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Exploring the link between patient-record fees and doctor switching

HCCH-medical_recordsWho owns your medical records – you or your doctor? If you answered that you do, you’re like most patients, according to a recent survey. But you would be wrong.

Legally, the doctors or hospitals who create medical records own them. Although federal law states they have to provide records to patients who request them at a reasonable cost, the definition of “reasonable” varies quite a bit. And that cost also has some surprising repercussions.

Three Stanford researchers – health economist Kate Bundorf, PhD, Laurence Baker, PhD, chief of health services research, and health and political economist Daniel Kessler, PhD, JD – examined the issue in a recent study in the American Journal of Health Economics. They compared rates of doctor-switching between states that have caps on medical-record copying fees and those that don’t.

The team found that patient record charges decreased the number of patients who switched doctors and that when there were caps on copying fees, more providers switched to electronic medical records. A Stanford GSB article described the findings in detail:

In states that imposed caps on fees for medical records, patients changed their primary doctors 11% more frequently and their specialty doctors 13% more frequently. In addition, the researchers found that health care providers were about 12% more likely to establish electronic medical records in states that imposed caps on copying fees.


The fact that more than 1 in 10 people would switch doctors if their records were easier to get means that copying fees matter. In addition, other research suggests that adoption of electronic medical records can significantly reduce mortality in complicated cases; to the extent this is correct, caps on copying fees not only enhance patient convenience but also save lives.

Kessler says the study suggests there is a good case for regulating the fees charged for medical records: “You can’t make it impossible for people to switch doctors. We know that can’t be the right direction.”

Baker agrees, telling me, “No one should have to feel like they're stuck with a doctor when they’d like to switch. Policies that help people get reasonable access to their medical records look like they can help.”

Previously: Can sharing patient records among hospitals eliminate duplicate tests and cut costs?U.S. Olympic team switches to electronic health recordsA new view of patient data: Using electronic medical records to guide treatment and Do electronic health records improve health? It's complicated
Image by Jackhsiao

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