Assignment: Review The Article Below And Answer The Question ✓ Solved

Assignment: Review the article below and answer the question

Assignment: Review the article below and answer the question. What do you feel is the major reason the US has not implemented the use of the Smart Card? If you can answer the question in a 1–2 paragraph answer, that will be acceptable.

The History of Smart Cards in Healthcare dates back to the 1990s. In 1998, the French health-care system began providing each patient with a small green card. Each patient carries “the carte vitale.” It is a Smart Card, a plastic credit card with a memory chip on it. It can open, access and update, all the essentials of a patient’s health records from a cloud-based host. With it, medical records, insurance information, prescriptions, and reimbursements are all available to the patient and caregivers. With it, provider verifies the patient’s ID at check-in. It also provides the doctor with a clinical history of the patient. Additionally, after the visit, it updates the medical information in the cloud and transmits a bill to the patient’s payer. At the present time, the French have 67 percent fewer administrative personnel per building than a comparable American establishment. Similarly, Taiwan, with the use of a smart health card, reduced its administrative costs to less than 2 percent of total health-care expenditures. This is possibly the lowest in the world.

In contrast, in 2012 the administrative complexity of the U.S. healthcare system was estimated to represent between $107 billion and $389 billion in wasteful spending on an annual basis, and in 2015 as much as $1 trillion. While much of the buzz about the digital future of health care has centered on electronic health records (EHRs), one of the biggest advancements in health care that will dramatically improve how we access, carry, and process medical records is the adoption of a Smart Card. The Smart Card will serve as a Common Access Card (CAC Card), storing all of the patients’ health information including diagnostic images in the cloud. Additionally, it serves as the key to open, assess, review, and upon completion of a consult, update the patients’ health records in the cloud for future medical visits.

A Cure for the US Healthcare System At the present time, the US government, hospitals, and Insurance companies are looking to improve quality and reduce costs. Healthcare wasted a total of $750 billion in 2009, which has increased to $1 trillion in 2015. Major legislative changes will require an approach that includes: 1. Making sure we’re accurately identifying the patient. 2. Keeping the patients’ identity secure and preventing others from using it to receive care or for other fraudulent purposes. 3. Preventing the waste associated with uncoordinated care among multiple providers. 4. Correcting pricing failures and abuse, including outrageously inflated drug prices. 5. Reducing all types of fraud and abuse. 6. Stopping redundant and unnecessary testing. 7. Decreasing overall the administrative costs, including the extremely high costs of billing. Smart cards (the US Military calls them “Common Access Cards” or “CAC cards”) can go a long way towards solving many of these problems. Their effectiveness in markedly decreasing fraud and abuse, redundant testing, and the high administrative costs of health care, has been proven in France and Taiwan.

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Privacy and data security concerns are paramount in US policy discourse and culture. The United States lacks a single, comprehensive national patient identifier and a unified privacy regime that regulates health data across all providers, payers, and settings with the same clarity and enforceability found in some other nations. HIPAA and related privacy/security rules create a strong baseline for safeguarding health information, but they also contribute to a complex compliance environment where data sharing across disparate systems must be carefully governed. A nationwide smart card that aggregates health data would necessitate robust, scalable identity verification, access controls, and audit trails to prevent misuse, yet establishing, updating, and enforcing these controls across thousands of hospitals, clinics, insurers, and government entities remains technically and politically challenging. The privacy framework in the US—while protective—can slow standardized, centralized data exchanges because it requires intricate consent, authorization, and data-minimization practices that may vary by state, payer, and provider. In this sense, privacy rules can function as both protection and barrier to creating a seamless card-based health information ecosystem (HIPAA Privacy Rule; HHS, 1996).

Interoperability and governance fragmentation complicate nationwide adoption. The US healthcare system is highly decentralized, with numerous payers, provider networks, and health information technology vendors. Achieving universal interoperability requires common data standards, consistent transmission protocols, and governance arrangements that align incentives across a broad constellation of stakeholders. In contrast, countries like France and Taiwan operate more centralized or tightly coordinated health systems with national-scale health information infrastructures that can more readily support smart-card implementations and cloud-based data sharing. Studies of administrative waste in the US highlight how misaligned incentives and fragmented governance contribute to bloated costs and inefficiencies (Woolhandler & Himmelstein, 2014). A nationwide smart card would thus demand not only technical interoperability but a durable, cross-sector governance model to sustain it (ONC Interoperability Roadmap; European Commission reports on eHealth interoperability).

Cost considerations—both upfront and ongoing—pose a significant hurdle. The implementation of a nationwide smart-card platform would entail substantial capital expenditure for card production, reader infrastructure, cloud-hosted health records, secure identity services, and ongoing maintenance. Even with demonstrated administrative savings in some countries, the United States faces a more complex and diverse market environment where achieving scale and supplier competition could be difficult. While some nations have reported cost savings—France with its Carte Vitale and Taiwan with its National Health Insurance Card—translating those savings to the US requires careful accounting of distributed implementation costs, ongoing security investments, and potential disruption to current billing and record-keeping practices (France Carte Vitale; Taiwan NHI Card; Woolhandler & Himmelstein, 2014).

The discipline of personal data security and identity verification adds another layer of complexity. A smart card that holds or points to health data must be protected against loss, theft, cloning, and unauthorized use. U.S. defense and government programs’ experience with strong, card-based identity systems (such as CAC) demonstrates that highly secure, policy-backed identity tokens can reduce fraud and improve access control in controlled environments. However, applying similar mechanisms across the civilian health sector would require extensive risk assessments, encryption standards, and trust frameworks that extend beyond the current scope of most health IT deployments (CAC program; DoD, 2013). Moreover, integrating cloud-based health records for broad clinical access raises questions about data sovereignty, cross-border data flows, and long-term data stewardship, which must be resolved to gain broad public trust (HIPAA; ONC Interoperability Roadmap).

Policy path dependence and stakeholder incentives also influence feasibility. Hospitals, insurers, and IT vendors often have aligned but divergent incentives—cost containment, revenue cycle integrity, patient privacy, and competitive differentiation all play roles. The political economy of national health IT reform in the United States makes consensus around a single, nationwide smart-card solution challenging. The experience of other nations suggests that strong centralized leadership, clear security and privacy guarantees, and patient-centric access controls are essential for success, yet achieving such alignment in the US policy environment has proven difficult. In the absence of broad consensus and a credible plan to manage risk, the US is more likely to pursue incremental improvements in health information exchange and identity management rather than a wholesale smart-card rollout (ONC Roadmap; HIPAA; Woolhandler & Himmelstein, 2014).

In sum, while smart cards hold promise for reducing identification errors, fraud, administrative waste, and redundant testing, the major hurdle to their nationwide adoption in the United States is the combination of privacy/security concerns, fragmented governance, and substantial upfront costs required to deliver a secure, interoperable, nationwide system. France and Taiwan illustrate what is possible with centralized or strongly coordinated systems; the United States would need to build a comparable governance framework, align incentives across a diverse ecosystem, and invest in robust security and identity infrastructures before a broad, nationwide smart-card program could become feasible.

References

• HIPAA Privacy Rule and Security Rules. U.S. Department of Health and Human Services. 1996.
• Office of the National Coordinator for Health Information Technology. (2015). Interoperability Roadmap.
• Woolhandler, S., & Himmelstein, D. U. (2014). Administrative waste in the U.S. health care system. The New England Journal of Medicine.
• Assurance Maladie. Carte Vitale. French Ministry of Solidarity and Health.
• Taiwan National Health Insurance Administration. National Health Insurance Card program.
• DoD. Common Access Card (CAC) Program. Department of Defense.
• European Commission. Interoperability of health information systems in the EU: A policy perspective.
• Mandl, K. D., & Kohane, I. S. (2009). The Case for Standardization of Health Information Exchange. Journal of the American Medical Informatics Association.
• National Institute of Standards and Technology. (2020). Digital Identity Guidelines (NIST SP 800-63).
• World Health Organization. (2011). Health information systems: Framework and governance for health data exchange.