Emergency Room Dilemma

Doctor Katherine Fullerton, a pediatric emergency physician, describes a dilemma she dealt with on a daily basis until quite recently:

Our [Electronic Medical Record] and record of past medical problems is a wonderful asset when I’m treating a sick child. Often the families are stressed, and forget many of the pertinent details, and this way nothing is missed. But could this same EMR be a barrier for these children when they become young adults and are trying to obtain their own insurance? Could the adorable 3 year old who is wheezing in room three, have been denied insurance as an adult because I wrote in the medical record that she has asthma? Will the six-year old hemophiliac in room five who is bleeding from a minor abrasion after wrestling with his cousin be denied insurance when he’s reached adulthood?

That’s a difficult problem. A doctor wants to treat a patient in the best way possible, but a doctor also doesn’t want to compromise the patient’s long-term health by taking steps that will make it hard for the patient to get treatment in the future. But there’s good news:

I am thankful that because of the health reform law, they can no longer be denied insurance for a pre-existing condition. With the new law, I do not have to worry that my careful history taking will harm their future.

Treatment of patients is best done in the context of maximum possible information about a patient’s health status. But this kind of disclosure has perverse consequences when it comes to insurance underwriting. Over time, we’ll presumably have technological improvements that allow us to read more relevant information off a person via genetic analysis. From a health standpoint, we’ll want to be able to do that. But we’ll only be able to apply this technology in value-adding ways if we move forward with ACA-style reforms of the insurance industry or else its supplantation with something more like Medicare.