Going retail on privacy breaches

February 28, 2007 — Fred Fortin

I failed in my last privacy post to mention what was happening in Massachusetts on protecting the privacy of personal credit card and financial information. There’s a bill in the state legislature there that would punish retailers when hackers or thieves get into their system and steal customer information. Under the proposed statute, retailers would be liable for the fraud-related losses and other specified costs of their customers.

Massachusetts regulators are also calling on retailers to start disclosing how well they protect customer credit-card and debit-card data. And in Congress, Barney Frank (D-Mass.) said he plans to craft a bill that would exempt companies from disclosing data breaches, provided they secure the data with encryption software or other technology that would render it virtually unreadable.

Here’s the rub: health care institutions, physician offices and other providers often store this kind of information as well. And they are, in many respects, retail operations. So you’ve got to wonder how they would fare under these kinds of legal requirements. Unfortunately for some small office practices the forces of change may simply be coming on too fast.

The pressure to trim costs and improve quality in health care using new information technology is enormous. Physicians especially are being hit hard and are trying frantically to catch up with Internet Nation. They’re struggling to adopt electronic medical records, submit electronic claims transactions to payers, write electronic prescriptions, share medical information with their colleagues through their local RHIOS, integrate their new mandated National Provider Identifier (courtesy of the federal government) into their systems and transact patient business by email. It’s a hefty investment in time, money and personal energy.

And since no good deed goes unpunished, you can now add to this electronic avalanche a new legal liability to their already immense risk of litigation.

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Big year so far for lost or stolen private health information

February 27, 2007 — Fred Fortin

This last month has been hell for those charged with protecting the privacy of health care information. Reports of big breaches in privacy and security are hitting us almost daily. In February alone:

  • John Hopkins University and John Hopkins Hospital reported the loss of data tapes containing information on thousands of university employees and patients;
  • The Birmingham Veterans Affairs Medical Center announced that non-encrypted computer hard drive was missing and about 535,000 veterans and 1.3 million doctors were affected. Some VA research activities have been suspended as a result;
  • Personal information on nearly 200,000 members of health insurer WellPoint Inc. was stolen from the office of a company vendor. The majority of people affected are Anthem Blue Cross and Blue Shield members in Kentucky, Indiana, Ohio and Virginia; and
  • A laptop theft compromised the private information of 22,000 patients at Kaiser Permanente’s Medical Center in Oakland. Kaiser has announced they are implementing a new system-wide policy that prohibits storage of member data on the hard drive of any desktop, laptop or mobile device.

And the month is not over yet! The list goes on, and on, and really on.

Disturbing little facts: One in ten laptops will be stolen during their lifetime; More than 1,100 laptop computers have vanished from the Department of Commerce since 2001, including nearly 250 from the Census Bureau containing such personal information as names, incomes and Social Security numbers.

In January, the Government Accountability Office (GAO) issued a report critical of the Department of Health and Human Services (DHHS) efforts to protect electronic personal health information. The GAO observed that DHHS had “not yet defined an overall approach for integrating its various privacy-related initiatives and addressing key privacy principles, nor has it defined milestones for integrating the results of these activities.”
Following these events, the leader of a federal panel charged with providing privacy recommendations for the national health information network, Paul Feldman, resigned, thwarted, he said, in efforts to develop adequate standards.

“We already know that the majority of people in this country fear that their health information is more prone to misuse in electronic form,” Feldman said. “We must not shirk our duty to protect them from such harm.”

So say he, so say all of us.

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China AIDS and Hepatitis B controversies recalls earlier writings

February 25, 2007 — Fred Fortin

Recent media attention on 80 year-old AIDS activist Dr. Gao Yaojie caught my attention. Dr. Gao gained fame for helping expose the tainted blood-selling operations that spread H.I.V. in central China in the 1990s. It seems her planned travel to the U.S. was being met with some official Chinese concerns. This is odd given the praises the government has been receiving of late for its bold efforts in the fight against AIDS.

Following on the heels of that story was one on the struggles in the workplace for those in China with Hepatitis B. The worker was reportedly told by his human resource manager, “you’re a hepatitis B carrier. You’re not fit for collective life, for working in a factory with colleagues.” The underlying meaning of the boss’s message was clear: we are afraid of you.

For those who have been in health care for awhile (U.S. or China), these are familiar if not disturbing stories. I have heard my share of them. They also prompted my recollection of some observations I wrote years ago on AIDS and surveillance. So I offer these to you as a kind of historical testimony to the misery epidemics continue to inflict on human relations.

“In Daniel Defoe’s classic fictional account of the bubonic plague in 17th century England, we are confronted, as Richard Goldstein observes, with “the plot” that we still impose on epidemics, a language of speaking plague that in some sense is foundational to the modern framing of our new experience with AIDS. We read in his imaginary journal of the collective denial of the plague’s death reality, of the alert paranoia over this inexplicable and invisible enemy, of the physical and emotional suffering endured, of the surrender by many to feelings of terror, of the dissolution and resurrection of community, and of the stark and often absurd character of public measures to contain the epidemic. The great visitation of 1665, once narrative and fictive, resonates as true; what was strange is now familiar. It is as if our AIDS experience, in humbling modern arrogance over 20th century technological superiority, has lessened somehow the historical difference between now and then.

“What is familiar in this reading is the continuous fear, expressed by both the sick and healthy alike, of being watched. Official examiners, watchmen, searchers, not to mention the inquiries of neighbors and friends, were all to be viewed with extreme suspicion during times of plague. Any sign of possible infection, real or imaginary, made one vulnerable to a number of devastating official impositions. . .

“Measures taken, embedded as they were in the rhetoric of public good, often led to the experiencing of private horror, and the physical suffering of plague victims became inseparable from the fears and effects of public exposure, inspection, judgement, rejection, and confinement or exile. To be watched was the first encounter with this dread, one to be avoided at all costs if possible, and if not, one in which all resources had to be brought to render it harmless.”

A.J. Fortin “AIDS, Surveillance and Public Policy”, Research in Law and Policy Studies (JAI Press Inc. 1995) vol. 4, pp.173-197)

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Chinese Competitive Cycling: Working up to Beijing 2008

February 24, 2007 — Fred Fortin

Beijing Olympics 2008 is getting close. So naturally the question on everyone’s lips is — how’s China’s cycling team shaping up?

At the 2004 Olympics, Jiang Yonghua won a silver medal in the women’s 500 metre time trial. In 2002, she was world record holder for the event until ceding the record to Australia’s Anna Meares in 2004. China’s women cyclists also did well at the 15th Asian Game in Doha last year winning two gold medals and one silver. One of the medalists, Guo Shuang is now training hard in Switzerland for the 2008 women’s sprint.

Members of China’s men’s cycling team, while not in the line up in 2004, are coming along. They competed in the men’s track cycling pursuit finals in Doha. South Korea won the gold, Iran the silver and China the bronze medals. (above photo: AFP PHOTO/MANAN VATSYAYANA) .

We’ll try to follow these athletes and others in the Chinese amateur cycling world as the Olympics start to warm up .

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Following Evidence-Based Medicine in China

February 23, 2007 — Fred Fortin

One of the movements in health care that I’d like to keep updating readers about from time to time is evolution of evidence-based medicine (EBM) in China. Developing countries face many challenges in adopting EBM methods in medical practice. A critical activity, for example, is the ongoing systematic review of current research relevant to one’s specialty. This is tough enough even in the best of circumstances. But when you add language difficulties, fewer resources, bad Internet, lack of skills, cultural differences, and problems in judging scientific value — well you get the picture.

Since 1996 China has shown increasing commitment to EBM. A number intellectual strongholds are now in place that augur well its growing importance in China’s health care. The West China Center of Medical Science (Sichuan University, Sichuan Province) along with the Chinese Cochrane Center in Chengdu and Peking University Centre for Evidence-Based Medicine (Beijing) are some examples. Both universities are included in the national 211 Project, a government program designed to strengthen institutions of higher learning.

A unique challenge for these centers will be the integration of Traditional Chinese Medicine into the mix. But studies have been under way for a number of years in both China and the U.S. to do just that.

Posted in Blog news, China, Healthcare. 2 Comments »

Globalization takes toll on China’s Flying Pigeons

February 22, 2007 — Fred Fortin

If you’ve spent anytime in downtown Beijing, you may have noticed the absence of birds.

Cities across the globe have long been avian “killing fields” with high-rise glass windows and city sprawl usually being the primary culprits. China’s large cities are no different — except maybe when it comes to sparrows.

But putting that sorry ecological episode aside for a moment, the bird I am thinking about here is the Flying Pigeon, China’s ubiquitous black bicycle that has been the standard transportation for millions over the years.

The flock of Flying Pigeons living in China is estimated to be around 500 million with 10 million nesting in Beijing. Without fear of contradiction, China can truly be called bike nation.

But this iconic symbol of simple physical self-reliance is now taking flight due to globalization, urban growth and car envy. And the long-term trade-off of this migration may not be that healthy as the predatory but more sedentary car culture takes over.

Posted in China, Cycling, Globalization, Healthcare. Leave a Comment »

Putting Together….Taking Apart

February 21, 2007 — Fred Fortin

“There is a time for putting together
And another time for taking apart.
He who understands
This course of events
Takes each new state
In its proper time
With neither sorrow nor joy.”

— Chuang Tzu

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The Rise of the Urban Chinese Consumer: Where’s Health Care?

February 20, 2007 — Fred Fortin

The year of the pig is in full swing. Almost wildly so. Do China’s consumers have a lot to celebrate about? Well maybe not about present circumstances, but certainly about the promise of the future. At least that is the considered opinion of a McKinsey&Company November 2006 report on the rise of China’s urban consumers.

Although consumption as a share of GDP has grown at a slower pace than economic output, “China’s economy is on the verge of an important transition in which its consumers will begin to take their place on the world stage.” The authors through their data argue that between 2006 and 2015, a “massive middle class” will emerge, and by 2025 China will become the ”third-largest consumer market in the world.”

They believe that the economic and demographic forces pushing this transformation are already well established. So it is really just a matter of “when” and not “if”.

The theory for this re-balancing of China’s economy towards consumption rests on two major assumptions: a decrease over time in the returns on financial investments, and an increase in the impact of domestic consumer spending on China’s economic growth.

On the flip side of the coin, the first assumption runs against a recent policy change in China’s investment policy – i.e. to become more aggressive — while the latter is being critiqued as a myth created by the “exuberant projections of investment banks.”

Myth or just good old predictive modeling, reality will eventually tell the story.

I was interested, however, in the report’s comments on health care. In 2005, Chinese households saved 37 percent of their disposable income. The primary reason for this high savings rate was the “weakness of the social safety net” such as unexpected health care costs. Almost as an aside, the report sounded a pessimistic note in that they assume the Chinese government will make only “modest progress” in this area. But as Chinese discretionary spending increases the “fastest growing product category will be private health care.” The report concludes “critical decisions will need to be made about government investment in the social safety net to free up consumption.”

And herein lies my discomfort, not with the report itself, but with subtext that informs it. Health care is framed here as a means to consumption and, in turn, a commodity to be consumed. In thinking this way, so much of what defines meaning in health care is simply lost.

More, important, one can ask of this view a very fundamental question: is the only obligation of China’s new private sector to offer health “products” to those who can pay? Is that all there is? What “critical decisions” must the private sector make to ensure better health care access, affordability and quality (as well as justice and equality)? How does this new private sector serve this essential public purpose?

These are questions not just for China but also for the west this as well. In the U.S. we still have a significant uninsured problem. The commodification of health care here doesn’t seem to have helped us very much with that challenge.

Posted in Blog news, China, Healthcare. 1 Comment »

Is China going back to grass roots health care ?

February 18, 2007 — Fred Fortin

Today we celebrate the Chinese New Year with 2007 being the year of the Pig. So it’s a good day to bring this new blog into the world. And since health and China are on our agenda there’s plenty to think about.

Since I visited a rural health clinic in Hongkou, Sichuan Province a couple years ago, a recent WSJ article by Nicholas Zamiska caught my attention. Zamiaka reports that farmers in Xinlian, China have taken charge of financing health care in their village of 1600 residents. They created their own private local health insurance cooperative, each paying a modest amount –$4.50 annually – for a very modest amount of health care in return. The twist on this health plan is that the farmers have a major voice in how the money is spent. Participation and democratization of health care here seems popular but not surprising as I will explain.

The plan was originally conceived in 2003 by William C. Hsiao, a senior professor of economics at Harvard’s School of Public Health and is taking off in other villages. The government is also keeping an eye on the program as it struggles with re-building China’s rural health care delivery system.

One immediate battle that the farmers are waging, with some reported success it seems, is with doctors who make money from prescribing costly drugs and procedures for people who just don’t need them. This is a very common and widespread problem in China given the perverse market incentives that now drive this behavior. And if all this sounds too familiar, then you’ve probably been following the debate on medical errors and evidenced-based medicine in the U.S., a topic for a later discussion. Even today only 30 to 40 percent of China’s population are urban dwellers.

The organizing farmers are also somewhat reminiscent of the American experience after the Great Depression. The social insurance movement was then in high gear giving birth to the U.S. social security program as well as hundreds of locally organized non-profit mutual benefit associations that eventually became the Blue Cross and Blue Shield movement. So there is a little of both the new school (getting into managed care) and the old school (local democratic private associations governing the medical money) in these rural happenings.

To understand why this new collectivism is not a surprise, let’s kick it up a historical notch. While much has been made of the rapid urbanization of China and the emerging business elite, it has often been in the rural areas where both revolution and markets have been fermenting since the founding of the PRC.

Mao’s army was an army of peasants. Conversely, it was poor farmers in Anhui Province trying to get out from under the yoke of official rural collectivization that sparked urban China’s venture into a freer marketplace. Even today only 30 to 40 percent of China’s population are urban dwellers.

Voluntary cooperatives like the one in Xinlian appear to be part of a new private collectivism struggling to deal with market conditions. The themes of fairness, participation and mutual benefit flow through these collective experiences. So some theorists see these rural collectives as leading the way to a unique and distinctly Chinese form of modernization. Others grant that these kind of rural enterprises are making real contribution to finding local solutions to local market problems, but worry that the impact of globalization is simply too big and too embedded in these local problems for them to have any serious impact.

Yet, my visit own to the Hongkou rural health center showed me that when a proud community has the resources and the will to fund health care, good things can happen.

There is an old axiom in the business, that all health care is local. Maybe it still is in Xinlian, at least for now.

Posted in Blog news, China, Globalization, Healthcare. 3 Comments »
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