IN A RECENT Perspective article, Jennifer A. Katze, M.D., suggested sinister consequences, and grave violations of confidentiality concerning personal medical information, because the Health Care Access and Cost Commission (HCACC) is collecting data from insurance companies and HMOs. Katze's gloomy predictions are based upon misinformation -- not the facts.
The truth is, HCACC is not collecting patients' medical records. Unlike the data held by providers and payers, the HCACC data base will not have the patient's name, address, race, date of birth or Social Security number. The data base being developed does not and will not contain any information identifying specific patients. Therefore, if a thief or anyone else wanted to obtain medical information about an individual, as Katze suggests could occur, the state's medical care data base would not be the place to look.
The data base will rely on a subset of billing information furnished by HCACC by insurance companies and HMOs who will hold the encrypted code that will tell them -- not HCACC -- the patient's identity. No information provided to HCACC is collected directly from health care providers.
Indeed, current law prohibits the commission from collecting information that would disclose the patient's identity. In addition, the medical data base is not an on-line entity -- there is no dial-in access to the data. The data base stands alone.
The federal government has collected information on Medicare beneficiaries for years. Maryland, like many other states, has collected hospital data without compromising patient privacy. This type of data is used widely by physicians, economists, researchers, and policy makers to address public health and health financing issues.
Why is the commission gathering data?
The commission is gathering medical data so that, at a minimum, consumers and employers will understand where their health care dollars are going and whether these dollars are being spent most efficiently. Just as important, the data bases will allow for comparisons of health care utilization and access to services among different insured populations and regions in the state and help decision makers develop solutions to health policy issues.
For example, we might find the answer to why people in the Baltimore metropolitan area spend on average 24 percent more on health care than Maryland residents in the Washington suburbs.
We could compare utilization patterns for particular illnesses for patients in HMOs against those with other forms of insurance.
We could study whether changes in required insurance coverage in the state -- such as mental health parity -- led to lower overall costs by encouraging early diagnosis and treatment on an out-patient basis. Up until now, such questions could be answered only on the basis of anecdote and speculation.
Taxpayers have a stake in assuring that our policy-makers base their decisions on the best information available. These policy-makers are charged with assuring that quality health care at an affordable price is available in our state. The commission was created in 1993 precisely because of concerns about increasing health care costs and decreasing availability of insurance. Part of the commission's mandate was the creation of this medical data base to help answer important, key questions.
Now that our health marketplace is constantly changing because of mergers, takeovers and the creation of new "networks," having data to answer the impact of these changes on Marylanders' ability to access health care and the cost of this care is even more important. The answers are hardly clear.
Last summer, a Robert Wood Johnson Foundation-Louis Harris poll found consumers were "consistently negative" about their increased out-of-pocket expenses and skeptical about whether savings from managed care's lower costs were being passed on to them. The citizens of Maryland have a right to expect answers based on complete data. This Maryland medical care data base is an integral part of answering those questions for Marylanders. This database will shine a light on the billions spent on health care in Maryland every year.
For those concerned about the misuse of medical data, the commission continues to support strengthening penalties to all who touch the data -- including physicians, insurers, and state employees. However, the data base the commission is creating is not the kind of data base that would provide the information sought by corporations for marketing or screening for health problems. Our data will be carefully secured and meet the obligation to provide information so decision-makers can make sound health policy choices.
Donald E. Wilson is the Dean of the University of Maryland School of Medicine and chairman of the Health Care Access and Cost Commission.
Pub Date: 7/28/96