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Issue #1457      2 June 2010

Budget 2010-2011

Warning: National ID card

The government plans to begin phasing in E-health patient records in 2012-13 with its initial focus on those with complex or chronic conditions, older people, Indigenous Australians and mothers and their new born. It involves the centralised recording of medical conditions, medications and medical history of individuals in a centralised data base. The government is going to great lengths to reassure the public that it will be a voluntary “opt-in” system with access controlled by the patient.

It could be highly beneficial for a patient’s medications and medical history to be accessible by doctors and other practitioners. Unfortunately, there are also a number of dangers associated with the scheme being introduced.

Firstly, how voluntary is voluntary and for how long will it be voluntary? The tax file number is voluntary, but if you do not have one you pay the highest marginal rate on all income at the time of receiving it. You cannot do business without one. If you do not have an E-Health card, will you, in a few years time, be able to receive Medicare benefits or a government pension without one?

Secondly, there is no guarantee of patient control or confidentiality. Government bureaucracies are notorious for leaks and mishaps with personal records.

Thirdly, there is no guarantee that further down the track that insurance companies or employers make access to the E-health records a condition of cover or employment. If the data collection is automatically linked to a doctor’s computer, then there could be a reluctance to even record information relating to certain conditions such as HIV positive, AIDS or substance abuse.

Under a punitive social security system, which already seeks to control how recipients spend their income, there is the possibility of withholding payments from people whose medical records reveal substance abuse or other “undeserving” behaviour.

There is a fourth danger – a very real one. The government intends to use the E-Health card as an ID card. The budget papers state: “Medicare Australia is developing the Healthcare Identifier service under contract to the National E-Health Transition Authority. This service will generate health care identifiers for patients, health care providers and health care organisations and is aimed at supporting the development of electronic health records in Australia.” At this stage it is not clear whether digital facial recognition, DNA or some other unique identifier will be used.

Subject to legislation being passed, work will officially begin on the national identifier in July 2010. “An operational contract is to be agreed between Medicare Australia and NeHTA for the ongoing delivery of the Healthcare Identifier service.”  

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