In a large managed care firm, more than one hundred people may have access to an individual's medical record. In the early 1980s, when most people were still enrolled in fee-for-service, one study found that up to 100 people had access to an individual's inpatient medical record (Siegler 1982). As payment and delivery systems have grown more complex, the number of personnel with access to the medical file is expected to be much higher. In addition, as managed behavioral health care firms merge and consolidate, they become responsible for maintaining records on more and more clients. Magellan Behavioral Health manages care for more than 62 million people, and Value Options manages care for more than 20 million people. Although these firms have implemented measures to ensure the security of their information systems, some experts have questioned whether any system that has so much sensitive data on so many people can adequately protect it (Pomerantz, 1999).
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