Mahajan Uma V, Wafapoor Vahid, Mahajan Omkar A, Anderson William S
School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
Strategic Innovation Group, LLC, Baltimore, MD, USA.
J Patient Exp. 2022 Jun 7;9:23743735221106604. doi: 10.1177/23743735221106604. eCollection 2022.
Modifications to Health Insurance Portability and Accountability Act (HIPAA) have allowed for the disclosure of patient protected health information (PHI) for the purpose of hospital fundraising. The public has recently raised ethical concerns regarding these practices. We examined the forces that brought about these HIPAA modifications. We first examined 304 comments submitted to the proposed rule for the HIPPA regulation modifications. We additionally queried the repository for lobbying activity by these commenters. We found that 57 out of the 304 comments pertained specifically to fundraising practices. The majority of comments were from hospital developmental (fundraising) offices (51%, 29 of 57 comments), and the majority (96%, 24 of 25 hospital comments; 83%, 34 of 41 total comments discussing PHI disclosure) supported additional PHI disclosure. There was a paucity of comments from physician organizations (1 of 57) and patient advocates (2 of 57). The majority of lobbying dollars (95% of over $81 million) were from commenters who favored the modifications. The lack of physician and patient representation in the rule-making process likely contributed to the creation of regulations that elicit ethical concerns in physicians, and potential harm for patients.
对《健康保险流通与责任法案》（HIPAA）的修订允许为医院筹款目的披露患者受保护的健康信息（PHI）。公众最近对这些做法提出了伦理方面的担忧。我们研究了促成这些HIPAA修订的各种力量。我们首先审查了提交给HIPPA法规修订提案规则的304条评论。我们还查询了这些评论者的游说活动资料库。我们发现，304条评论中有57条特别涉及筹款做法。大多数评论来自医院发展（筹款）办公室（51%，57条评论中的29条），并且大多数（96%，25条医院评论中的24条；83%，讨论PHI披露的41条总评论中的34条）支持增加PHI披露。来自医生组织的评论很少（57条中的1条），患者权益倡导者的评论也很少（57条中的2条）。大多数游说资金（超过8100万美元的95%）来自赞成修订的评论者。在规则制定过程中缺乏医生和患者的代表，这可能导致了引发医生伦理担忧以及对患者造成潜在伤害的法规的制定。
