The need to know versus the right to know: privacy of patient medical data in an information-based society

"Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret."(1) "Safeguards to privacy in individual health care information are imperative to preserve the health care delivery relationship and the integrity of the patient record."(2) As early as the fourth and fifth centuries B.C., Hippocrates contemplated the importance of medical information to the care and treatment of patients. His oath suggests that privacy of a patient's medical information creates the foundation upon which a patient reposes trust in his or her physician. While defining the earliest version of the physician-patient privilege, the oath does not envision the extent of modern day access to healthcare information. A patient's relationship with the modern healthcare delivery system often includes a team of physicians, nurses, and other clinical support personnel. This relationship extends beyond direct caregivers and may include healthcare administrators, payor organizations, and persons unfamiliar with a patient's identity, such as researchers and public health officials. Accessing a patient's medical information links these participants to the patient's healthcare delivery relationship. The Hippocratic Oath does not contemplate such broad access, nor does it contemplate the emerging privacy crisis resulting from the application of computer technology to medical record storage and retrieval. The combination of broad access, individual privacy rights, and computer technology requires a rethinking of measures designed to protect the realities of the modern medical information society.     

A review of recent developments affecting COBRA rights

Due to the high cost of health care claims and COBRA's status as remedial legislation, COBRA has generated a significant amount of litigation in recent years. While the early COBRA decisions tended to broaden the law in order to provide a remedy to an otherwise uninsured qualified beneficiary, the recent trend in the case law has been to limit the expansion of COBRA rights based on a narrower construction of the statute. Even so, COBRA still represents a legal minefield for employers. As a result, a careful employer will minimize its exposure by monitoring changes in the law and its interpretation and making appropriate modifications to its COBRA documentation and administration. This article discusses some of the more significant recent changes in the law affecting qualified beneficiaries' COBRA rights--and therefore, employers' exposure.     

Voting May Be Habit-Forming: Evidence from a Randomized Field Experiment

Habit is a frequently mentioned but understudied cause of political action. This article provides the first direct test of the hypothesis that casting a ballot in one election increases one's propensity to go to the polls in the future. A field experiment involving 25,200 registered voters was conducted prior to the November general election of 1998. Subjects were randomly assigned to treatment conditions in which they were urged to vote through direct mail or face-to-face canvassing. Compared to a control group that received no contact, the treatment groups were significantly more likely to vote in 1998. The treatment groups were also significantly more likely to vote in local elections held in November of 1999. After deriving a statistical estimator to isolate the effect of habit, we find that, ceteris paribus, voting in one election substantially increases the likelihood of voting in the future. Indeed, the influence of past voting exceeds the effects of age and education reported in previous studies.     

Party knowledge and candidate knowledge: constituency campaigning and voting and the 1997 British General Election

There has been a recent resurgence of interest in the electoral impact of constituency campaigns in British General Elections. Much is now known about the electoral consequences of local campaigns on parties’ constituency vote shares. Yet more remains to be discovered about the impacts of these local campaigns on voters’ knowledge of parties and candidates. Analysis of data from the 1997 British General Election demonstrates that the local campaign is associated with improved voter knowledge of who is standing for each party in a constituency, which is, in its turn, associated with an increased chance of voting for the party in the election, other things being equal. Campaign efforts at different scales, from the national to the local, have different impacts on voters’ knowledge.