Biomedical Engineering Reference
In-Depth Information
criminal purposes or strategic reasons (think of employers being interested
in the medical records of their employees or applicants) can cause serious
problems for individuals in society.
Besides safe transfer of medical data, at the same time health insurance
companies have particular interest in data generated by monitoring technol-
ogies because it can potentially give them more control over their long-term
expenditures and over patient behavior and lifestyles and their compliance
to medical advice. In our interviews, it has been anticipated that in light of
cutting health-care costs, one possibility is that health-care insurance compa-
nies will become interested in the data in return for reimbursement options
(as a new business model). More specific, two options have been mentioned
during our interviews. One possibility was related to rewarding patients for
their healthy lifestyles and compliancy with medical advice in return for
access to their medical data. These business models might have benefits in
terms of empowering the society to become more aware of their responsibili-
ties for their own health, thereby tackling the roots of costs of health care
(also by promoting preventive health care); however, at the same time, it also
means that the risk of violating the privacy of individuals is increasing. This
situation can become controversial, for example, if individuals refuse using
these technologies in the long term.
The other strategy mentioned in the interviews was related to rewarding
medical professionals for their performance results (payment on the basis
of result). There is already more transparency required from health-care
institutions in the Netherlands (KPN 2006). It is argued that such transpar-
ency will enhance the quality of care delivered by several health-care insti-
tutions that are functioning in this sector. In effect, this might contribute
to the competitive drive of these institutions in the market. However, shift-
ing reimbursement strategies toward result-based payment can have serious
negative impacts. For instance, one of our interviewee's in the health-care
sector mentioned that such strategies might affect the business models of
health-care professionals to shift weighing commercial incentives stronger
than humanitarian incentives while delivering their services. This under-
mines the whole notion of equal access to health care and can have serious
consequences for society.
Another issue related to compliance with medical advice. The envisioned
applications of BAN are usually intended to monitor vital physiological signs,
assuming that the context is according to normal conditions of living and in
compliance with specific medical advice. However, it should be considered
that the main target groups, such as seniors and patients with chronic ill-
nesses, do not necessarily live healthy lifestyles all the time. The capability
of BAN applications to monitor and identify unhealthy lifestyle or behavior
then becomes intrusive. The interesting question to be posed here are as fol-
lows: If detected by the monitoring system, should people be held respon-
sible for their noncompliance to certain advice? Can people also refuse to
use these technologies in the long term? Or is it desirable if professionals or
