State legislators are tiptoeing into a difficult balancing act -- weighing the need to control health care costs against the sensitive issue of patient confidentiality.
Under a 3-year-old law, Maryland has begun assembling a statewide computer database of medical records to show what kinds of health care state residents are getting and what they are paying for it.
That information already has been collected on a voluntary basis from a variety of sources including Medicaid and some private insurance companies, but soon such reports will become mandatory.
And that has raised concerns about whether patient confidentiality is being maintained adequately.
Patients who are HIV-positive, who are being treated for mental illness or who have some other sensitive medical condition may fear seeking treatment despite assurances that patient names will not be used, critics have said.
Yesterday, during a joint hearing before two House committees, the chairman of the commission putting together the database promised to change the law to protect patient confidentiality.
"The commission is keenly aware of the need to protect the information," said Dr. Donald M. Wilson, dean of the University of Maryland School of Medicine and chairman of the Health Care Access and Cost Commission. "We want to answer what and why and not who."
Legislation introduced by Del. Marilyn Goldwater, a Montgomery County Democrat, and Sen. Paula C. Hollinger, a Baltimore County Democrat, would exempt from the reporting system patients who pay for medical services themselves. It also would delete birthdays from records (keeping month and year only), and drop patient identification codes.
"Sometimes, people pay on their own because they don't want (( anybody to know," said Ms. Hollinger. "These are the areas that need correction."
Del. James M. Kelly, a Baltimore County Republican, would go even further.
Under legislation proposed by Mr. Kelly, no information could be given to the database unless a patient signed a consent form.
"I can't think of anything more personal, private or sensitive than one's medical history," he said. "I think the commission's goals are noble and noteworthy, but you have to ask the person."
John M. Colmers, the commission's executive director, said members support the Hollinger-Goldwater bills, but oppose patient consent, which they believe would be too expensive and unwieldy.
"It would be a burden on physicians and insurance companies," he said.
The commission yesterday gave its first report, based on volunteer reporting from medical care given in 1993.
Reports covering 1994 and 1995 are expected to be completed this fall.
Among the commission's findings:
* Maryland residents spent $13.4 billion on health care, about 11.5 percent of their personal income or $2,690 a person.
* More than half of the costs are hospital inpatient care and physician services.
* The biggest chunk of the health care bill, 29.8 percent, was paid by private insurance companies, followed by Medicare, 20.4 percent, and out-of-pocket payments, 18.9 percent.
* The Baltimore area had the highest per capita medical costs ($2,753) and the Washington area the lowest ($2,221).
Commission officials said the database will provide a better picture of how much health care costs in Maryland, how that compares to the rest of the country and whether residents are getting a good value.
"We're seeing some surprises already," said House Environmental Matters Committee Chairman Ronald A. Guns, a Cecil County Democrat.