Monday, May 19, 2008

Google Health--online personal health records

In my opinion, this will soon be the status quo. Regardless, it's an interesting idea.

Google makes health service publicly available
By RACHEL METZ, The Associated Press
Google's online filing cabinet for medical records opened to the public Monday, giving users instant electronic access to their health histories while reigniting privacy concerns.

Called Google (nasdaq: GOOG - news - people ) Health, the service lets users link information from a handful of pharmacies and care providers, including Quest Diagnostics (nyse: DGX - news - people ) labs. Google plans to add more.

Similar offerings include Microsoft Corp. (nasdaq: MSFT - news - people )'s HealthVault and Revolution Health, which is backed by AOL co-founder Steve Case.

Google Health differentiates itself from the pack through its user interface and things like the public availability of its application program interface, or API, said Marissa Mayer, the Google executive overseeing the service.

Mary Adams, 45, a Cleveland Clinic patient who participated in the Google Health pilot, said that she was initially concerned about the privacy of her medical information.

Still, she felt safe enough to enroll and has been using the service for about six months, linking it with an online health management tool from the Cleveland Clinic and adding information on prescriptions and doctors to her online profile.

"I hate pieces of paper lying around my house, so I love the fact that i can log on with my normal Google login info and see everything at a glance," she said, adding that with its public availability she'll try to get her sister to use it.

The service, still a non-final "beta" version, does not include ads. But Mayer said Google doesn't plan to start placing them to support the site. A search box on Google Health pages leads to standard Google search results pages, where there are advertisements.

Besides importing records from providers, users can enhance their password-protected profiles with details such as allergies and medications, they can search for doctors and they can locate Web-based health-related tools.

Mountain View-based Google Inc. views its expansion into health records management as logical because its search engine already processes millions of requests from people trying to find information about injuries, illnesses and recommended treatments.

Before this public launch, Google stored medical records for a few thousand patient volunteers at the nonprofit Cleveland Clinic.

The health venture provides fodder for privacy watchdogs who believe Google already has too much about the interests and habits of its users in its logs of search requests and its vaults of e-mail archives.

Pam Dixon, executive director of the World Privacy Forum, said services like Google Health are troublesome because they aren't covered by the Health Insurance Portability and Accountability Act, or HIPAA.

Dixon's group issued a cautionary report on the topic in February on such third-party services.

Passed in 1996, HIPAA set strict standards for the security of medical records. Among other things, the law requires anyone seeking a patient's records by subpoena to notify the patient and give the patient an opportunity to fight the request.

By transferring records to an external service, patients could unwittingly make it easier for the government, a legal adversary or a marketing concern to obtain private information, Dixon said.

"We are in uncharted territory here. A privacy policy, I don't think, is enough to protect what needs to be protected in a doctor-patient record," Dixon said.

Mayer said, however, that users medical records "are generally speaking as safe with Google as they would be with a HIPAA-regulated entity."

During a webcast Monday, she said users' health information is stored at Google's "highest level of security" on computers that are more secure than those used for the company's search functions.

Mayer said in an interview with The Associated Press that Google will not aggregate users' health information across services so activity on the health service will not show up in search results.

Friday, April 18, 2008

Health Policy Made Ridiculously Simple

AMSA has a great set of primers on health policy, under their "Health Policy Made Ridiculously Simple" section. Find it here: http://www.amsa.org/hp/hpsimple.cfm

Monday, April 7, 2008

Tax Financing in Health Care

Even in America, where we do not have a national health care system, over half of our health-care spending is financed through tax dollars. Some background on Medicare financing, and taxes in general, is below.

http://www.kff.org/medicare/7305.cfm

http://en.wikipedia.org/wiki/Progressive_tax
http://en.wikipedia.org/wiki/Regressive_tax
http://en.wikipedia.org/wiki/Hypothecation

Employment-based Health Insurance

In the last decade we have seen a rise in problems with America's traditional employment-based health insurance, including rising cost of business (Ford pays more for health care per car than for steel), trouble for small businesses, loss of job mobility, and a perverse incentive for employers to choose health plans not best suited to the needs of their employees. Some of the articles below touch on the debate over these issues, but they only represent a small proportion of the wealth of information available on this topic.

http://content.healthaffairs.org/cgi/reprint/hlthaff.w3.237v1.pdf

http://www.jstor.org/sici?sici=0033-5533(199402)109%3A1%3C27%3
AEHIAJM%3E2.0.CO%3B2-F&cookieSet=1

http://books.google.com/books?hl=en&lr=&id=tIXSFDEzDf8C&oi=fnd&pg=PA1&dq=
employment+based+health+insurance&ots=VWTyA-DuHt&sig=PG_5gBng71hWgulrhe-
Zhr6uoRk#PPP9,M1

Medical Savings Accounts

There really are no reputable papers supporting medical savings accounts, so if the opinions represented here appear biased it is because there is consensus in the policy community that MSAs are a bad idea. However, that doesn't stop many American politicians from using MSAs as a cornerstone for their policy reform packages, so it is important to understand their arguments and why they don't hold true in theory or in practice.

http://books.google.com/books?hl=en&lr=&id=EHGelqyhVKQC&oi=fnd&pg=PA133&dq=
medical+savings+account&ots=3_--PndlUi&sig=IyxF8rnZCpTXlQyHSB0ORQetAA8#PPA133,M1

http://www.cmaj.ca/cgi/reprint/167/2/143

RAND Health Insurance Study

The definitive study on the impact of cost-sharing on health behavior was done by the RAND group in the 1970s. There are links to the RAND website and a few discussions of the study below. I've tried to get a few different perspectives in the mix, remember to think about the
biases of each source as you read through them.

http://rand.org/pubs/reports/R3055/

http://www.kff.org/insurance/upload/7566.pdf

http://cdhc.ncpa.org/policy-issues/rand-retrospective-study-finds-cost-sharing-affects-medical-usage

April 8 HPAP

The topic for Health Policy and a Pint this month is fundraising. There are several ways to collect money to pay for health care, including:

1. Taxes
2. Insurance Premiums
a. Employer
b. Individual
3. Out of pocket
a. Co-payments
b. Co-insurance
4. Health Savings Accounts (combination out-of-pocket and tax incentives)

Below is a link to the online version of a book with everything you might ever want to know about health care financing. I'll put up separate posts with background info on these topics as I find it. We will also have brief presentations before our discussion. I hope to see everyone at the Kitty Cat Club tomorrow at 5!

http://mcgraw-hill.co.uk/openup/chapters/0335209246.pdf

Monday, March 24, 2008

Health Policy and a Pint Goes National!

Health Policy and a Pint is going to become a national AMSA franchise! We need your help to make it as good as it can be - let us know what works and what doesn't, and any suggestions you may have for the future of HPAP.

Tuesday, January 8, 2008

Health Policy and a Pint

This Tuesday, February 8th AMSA is hosting the first meeting of Health Policy and a Pint. Join us at the Kitty Kat Club in Dinkytown at 5 pm to discuss the health care plans of the '08 Presidential hopefuls. We will be focusing on the plans of the winners of the Iowa Caucus, Senator Obama (D) and Governor Huckabee (R).

For more information on all candidates, visit the AMSA website or the League of Women Voters website.

For Barack Obama, see http://www.barackobama.com/issues/healthcare/

For Mike Huckabee, see http://www.mikehuckabee.com/?FuseAction=Issues.View&Issue_id=8