Health Insurance Portability and Accountability Act (HIPAA)

Paper Details: Health Insurance Portability and Accountability Act (HIPAA) and its affect on confidentiality – should be related to human subjects research if possible.

Health Insurance Portability and Accountability Act (HIPAA) and its affect on confidentiality – should be related to human subjects research if possible.

The Heath Insurance Portability and Accountability Act of 1996, better known as HIPAA, was created to “improve portability and continuity of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery, to improve access to long-term care services and coverage, [and] to simplify the administration of health insurance ….” Clearly, HIPAA plays a large role in the administration of health plans.

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One element of health care that HIPAA regulates is health information. HIPAA defines health information as information that is “oral or recorded in any form or medium,” and created or received by a healthcare provider, health plan, or public health authority. HIPAA elaborates on this definition by noting that this information can relate to the “past, present, or future physical or mental health or condition of an individual, the provision of health care to an individual … [or] payment for the provision of health care to an individual.”

Since obtaining personal healthcare information is an essential part of running a health plan, HIPAA applies in many situations that plan administrators face. Transmission of personal health data is necessary because health plans work with billing for procedures, claims, and enrollments among patients. Although HIPAA specifies the protective measures that an individual transmitting personal health data must follow, including consent for use or disclosure of information, HIPAA does not require authorization for transfers that pertain to payment, claims, eligibility for a health plan, or enrollment in a health plan. Due to this leniency, many states have enacted stricter privacy laws.

Creating stringent privacy laws is an effective method for legislators to protect their consumers, as state law trumps HIPAA when the state law is stricter. However, in order to meet the “more stringent” criterion, the law must relate to protection of “individually identifiable health information.” A law “”relates to the privacy of individually identifiable health information’ when “the state law has the specific purpose of protecting the privacy of health information or affects the privacy of health information in a direct, clear and substantial way.”‘ Conflicts typically arise as states often prohibit the use or sharing of health information in situations where HIPAA allows the release of this data. Furthermore, states often increase the privacy rights of an individual in relation to private health information. As such, health plan administrators must be aware of both federal and state privacy regulations.

The computerization of medical records and the increased reliance upon computers, telecommunications, and other technologies has caused patients, health care providers, and many other participants in the provision of health care to focus on patient privacy and medical record confidentiality. A question arises as to whether the new technologies increase or decrease the exposure to misuse or disclosure of information that many consider to be their most – or one of their most – important secrets. The debate will continue as society adapts to these new modes of processing information and people better understand the capabilities (good or bad) of the technology. Currently, professional organizations and private interest groups are lobbying for the enactment of laws that address this concern.

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