More Insurers Using Computer Technology To Determine Risk, Raising Privacy Concerns
Dow Jones/Wall Street Journal on Sept. 12 examines "predictive modeling" technology programs, which an increasing number of health insurers use to determine which patients may have future health problems. Under the systems, health insurers use a computer program to "crunch" patient personal and medical information -- such as age, prescription drug use, gender, family history, blood test results and reports from doctors -- and "pinpoint those who would benefit from preven[tive] care," which can reduce costs. Some predictive modeling systems can predict which patients will have future health problems about 40% to 70% of the time, Dow Jones/Journal reports. Several large health insurers -- such as Aetna, UnitedHealth Group and Cigna -- use the systems, and analysts expect expanded use in the future. Ben Leedle, president and CEO of American Healthways, said, "There is real pressure from employers for health plans to do more than just collect premiums. Health plans are being looked to by employers for solutions" to the increased cost of health care. However, opponents "question the precision" of predictive modeling systems, and "privacy issues abound," Dow Jones/Journal reports. Some opponents have raised concerns that drug makers could use the systems to market preventive treatments to targeted populations or that health insurers could use them to "protect themselves from people who are health risks." Dr. Marcia Angell, senior lecturer in social medicine at Harvard Medical School, said, "We have the only health care systems in the world where success is based on avoiding sick people. ... This is just another way to do it" (Bennett, Dow Jones/Wall Street Journal, 9/12).
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