TARGETED AREAS
Using names to track new HIV cases rather than anonymous codes is likely to provoke one of the most emotional debates among the proposals to reorganize the state’s vast health and welfare system.
Concerns over protecting patients’ privacy had already created divisions among medical professionals and activists.
In 2002, public health officials began requiring doctors and laboratories to report new HIV cases to the state using a unique identifier -- an alphanumeric code -- rather than a name.
But the code-based system is “labor intensive, less accurate and more complex than the name-based system” and puts at risk $50 million in federal funding, the government-streamlining panel concluded.
The plan noted that 36 other states use name-based reporting and that California is the only state among the five largest that requires codes for HIV reporting and names for reporting AIDS patients.
The State Office of AIDS lacks the money to even evaluate its current reporting system and show that it meets criteria established by the national Centers for Disease Control and Prevention, the report concluded. The CDC considers code-based data to be unreliable.
Some medical professionals and AIDS activists endorsed the change Friday, saying the code-based system is too cumbersome and that doctors and laboratories are not reporting cases because of the added paperwork.
“The purpose of epidemiology is to track diseases and to find hotspots, and from that standpoint the current system is unworkable,” said Michael Weinstein, president of the AIDS Healthcare Foundation, which runs 12 HIV clinics in California. “The unique identifier is complicated to report, and it’s hard to determine whether a person is being counted twice.”
But others contended that using patients’ names would compromise confidentiality and make them less likely to get tested.
“We need to do everything we can to encourage people to get tested, and there are people at risk who would not with a names-based system,” said Fred Dillon, director of policy and communications for the San Francisco AIDS Foundation. “Even with name reporting, many jurisdictions say they don’t have the time to report, so to say this would fix the system completely is false.”
Health and human services is the state’s second-largest area of expenditure, encompassing $24.6 billion in general fund money and 29,700 employees.
To save money and improve efficiency, the panel proposed fundamental changes in services for children, the disabled, elderly, welfare recipients and child-care providers.
