ABSTRACT
Provider and payer groups have endorsed the goal of improving the integration of primary care and behavioral health across a variety of programs and settings. There is an interest in sharing patients' medical information, a goal that is permissible within HIPAA, but there are concerns about more restrictive state medical privacy laws. This article assesses whether a substantial number of state medical privacy laws are, or could be interpreted to be, more restrictive than HIPAA. Preliminary investigation found that in almost one third of the states (including large-population states such as Florida, Georgia, Massachusetts, New York, and Texas), primary care physicians (PCPs) may have difficulty accessing mental health treatment records without the patient's (or his/her guardian/conservator's) written consent. If a comprehensive legal analysis supports this conclusion, then those advocating integration of behavioral and primary care may need to consider seeking appropriate state legislative solutions.
Subject(s)
Confidentiality/legislation & jurisprudence , Medical Records/legislation & jurisprudence , Mental Disorders/therapy , Physicians, Primary Care , Humans , Primary Health CareSubject(s)
Age Factors , Aged , Decision Making , Ethical Analysis , Ethics , Health Care Rationing , International Cooperation , Internationality , Patient Selection , Public Policy , Renal Dialysis , Resource Allocation , Social Justice , Withholding Treatment , Attitude , Cost-Benefit Analysis , Cultural Diversity , Delivery of Health Care , Ethical Theory , Ethicists , Euthanasia, Passive , Family , Humans , Jurisprudence , Kidney Diseases , Life Support Care , Mental Competency , Morbidity , Mortality , National Health Programs , Patient Care Team , Patients , Persons with Mental Disabilities , Physicians , Prejudice , Prognosis , Quality of Life , Risk , Risk Assessment , Social Values , Statistics as Topic , Third-Party Consent , Treatment Outcome , Treatment Refusal , United Kingdom , United StatesSubject(s)
Age Factors , Aged , Health Care Rationing , International Cooperation , Internationality , Patient Satisfaction , Patient Selection , Prognosis , Public Policy , Quality of Life , Renal Dialysis , Resource Allocation , Treatment Outcome , Withholding Treatment , Attitude , Deception , Decision Making , Europe , Euthanasia, Passive , Financing, Government , History , Humans , Kidney , Kidney Diseases , Life Support Care , Morbidity , Mortality , National Health Programs , Organ Transplantation , Physicians , Referral and Consultation , Refusal to Treat , Statistics as Topic , Treatment Refusal , United Kingdom , United StatesABSTRACT
KIE: A case study is presented in which the 7-year-old son of an uninsured, unemployed single parent dies of leukemia before sufficient funds can be raised from the public for a bone marrow transplant. The state legislature had voted to reallocate Medicaid funding from organ transplants to medical services for low-income children and pregnant women. Three commentaries consider the moral justification for the legislature's decision and the priorities that should be set by policy makers for the allocation of health care resources.^ieng
