It turns out that, as with many things in America, the reason is political rather than practical.
Anyone who has dealt with building products for the US healthcare system will be aware of the Health Insurance Portability and Accountability Act (HIPAA) which was signed into law in 1996. One of the requirements of HIPAA was that every person in the United States would be identified with a unique, persistent healthcare identifier number.
The lack of such a unique identifier creates huge problems with healthcare administration in the US. If a patient visits a healthcare provider, and the staff there are unable to find their medical record, then a new one is created, meaning that past medical information is not associated with the patient.
It has been reported that 1 in 5 electronic healthcare records in the US are duplicates.
It’s a problem that disproportionately affects ethnic minority and disadvantaged patients:
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Black patients make up 13% of their patient population but 21% of duplicate records;
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Hispanic/ Latino patients make up 21% of the population, yet they make up 35% of duplicates;
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The homeless population makes up 4.3% of patients, but 12% of its duplicates; and
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Migrant patients make up 2.1% of the patient population but 3.6% of its duplicates.
Source: https://ochin.org/ and the Patient ID Now Coalition (publication).
Death Due to Duplication
An example of the devastating consequences of the lack of a unique healthcare identifier is given by a woman who arranged with her doctor to have a mammogram, but then never received any results. She assumed that no news was good news (nothing to report, as is common in healthcare), however it transpired that her scan had been mistakenly mismatched to someone with a similar name and sent to them instead.
By the time she and her doctor realised that the mammogram results were missing, it was too late. She in fact did have cancer, which in the absence of timely treatment had already spread and was now terminal.
The COVID-19 pandemic further highlighted the need for a healthcare patient identifier: in the rush to test and vaccinate thousands of patients per day, test results sometimes could not be sent to the correct patient or were sent to the wrong individuals. Furthermore, as patients were being vaccinated it became increasingly difficult to track who had been vaccinated already, and who had already tested positive for COVID.
Financially the impact is significant on the US Healthcare system. 1 in 3 denied health insurance claims are down to patient identification problems, costing the healthcare system $6 Billion per year.
So if the need for a universal healthcare number is so obvious, and costing the US healthcare system so much money, why is there not a universal healthcare number as is common in other Western medical systems, such as the United Kingdom’s National Health Service (NHS)?
Enter the Politics
The answer is, unsurprisingly, political. Representative Ron Paul (R-TX) effectively banned the universal healthcare number by preventing any funding being used to develop the system. Why? His curious desire to stop government involvement in individuals’ healthcare.
Paul, himself a physician, said “I know firsthand how much the doctor-patient relationship relies on trust and privacy, which would be undermined by a National Patient ID,” warning that to remove the ban would “open the floodgates for a government-issued ID to be linked with the private medical history of every man, woman, and child in America.”
As many countries, such as the United Kingdom and Germany have shown, the benefits of having a universal healthcare number far outweigh any possible negative consequences.
Identity Resolution to the rescue?
So is this another example where identity resolution technology would solve the issue? Well, yes, it would solve the symptoms, reduce errors, and reduce the time it takes to identify duplicates, probably saving lots of money and, more importantly, improving care, but it should not be necessary.
US politicians should get behind a universal healthcare number, provide it with funding, and let the benefits flow to their citizens AND their healthcare insurance companies.
Sources:
