeed, the reason HMOs exist, according to the US Supreme Court, is to ration healthcare - to limit the use of healthcare services by patients.

   So given their business model (which relies on withholding medical services from patients whenever possible), awarding insurance companies custody of everyone’s electronic medical records, making them the arbiters of what shows up in those records and how the information is used, just seems ill advised to me. Go ahead and give them your personal info if you’d like, and God bless you.

   As for me, I choose not to voluntarily give Gekkonians any more power than they already have over my and my loved ones’ survival. Perhaps they won’t abuse this information, ’tis true. But if they don’t, it will only be because they haven’t figured out a way to limit my healthcare by doing so.

3. The Covert Rationing Blog » Blog Archive » Aetna CEO Must Have Missed This wrote on 10/6/07 at 11:20 am :

   […] should indeed be broadcast far and wide.  This is why (though Mr. Williams must have missed it), DrRich took pains to do just that a few months ago when the story was first […]

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