>pharmacological intervention, as regards agency, is at least a
>two-way affair -- in the context of what one as patient/patients
>is/are willing to do, and what the doctor/s is/are willing to do to
>patient/s. then moving in/out/up a level from individual or group
>relations the legal, moral, cultural, political, economic normic
>constraints/licenses come into play.
***** U.S. Study Finds Uninsured Ignore Signs of Illness
CHICAGO, May 7 (Reuters) - People without health insurance are far less likely to seek medical help when confronted with symptoms of potentially serious illness, U.S. researchers reported on Sunday.
They said the finding was particularly disturbing since the number of people without health insurance in the United States -- now 44 million -- is likely to grow by another million in the next five years.
``Our findings suggest that lack of health insurance is a major barrier to obtaining health care for important symptomatic conditions,'' said the report from Case Western Reserve University in Cleveland.
The authors said it has been generally known that the uninsured get less care but not much was known about what happens when serious symptoms crop up.
The study -- published in this week's issue of the Archives of Internal Medicine -- was based on data from 574 people that was collected in 1994 by the National Centre for Health Statistics.
In the study, people were asked about their response to 15 serious health problems, such as blurred vision, a severe ankle sprain or the appearance of a tumour or mass in the breast, during the previous three months.
Of the group 499 had health insurance and 75 did not. Among the insured, 45 percent of all new symptoms prompted medical treatment compared to 24 percent for the uninsured.
There was also a big difference between the two groups when it came to simply thinking about getting care but not following through. Nearly a third of all symptoms prompted that response among the uninsured compared to 13 percent among those with insurance.
``The results of this study are particularly disturbing in light of projected increases in the number of uninsured and anticipated decreases in the ability of providers to deliver uncompensated care,'' the report said.
``Pressures from managed care will probably reduce delivery of uncompensated care, and 'safety net providers' that serve as a critical source of care for the uninsured are likely to face increasing financial pressure as well,'' it added.
``It is ironic that at a time when out country is establishing a 'Patient's Bill of Rights' we still have not established the right to be a patient. The ability of the uninsured to obtain medical care for even the most serious and disabling conditions is likely to worsen in the coming years,'' the report concluded.
<http://www.masscare.org/articles5_00.htm> *****
***** Men Less Likely to Seek Medical Help by Steven Simpson, Ph.D.
A Harris survey has found that nearly a quarter of American men had not seen a doctor in the previous year, while only eight percent of women had not. Four out of five women surveyed reported having a regular doctor and only two out of three men did. There is a growing interest in men's health seeking habits, as experts urge men to get regular health checkups and do routine exams. Experts say there seems to be a notion among American men that seeking medical help is not manly. This is changing with the new openness about prostate cancer and the availability of Viagra. While men have the largest disposable income, women are the greatest consumers of health care. Women often take responsibility for men's health as well as their own, whether it is a son, father or husband. Men mistakenly assume they are less vulnerable to illness and injury than women. U.S. women's life expectancy at birth is six years longer than men's. One way to persuade men to take better care of themselves is to appeal to their sense of duty and responsibility to their family.
Rita Rubin, "Unhealthy attitude toward checkups costs lives" USA Today, June 26, 2000, 7D
<http://www.parentsoup.com/parentsplace/print/0,3292,637-15671-7-famil y-NEWS,00.html> *****
***** Privacy and Confidentiality of Behavioral Health Care Records: The Consumer Perspective, Jean Campbell, Ph.D.
We have tried to be as objective as possible in our analysis, but objectivity is not synonymous with a lack of perspective. Our analysis makes no pretense at being "value-free." Our operating bias may be made explicit; we are partial to the values of equality, participation, and legality--in short, to those values we think of as the values of constitutional democracy. We believe in due process of law and look forward toward a society in which order is achieved through consent, not coercion.
Jerome Skolnick from The Politics of Protest (1969)
The Emerging Dilemma
The use of electronic medical records is no longer equivocal, and the potential benefits are manifold. Irretrievably the nation has been propelled into an era of computers and electronic networks. According to a Time magazine article (Quittner, 1997), "Our right to be left alone has disappeared, bit by bit, in Little Brotherly steps. Still, we've got something in return, and it's not all bad" (29). Electronic linkage of medical records promise improved care, both at the system level and at the individual level of service utilization. The development and implementation of managed health care plans depend on information about individuals in order to determine who should be enrolled, to set rates, to determine quality and effectiveness of services, and to engage in prior and concurrent review. Personal health data has become a refined commodity that had considerable worth in the health care market place. Most important, the capacity to transmit patient specific information within the network of providers greatly benefits consumers. Individual care can now be integrated through access to computerized information, rather than each medical episode remaining a discreet, unrelated event (Petrila, 1996). For example, the name of a person's psychiatrist or medication records could be instantly available to doctors in a psychiatric emergency room, even though the individual being evaluated might not be able to provide this information. Also, the repeated collection of encounter data or a person's medical history could be eliminated saving the staff and the consumer much time and effort.
However, people care deeply about their medical privacy. It is personal. The risks of exposure of medical records that can profoundly change people's lives are multiplying, and with increasing frequency the public reads or hears of cases where individuals have lost insurance, jobs, housing, or suffered public humiliation because of something in their medical records. The following incidents are just a few examples taken from an in-depth series of articles on medical privacy published in The Tampa Tribune (Palosky & Stanley, February 15, 1997; Palosky & Stanley, March 2, 1997; Stanley & Palosky, March 2, 1997):
1.A Tampa woman never expected anyone to learn about her sessions with a therapist but when she got hurt in a car wreck and sued, defense lawyers claimed her problems were mental, not physical. At the trail, an attorney read to the jury the details of her past emotional problems from the therapist's notes. "I looked like a crazy person, and I lost the case," reported the woman. 2.In California, a state agency denied a man a job in part because he had been treated for depression. 3.When Rep. Nydia Velaquez, D-New York, first ran for Congress in 1992, the New York Post published details about her past suicide attempt. She won and later sued her hospital for failing to protect her records. 4.The names of 4,000 people on a Florida state-created list of AIDS patients were copied from a state computer and mailed to newspapers.
Inadvertent breaches of confidentiality, health data searches by law enforcement agencies, and the myriad of data merging activities now taking place have created a chilling effect on people who seek medical help. Stigmatized populations such as people with mental illness, HIV/AIDS, or alcohol and substance abuse problems are the most vulnerable to violations of health privacy since the practical consequences of being identified are extreme. In general, medical privacy issues facing a person with bipolar disorder do not substantially differ from those facing someone who is HIV positive. Not only have the ravages of disease long victimized such people, but they have also been forced to confront attendant prejudice, discrimination, and public fear. Medical privacy, therefore, looms over their everyday lives and must be addressed within the critical context of civil liberties.
Within the general debate regarding privacy and confidentiality of health records, this chapter analyzes the demands of health consumers to control the use of their own health data, and for protections as human subjects within behavioral health management information systems. In particular, as mental health consumers have gained access to positions in health research and policy, many feel both compelled and uniquely qualified to champion the health privacy concerns. Where patient-doctor relationships with the healthcare system are already strained by the information demands of managed care, the critical voice of mental health consumers represents a much-needed corrective to the data rush on medical records facilitated by technological advances in health data management....
<http://www.madnation.org/bioethics/privacy.htm> *****
Yoshie