Privacy and Health Insurance

Abstract

Privacy has served a crucial function in the physician patient relationship and an essential foundation for maximizing patient health and well-being. The increasing complexity of medical care and financing has weakened the reality of medical privacy as well as patients’ perception of confidentiality. In general, computerization has only compounded the problem, making it much easier to multiply and transfer data in ways that stretch the traditional boundaries of confidentiality beyond plausibility.

The primary justification for collecting individual medical data for the purpose of underwriting insurance coverage is insurers’ fear of covering a person who knows more about her own risk than the insurer undertaking the coverage. The prospect of genetic tests with the potential to reveal an unprecedented quantity and quality of health information intensifies concern about the conflict between health insurers’ approaches to underwriting and patients’ and physicians’ need for medical privacy. Individual risk assessment for health coverage is inimical to the medical privacy of those who are covered by it. Access to individual patient medical records by health insurers so seriously compromises individual privacy, personal freedom, informed consent, the physician—patient relationship, and access to care that such access may be deemed incompatible with fundamental requirements of an ethically acceptable health-care milieu.

When thinking about the privacy of medical information, we should not conceptualize privacy as an adjunct to health care that is separable and nice, but not essential. Although significant steps have been taken to reduce the incentive of health-benefit providers from using genetic information to restrict coverage, much more needs to be done to ensure the privacy of genetic information.