Two new analyses in the Fall 2009 issue of the Guttmacher Policy Review examine how health care reform might affect medical providers—in particular those who provide sexual and reproductive health services—in two important and interrelated areas: confidentiality of services and health information technology.

Confidentiality of Services

Widely used health insurance billing and claims procedures unintentionally but routinely violate basic confidentiality for anyone enrolled as a dependent on someone else’s policy, such as spouses, teens and young adult children of primary policyholders, according to "Unintended Consequences: How Insurance Processes Inadvertently Abrogate Patient Confidentiality," by Rachel Benson Gold. In particular, the practice of sending "explanation of benefits" forms to a policyholder violates confidentiality for anyone enrolled as a dependent on their policy. This may be especially acute for individuals seeking sensitive services, such as sexual and reproductive health care.

"Confidentiality is a fundamental principle underlying the provision of health care," says Gold. "By increasing the number of insured individuals and broadening the group eligible to be covered as dependents, health care reform—despite its many positive benefits—could greatly expand the number of affected Americans. It makes it all the more important to address the issue of confidentiality."

Gold concludes that current policy and practice offer potentially useful models to address long-standing confidentiality concerns, including the development of payment methods that preserve the integrity of the billing process while ensuring the provision of confidential care. In contrast, a failure to address the issue not only erects roadblocks for those needing sensitive services, it could also lead insured teens and other dependents to turn to publicly funded family planning centers for confidential care, thereby exacerbating an already serious funding situation for safety-net providers.

Health Information Technology

Because of its potential both to improve care and to moderate costs, health information technology features prominently in both current health care reform efforts and the 2009 stimulus bill. But family planning providers seeking to use significant new financial incentives face a host of challenges, including confidentiality issues and difficulties tailoring new technologies—such as electronic health records—to meet the requirements of public health programs like Title X, according to "Family Planning Centers and the Adoption of Health Information Technology," by Adam Sonfield.

"Investing in health information technology is not only financially and programmatically wise, but probably inevitable," says Sonfield. "Family planning providers are already moving in that direction, if at times fitfully, and they will need to overcome a number of hurdles to be successful. Providers’ ability to obtain health information technology funding is paramount, but implementation challenges abound."

According to Sonfield, providers’ success in adopting new technologies will depend on numerous decisions at the federal and state levels, for instance in determining how well new data reporting requirements will mesh with existing ones that family planning and other safety-net providers must meet under Title X and other government programs. Also, privacy standards needed to safeguard patient confidentiality will have to be coordinated at the federal level and with states, localities and foreign governments. As federal and state regulators set standards, it is crucial that they take into account the reality of sensitive medical care, including sexual and reproductive health care.