1. [Jordan] wants to sign up for health insurance. The application requests basic information such as his name, address, age, and prior medical insurance providers.

  2. [Suzanne] wants to sign up for health insurance. The application asks her for basic personal information as well as an immunization record.

  3. [Mandy] wants to sign up for health insurance. The application asks her for basic personal information, as well as a detailed description of all prior illnesses.

  4. [Andrew] wants to sign up for health insurance. The application requires him to list all doctors who have treated him, to answer specific questions about his behaviors, and to give permission for a financial background check.

  5. [David] wants to sign up for health insurance. The application consists of a copy of his full files from prior insurance providers and doctors, a detailed medical history, and an interview as well as a physical examination that includes blood and urine tests.

  6. [Joanna] wants to sign up for health insurance. The application consists of a copy of her full files from prior insurance providers and doctors, a detailed medical history, and an interview as well as a physical examination that includes blood and urine tests. In addition, the health insurance company purchases customer information from local grocery store membership programs so that it can consider her dietary habits.

Given such a variegated landscape, the lines between proper and improper use of health information are unclear. The use of information for the treatment of an individual is generally accepted, but the scope of the set of people who might need to use the information for that purpose is becoming less and less clear. The right of a society to ensure the public health of all its members has long been seen as taking precedence over the privacy of the individual when it comes to the incidence of infectious disease, as illustrated by the tracing by public health authorities of an infected person’s sexual contacts in the case of sexually transmitted disease. Some see the release of health information to insurance companies to allow payment for services to the individual as having direct benefit to the patient and therefore not subject to the informed consent required for other kinds of release of that information, but do not see direct benefit in the release of such information to pharmaceutical companies.

Determining the proper balance between access to information and protection of privacy in the business, practice, and science aspects of medicine under the new realities of medical treatment is not something that can or should be done casually or by some small group either inside or outside the industry. The decisions made in this area will have an impact on the lives of everyone, and will affect the cost, efficacy, and range



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