What Patients Think About Electronic Medical Records
A new survey suggests patients are less than forthcoming if they believe their medical records are being shared with outsiders. About 15 percent said they would conceal information from their doctor, while one-third would consider withholding information. What do patients have to hide? Information on their exercise habits (13%), eating habits (9%), smoking (7%), drinking (7%), illegal drug use (4%) and unprotected sex (4%) were the main items respondents would conceal.
This makes perfect sense.
How could it be otherwise?
That’s yet another problem with over-use of third-party payment. Things you tell your doctor about could make insurers reluctant to provide coverage.
Yet, I do believe patients should bear more responsibility for their health metrics.
No one wants to paint themselves in a bad light, especially when the world is watching.
Given that records are going to be open to government examination under ObamaCare, people would be crazy to tell the physician of any illegal act or admit to any behavior not in accord with current health recommendations.
As for any kind of mental health condition, forget it, especially if you ever might apply for a job requiring a security clearance, or need to defend yourself against the government in a legal proceeding.
Recall that Inspector General Gerald Walpin was fired by the Obama administration for resisting misuse of federal funds, and that media explanations of the firing suggested that he was elderly and too “confused,” and “disoriented” to effectively do his job. Think your own medical record might ever have the note that you were confused in it?
Linda discusses a number of paranoid fantasies about the health care bill.
I would refer you to yesterday’s article by Reuters on WellPoint’s rescission policies. Apparently, if you get breast cancer, they automatically start an extensive investigation of your medical history to look for the smallest clerical error in your application. They then cancel your coverage.
I don’t think Linda is being paranoid at all. I believe we are dealing with vicious people who have their own agenda and plan go take no prisoners along the way. Every day I seem to hear of another person or company that is being privately threatened by this White House.
At least WellPoint can’t file criminal charges against us because we oppose them politically.
artk,
Some people who have chosen not to buy health insurance find out they are ill and then want health insurance coverage so that other people pay their medical bills. Happens when women become pregnant, too.
They apply for insurance and lie on their applications. What would you have insurers do? Investigate everyone before they underwrite, which would cost a huge amount, or, in the event of a big claim, investigate people in the period (generally something like 2 years) before the policy becomes guaranteed renewable? That the policy can be canceled is clearly stated in insurance documents, at least in my state.
Since we have government to enforce the contract and make sure that the rescission is reasonable, we save a bundle of money by not having to investigate the majority of people telling the truth to catch a small minority of liars.
Keep in mind that a number of Obama claims about rescission have been debunked. John Graham has a most informative post on this blog at http://www.john-goodman-blog.com/someone-please-tell-the-president-it%e2%80%99s-been-illegal-to-drop-coverage-since-1997/
Linda sez: “Keep in mind that a number of Obama claims about rescission have been debunked”
Stop avoiding the issue, address the Reuters article. For those of you who don’t know, Reuters main business is supplying information to the financial services industry, certainly not the “liberal media”. You’re defending the indefensible. Here’s another example, this time from Assurant.
I think the reality is somewhere between Art’s and Linda’s world, even though I’ve never paid much attention to Obama’s claims about anything.
What Linda seems to be saying is that it takes about two years to become fully covered with underwritten insurance. And also that “underwritten” is somewhat of a misnomer: since it would be too expensive to review every applicant’s medical history, insurance companies generally base their “risk assessment” on a couple of pages of yes/no answers in the application. Rather than assessing risk, they simply reject any application that seems the least bit hinky and approve the rest conditionally, subject to having no major claims in the next two years.
Perhaps this model of coverage would make more sense if insurers sold “coverage options” which establish conditional eligibility but don’t start coverage until 18 or 24 months after purchase. That way someone starting e.g. COBRA coverage could apply for insurance that doesn’t kick in until the COBRA expires. In the meantime, he has reliable albeit expensive coverage without having to maintain two policies concurrently.
One thing Linda (or anyone else at NCPA) has never addressed is the fact that if everyone purchased underwritten coverage which was guaranteed-renewable at class-average rates, then over time the pricing structure would be equivalent to coverage that was community rated.
Bart–one does have full coverage during those two years. However, if an unusual claim comes up, the insurer may then decide to go over your records with a fine-toothed comb to make sure that you weren’t hiding a diagnosis.
Sometimes insurers do try to wiggle out of their obligations by making ridiculous claims about what someone didn’t tell them. Then everyone goes to court and, through the judicial process, insurers acting like slime get slapped with a huge fine and are told to honor the contract or else.
As for the effect of guaranteed renewability on rates and how its results compare to guaranteed issue, some academics have considered the issue. You’ll find a short summary of the work at http://www.econlib.org/library/Columns/y2009/Gormanhealthinsurance.html
Bart:
I like your suggestion of conditional eligibility that starts 18-24 months after coverage begins.
i can appreciate the concerns about having full cocerage from the get go.
However, if one uses reason in his analysis, he knows his chances of having a claim increase with age.
Thus, having coverage increase over time is one excellent way of dealing with risk.
I am curious why you believe that class-average rates become community-rated over time?
Don Levit
Don,
Just for clarity, my idea was to be able to purchase an option for coverage at a later date, perhaps for a small fixed price intended to cover the cost of underwriting. The applicant fills out typical insurance application with basic health questions, and the insurance company approves or declines the application. After 24 months, during which the applicant uses other coverage, then assuming no health conditions manifest in the interim that could be construed as preexisting conditions, the applicant is considered fully vetted and begins paying premiums and receiving coverage.
My statement about guaranteed renewal becoming equivalent to community rating was based on the idealized scenario where everyone would purchase private coverage at an early age and maintain it for life. Since everyone applies young, almost no one is declined coverage. Therefore virtually everyone starts out paying the preferred rate, and is protected for life from rate increases based on subsequent health issues.
Over time, as some of the plan members develop expensive conditions, the plan’s costs go up. Since the sick peoples’ premiums can’t be raised relative to well people, everyone’s premiums have to increase.
I’ve never seen an exact definition of “class average,” but it seems to me that if the highest premium in a class is equal to the average premium, then the lowest premium must equal the average as well. This assumes there are no late enrollees paying uprated premiums (again, I’m talking about the idealized case where everyone starts coverage early).
If “class” is taken to mean “age cohort,” so that premiums can increase with age but not because of health, then the result is equivalent to modified community rating. If there is only one class, then pure community rating.
If my understanding of “class average” is off, please correct me. But this is the point I was trying to make; Linda’s link above doesn’t appear to address it.
Bart:
Thanks for your comment.
It seems to me that, over time, all members receive community rating, either modified or pure.
In a sense, this is fair, in my opinion, for people should not be able to differentiate themselves as either “sick” or ‘healthy” after entrance, to receive lower premiums (if healthy).
What can happen, though, is that those who are healthy will, indeed, have lower premiums and higher deductibles if they have planned ahead and set aside a savings account, or even a savings/insurance combo account, to help pay for the higher deductible.
Once one reaches a deductible of $25,000-$50,000, the community rating thereafter is similar, regardless of age.
Don Levit
Bart,
The point of the link was supposed to be that academic work tends to show that in the existing individual market people with serious illnesses tend to renew. This may be why, over time, age and sex are better predictors of premiums in the individual market than chronic conditions and there is substantial risk pooling. This result seems to be similar to the results claimed for community rating, but at a lower overall cost.
Essentially the individual market does what you envision if people buy insurance at a young age. You must be underwritten once. After that, you are underwritten only if you want to change policies.
Linda,
Thanks, I see now why you think the article addressed my point. But the article looks only at empirical data skewed by favorable selection in order to make an unfair comparison.
My point was that if everyone exhibits what we would presumably agree is desirable behavior– namely, insuring early and staying insured– then a long-lived individual pool would look like the general population, so there would be no difference in cost between individual and community rating.
The lower cost is not intrinsic to individual rating, but is a result of people behaving stupidly by failing to insure early and remain insured. If a lower cost achieved in this way is a desirable thing for society, then it must follow that people behaving stupidly is also desirable for society.
The Reinvestment Act might require physicians and practices to have EHR’s and EMR’s and that’s exactly why patients should consider acquiring their own Personal Medical Records. It’s great because there are companies that will obtain your medical history for you and in the end prevents the patient from forgetting what their med history is and fewer errors either in the ER or the OR would come from the doctors. This is an interesting article and I really would like to see how companies such as MedeFile Records can collaborate with EHR’s and EMR’s in obtaining an easy to use system for both patient and doctor.
Yes, I do. I’m happy with my health cogaerve. I cover myself and have the money to do it. I don’t want to pay a tax penalty to cover somebody else. I’ve had check ups, and 3 ER visits and paid it all myself.