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Implementation costs

  At 11:43 PM 1/30/96 -0500, you wrote, responding to my comment that
  collecting data linked to personal identifiers cost more,:
  >Why will it be much cheaper to
  >collect data that is not identified?  The collection system will still
  >have to be established, and a lot of the fixed costs will be incurred
  >anyway.  Where do the savings come from?
  The data comes to the state from claims payors on computer disks and/or
  tapes.  Because the enabling statute requires that the data collected
  contain certain personal identifiers, the statute requires (to provide a
  measure of privacy) that the data come to the state encrypted but with the
  states' access to the key.  Also because personal identifiers are captured,
  higher levels of security is necessary to prevent against unauthorized
  access, theft, and tampering.  This all costs money -- attributable to the
  collection of personal identifiers.  Logorithms, encryption and layers of
  security are hardly my area of knowledge and if I am way off base on this,
  please let me know or suggest a knowledgeable expert on the costs issues
  (hopefully) with ties to Maryland who would be in a position to shed light
  on these core issues. 
  You also said,
  >If you can't beat the argument, then the privacy proponents will have to
  pay for it.
  I disagree.  If anyone bears the burden of proof in this debate, it is the
  state which must be put to the test of proving that the high dollar cost of
  capturing confidential personal information and the privacy intrusions
  inherent in the process are outweighed by the utility of the database.  This
  cannot simply be assumed.  Patients already feel oppressed by managed care
  gatekeepers and already worry that  HMOs have coopted their doctors into
  providing limited treatment information.   The last thing patients want to
  hear is that there is another reason not to trust their doctors because of
  the fear that their confidential treatment records will be turned over to
  the state without their knowledge or consent.  If patients can't speak
  freely to their health care providers, treatment will suffer and patients
  will avoid treatment with the ironic result that health care costs will rise
  -- just the opposite of what the database hopes to accomplish..  
  Mimi Azrael  <t182@mci.newscorp.com>
  Azrael, Gann & Franz
  101 East Chesapeake Avenue, Fifth Floor, Baltimore, MD 21286
  Telephone 410-821-6800