Political Attitudes on the Dutch Electronic Patient Record

Political Attitudes on the Dutch Electronic Patient Record

Evert Mouw
DOI: 10.4018/ijphim.2014010103
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In the Netherlands, the introduction of a nationwide electronic patient record (EPR) infrastructure was rejected in 2011 after a heated political debate. Such debate is influenced by the political attitudes of politicians and voters, such as their trust in governments. The objective is to explore the relation between political attitudes of individuals and the priority they give to health privacy. The method is from a new survey that was developed; the Health Privacy and Political Attitudes Survey. The survey is as compatible as possible with a few well-known surveys. With 218 respondents enough data was collected for a first explorative study. Little correlations were found between political attitudes and the individual's priorisation of health privacy or their trust in a nationwide EPR. In general, most respondents valued their health privacy highly and trust in a nationwide EPR was low, irrespective of their political affiliation or their political attitudes. One exception were respondents with authoritarian attitudes. Such individuals had, on average, more trust in (government regulated) electronic records. More trust in the law correlates with less fear for problems with the EPR. Interestingly, higher educated and older respondents have, on average, the same level of trust in the EPR as others but are more apt to act when they distrust the system (opt-out). In general, political attitudes and one's trust in electronic patient records (EPRs) are not strongly related, but individuals who score high on authoritarian attitudes and trust in the law are more likely to also trust EPRs. Still, nearly everybody places a high value on health privacy, so EPR providers should be careful in this regard.
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1. Introduction

In April 2011, the plan to introduce legislation for a nationwide Electronic Patient Record (EPR) communications system in the Netherlands failed. It was a close call – the letters informing civilians about the new EPR were already sent. The Lower Chamber of Dutch Parliament had passed the legislation. The Senate (Upper Chamber) usually agrees with the Lower Chamber, although sometimes minor adjustments are required. But this time, the minister of health, Schippers (VVD1, a conservative-liberal party), saw her law proposal unanimously rejected, mainly over concerns over data security and privacy2. One of the leading Senate senators vocally rejecting the proposal was Dupuis, also member of the VVD. This disagreement within one political party already hints at the unconventional political cleavages separating people on this issue.

The unanimous rejection of the EPR law does not reflect the finding of most opinion reseach surveys that hint to a strong public support for digitalised health records – see table 1. As much of the political debate was over privacy concerns, a better understanding of health pricacy might help to understand why the Dutch Senate rejected the proposal.

Table 1.
Public popularity of health databases by country
CountryYearPerc.Support in favour ofSource
Canada200378%genetic research database Pollara and Earnscliffe, 2003
Sweden200580%shared, national HER Rynning, 2007
USA200572%health information network Public Opinion Strategies, 2005
USA200879%electronic PHR Westin, 2008
Australia200882%individual HERUMR Research, 2008
Netherlands200963%electronic EPR de Hond, 2009
Netherlands200985%electronic EPR TNS NIPO, 2009

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