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National Information Center on Health Services Research and Health Care Technology (NICHSR)

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Introduction to Health Services Research : A Self-Study Course

Module 2: Brief History of Health Services Research (Page 36 of 40)

Today's Major Health Services Issues, Continued

Genetics

Congress will continue to consider legislation to expand the use of genetic information and technology while also protecting individuals from discrimination based on genetic conditions. Genetic discrimination has been documented in both denials for health insurance and in individuals losing their employment because of perceived risk resulting from their genetic status.

Concerns about the use of gene therapy have risen with the death of at least one patient. The use of human embryos in stem cell research is controversial. With the recent news that skin cells can be implanted in a human egg and induced to divide has important ethical implications. Recent efforts (2006) by researchers have found that one cell from an embryo can be removed without harming the embryo and can be used in stem cell research.

Medical Confidentiality

Snapshot of the CMS's HIPAA home page. This image will open a new window. Close the window to return to this page.With the passage of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, patients now have an increased measure of confidentiality of their medical records.

The Centers for Medicare & Medicaid Services (CMS) is responsible for establishing and implementing national standards for electronic health care transactions and national identifiers for providers, health plans, and employers. Information for the public, health professionals and governments on HIPAA is available online.

The law also addresses the security and privacy of health data and includes important new protections for the 1 in 10 workers who move from one job to another, who are self-employed, or who have pre-existing medical conditions.

HIPAA, Title I, also protects health insurance coverage for workers and their families when they change or lose their jobs.

Mental Illness and Substance Abuse

“Let me say we must step up our efforts to treat and prevent mental illness. No American should ever be afraid -- ever -- to address this disease.” – President Clinton in his State of the Union Address, January 19, 1999

Substance abuse (alcohol and tobacco especially) continues to be high among American youth, and millions of aging Americans will likely face depression or other mental illness in the years ahead. However, data show that insurance benefits for both mental illness and substance abuse treatment continues to lag behind those for traditional physical illness.

Snapshot of the Surgeon General's report on mental health. This image opens in a new window. Close the window to return to this page.The need for improved health care was recently granted political visibility in the Surgeon General's landmark report titled, Mental Health: A Report of the Surgeon General (DHHS, 1999).

 

Mental Health Parity Act Passes

The Clinton-Gore Administration advocated for and signed into law the 1996 Mental Health Parity Act which came into effect in 1998. It required that health plans "provide the same annual and lifetime spending caps for mental health benefits as they do for medical and surgical benefits."

Executive Order Mandates Mental Health Coverage for Federal Employees

Also, President Clinton's Executive Order 13124 (June 4, 1999) mandated parity in health insurance coverage of physical and mental health for all federal employees.

Personal or Societal Responsibility for Health

Many of us around the world exhibit unhealthy behaviors (eating too much and not exercising enough). The questions of whether people with unhealthy behaviors should have the same access to health care - such as organ transplants - as those who have taken care of themselves continue to be raised in some quarters. In an era of scarce health resources, will society pay for excess procedures in order to keep those with unhealthy behaviors well? Numerous ethical issues surround this topic.

As an example, one of the big issues in the past few years has been the increase in the number of obese in the United States. The Trust for America's Health (TFAH) recently released a report titled, F as in Fat: How Obesity Policies are Failing America, 2006. It describes how Americans are getting fatter - the number of obese is up from 15 percent in 1980 to 32 percent in 2004.

View Key Projects and Milestones in Health Services Research.

Discussion Questions

  1. How important is HIPAA in the work you do? What kinds of changes has it made in your work environment? Has HIPAA changed how you provide information to researchers? To the public? Has it changed the collection and analysis of patient-related data?
  2. Preventing and treating mental illness is an expensive undertaking. Can society afford to treat those who are mentally ill? Can it afford not to? If the mentally ill are not treated what happens to them? Is there a cost to society for not treating the mentally ill? Describe.
  3. Which side of the fence do you come down on with respect to personal/societal responsibility for health? Discuss this in light of the built environment and walker-unfriendly neighborhoods and the increase in obesity that we see in the United States. Are Americans obsessed with their weight or do they have good cause to be worried? Back up your opinion.
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