Health Insurance Portability and Accountability Act

Introduction

One of the concerns faced by individuals in the United States is the lack of privacy in the medical field concerning their medical records. With the increase in medical tests including genetic research an individuals medical records could contain information that would result in discriminatory acts being committed against them in the job and housing markets. This increase in medical information combined with the patients increased concern over how that information could be used against the patient resulted in individuals who needed the medical care refusing to seek that assistance.

Main Text

This is one of the main reasons that the Health Insurance Portability and Accountability Act (HIPAA) was passed by Congress in 1996. This Act while increasing the amount of control that individuals had over their right to privacy in the medical community created several new abilities for the federal government. The HIPAA Act places increased restrictions upon the medical community restricting how a patient can be discussed and how medical records were stored and transferred.

This Act also allows the federal government the ability to regulate the health care industry for the first time. HIPAA decreases the restrictions placed on individuals as they change jobs and employer sponsored health insurance. The inability to maintain health insurance while changing jobs caused many individuals to maintain a job that offered medical insurance rather then seeking different opportunities. This job-lock causes the economy to stagnate and employers to maintain control over the individuals that they have trained and equipped to maintain their businesses (Berger, Mark, C., Black, Dan, A., Scott, Frank, A., (2004).

The ability of an individual to maintain health insurance while changing jobs increases the effectiveness of the health care industry. This ability of maintaining health insurance allows an individual to change jobs without placing their health at risk resulting in the possible financial instability to that family or individual or dangers to the public health if their medical condition was contagious.

This program could also be used as a template for increasing the amount of federal involvement in different consumer based fields of service (Ladenheim, K. (1997). While HIPAA is intended to allow the federal government the ability to have a more active role in the regulation of private insurance and health-care delivery, it also allows the individuals states to increase the protections offered to the consumer. While states may increase the protections set in place by HIPAA, the HIPAA regulations set the minimum level of protection (Ladenheim, K. (1997).

The HIPAA Act of 1996 was passed when the need for a national policy protecting patients medical records was discovered (Hanna, K. E., March 2001). While the main intent of the Act was to allow individuals to continue their health insurance coverage from job to job it also focused on the privacy issues inherent in the containment of medical records. This allows individuals greater control over their health care information including clear directions on how they can use, keep and disclose their health information (Hanna, K. E., March 2001). Patients must also provide consent before their medical information can be shared for any purpose including payment (Hanna, K. E., March 2001). One area in which these laws protect the consumer is at the pharmacy when medical prescriptions are dispersed to the patient. The pharmacy is required to have areas designated as private to discus the medication and any effects that it might have on both the illness and possible side effects that the drug could cause.

The HIPAA protections were put in place to protect the individual as well as decrease the risk to public health if individual with contagious disease go untreated because of their concern over privacy (Badzek, L. & Gross, L. (June 1999). One of the medical professions that is most effected by these legal restrictions is that of the nurse. The relationship between nurse and patient is based on fidelity, respect for the individual and restraint from causing harm to the patients. This includes protecting the patient’s right to privacy. Any breach to the patient’s privacy could damage that relationship between nurse and patient resulting in the transfer of information between the patient and the nurse. This lack of communication could result in decreasing the effectiveness of care received by the patient (Badzek, L. & Gross, L. (June 1999).

An area in which nurses need to be more watchful over their communications is situations in which they are outside of their normal environment and consulting with other medical professions over their patients care. With the increased use of cell phones and pagers nurses are put in positions in which they might be discussing the care of the patient in an inappropriate setting. The nurses must continue to careful about when and where the treatment of their patients are discussed as well as continuing to be careful of the patients medical records (Badzek, L. & Gross, L. (June 1999)..

HIPAA protects the individual’s right to privacy with concern over their medical records and health information. While the rules concerning privacy are similar for adults and minors, this protects the minors from parental access to their health information. As minors are increasing the behaviors that could result in medical conditions that require treatment, minors are reluctant to seek medical attention when they believe that the condition would be relayed to their parents. While it is important for parents and their children to maintain open lines of communication, the protection of the public health overrides the parent’s right to their medical information. The age of the child to this level of privacy is dependent upon the age of consent in the state that the minor resides. In some states the age of consent is 16 while in others the age is as low as 12 years of age. This protection allows increased confidential adolescent health care services (English, A. & Ford, C. A., March 2004).

This protection was increased in HIPAA due to the concern of adolescents not seeking medical assistance due to concerns over privacy. Unless the minor makes the parent their personal representative the medical community is required to treat them as adults with the full implications over their privacy. Under the requirements presented in HIPAA the parent is not automatically the personal representative of the minor and as such does not have access to the health information unless specifically allowed by the minor (English, A. & Ford, C. A., March 2004). This protection is especially seen in the Emergency Medical Service (EMS) in which a parent could attempt to refuse medical treatment for their child, however, if that child were above the age of consent in that state the EMS personal are required to obey the wishes of the minor in regards to medical treatment.

The requirements set by HIPAA have the ability to fundamentally affect research on human tissues. As the ability to manipulate the genetic information of individuals in order to research cures for the diseases experienced by individuals has created for-profit organizations specializing in the storage of medical samples for research has grown. These repositories of research materials have been created by companies with the purpose of expanding the material available for research (Allen, M. D., September 2004). The HIPAA regulations require that a health care researcher provide a disclosure to the patient on the proposed research and storage of the specimen in a repository. The patient must sign a consent form before any research may begin (Allen, M. D., September 2004).

This requirement is only placed on the healthcare provider who obtains the sample rather then the commercial company who sponsored the research. In the consent forms that are signed by the patient the name of the company receiving the genetic material is figured prominently in the documents signed by the patient, which increases the potential legal issues (Allen, M. D., September 2004). There have been legal cases brought against research companies over the perceived right of individuals to maintain ownership of their tissues and organs used in research. The legal system is hesitant to assign continued ownership rights over these samples that were obtained through surgical interventions to the individual undergoing surgery. The samples taken require additional research and resources to discover new medical interventions against that illness (Allen, M. D., September 2004).

The legal requirements presented through the application of HIPAA have increased the protections received by patients from the medical community. Individuals have little concern over if and how their treatments will affect their daily life and the concern over patient privacy does not effect an individual’s decision to receive medical assistance. HIPAA also protects an individual’s right to health insurance without regard to prior medical conditions if the proper requirements are met by the individual. The protections offered by HIPAA have been accepted and implemented by health care providers throughout the United States and any changes to the requirements will be dependent upon increased technological advances. Advances in how medical records are transmitted or medications administered will be effected, regulated and distributed by the HIPAA requirements.

Annotated Bibliography

Allen, M. D. (2004). Commercial Tissue Repositories: HIPAA Raises Sponsors’ Fears. Ethics and Human Research, 26(5), 9-11.

The requirements set by HIPAA have the ability to fundamentally affect research on human tissues. In the past commercial repositories for research materials have been created by companies with the purpose of expanding the material available for research. The HIPAA regulations require that a health care researcher provide a disclosure to the patient on the proposed research and storage of the specimen in a repository. The patient must sign a consent form before any research may begin. This requirement is only placed on the healthcare provider who obtains the sample rather then the commercial company who sponsored the research but their company is figured prominently in the documents signed by the patient increasing the potential legal issues.

Badzek, L. & Gross, L. (1999). Issues Update: Confidentiality and Privacy: At the Forefront for Nurses. The American Journal of Nursing, 99(6), 52-54.

Due to the increased transmission of medical records due to the use of computers, faxes and emails the issues of patient privacy have increased to prompt Congress to intervene in the situation. Individuals are concerned that their medical records could be used to deny health insurance or create issues of discrimination in their job if these records are not adequately protected. The relationship between nurse and patient is based on fidelity, respect for the individual and restraint from causing harm to the patients. Any breach to the patient’s privacy could damage that relationship and affect the care the patient receives.

Berger, Mark, C., Black, Dan, A., Scott, Frank, A., (2004). Is There Job Lock? Evidence from the Pre-HIPAA Era. Southern Economic Journal. 70(4), 953-976.

This article tested for job-lock comparing the differences between individuals who received health insurance from their companies with family members who had no chronic health concerns. While the researchers found no statistical evidence that job-lock was experienced by individuals they did find shorter terms

of employment for individuals covered by a spouse’s health insurance plan when compared to longer employment spans for individuals who were covered under their employers plans. The researchers took this as evidence of job-lock.

English, A. & Ford, C. A. (2004). The HIPAA Privacy Rule and Adolescents: Legal Questions and Clinical Challenges. Perspectives on Sexual and Reproductive Health, 36(2), 80-86.

HIPAA protects the individual’s right to privacy with concern over their medical records and health information. While the rules concerning privacy are similar for adults and minors, this protects the minors from parental access to their health information. This protection allows increased confidential adolescent health care services. This protection was increased in HIPAA due to the concern of adolescents not seeking medical assistance due to concerns over privacy. With this provision the parent is not automatically the personal representative of the minor and as such does not have access to the health information unless specifically allowed by the minor.

Hanna, K. E. (2001). Capital Report: No End in Sight for Final Rules on Medical Privacy. The Hastings Center Report, 31(2), 8.

The HIPAA Act of 1996 was passed when the need for a national policy protecting patients medical records. The main intent of the Act was to allow individuals to continue their health insurance coverage from job to job it also focused on the privacy issues inherent in the containment of medical records. This allows individuals greater control over their health care information including clear directions on how they can use, keep and disclose their health information. Patients must also provide consent before their medical information can be shared for any purpose including payment.

Hing, Esther, Jensen, Gail, A. (1999). Health Insurance Portability and Accountability Act of 1996: Lessons from the States. Medical Care. 37(7). 692-705.

The researchers examined the effect on the Health Insurance Portability and Accountability Act (HIPAA) of 1996 on small companies. The researches were focused on examining the effects on the provisions of coverage, the number of individuals covered by the plan and any practices of exclusion that the employers exhibited toward their employees. The researches concluded that through the reforms presented by HIPAA would increase the number of small firms who provided health insurance to their employees.

Ladenheim, K. (1997). Health Insurance in Transition: The Health Insurance Portability and Accountability Act of 1996. Publius, 27(2), 33-51.

The Health Insurance Portability and Accountability Act (HIPAA) in 1996 allowed the federal government into health insurance regulation for the first time. This program could be used as a template for increasing federal involvement in the health insurance field. HIPAA also is intended to allow the federal government the ability to have a more active role in the regulation of private insurance and health-care delivery. While states may increase the protections set in place by HIPAA, the HIPAA regulations set the minimum level of protection.

Stoupe, Kevin T., Kinney, Eleanor, D., Kniesner, Thomas, J.J., (2001). Chronic Illness and Health Insurance-Related Job Lock. Journal of Policy Analysis and Management. 20(3), 525-544.

The researchers examined the job duration patterns of individuals for evidence of job-lock due to health insurance among workers who were either chronically ill or responsible for family members who where chronically ill. The researches used data obtained from the state of Indiana before Health Insurance Portability and Accountability Act (HIPAA) of 1996 was enacted. This data was compared to individuals who were not responsible for individuals being treated with a chronic illness. The researchers found that individuals who were responsible for those family members experienced job-lock.