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LAW OF THE LAND Posted: April 15, 2002 By Jon Dougherty
Leading health experts and researchers say the nation's
medical privacy is slowly being sacrificed by Congress and government
bureaucrats to big business interests even though most Americans prefer to
keep their medical records concealed.
Last month the Bush administration called for the public's
input on a "final" medical privacy rule that the Department of
Health and Human Services – which is accepting
comments until April 26 – says will keep medical records safe
"while improving access to care."
The "federal privacy regulations guarantee patients full
access to their medical records, give them more control over how their
personal information is used and disclosed, and provide a clear avenue of
recourse if their medical privacy is compromised," said HHS Director
Tommy Thompson, in announcing the administration's policy March 21.
But according to Robin Kaigh, a New York lawyer who has
tracked medical privacy since the passage of the 1996 Health Insurance
Portability and Accountability Act, changes suggested by the
administration reduce a patient's ability to decide who can view medical
records by removing consent forms for treatment, payment and health care
operations.
That assessment was confirmed by the Institute
for Health Freedom, which adds that the administration's rule changes
would also allow a person's genetic information to be disclosed.
"This rule actually does the reverse of giving privacy
– it allows the federal government to decide who should have access to
every citizen's medical records," Kaigh told WorldNetDaily. "For
example, without the need for patient consent or for subpoena or advance
notice to the doctor the federal government can access medical records. It
was a provision that was written during the Clinton administration but
left intact by Bush."
The reason, she says, is because the administration feels the
HHS Office for Civil Rights "needs to access medical records in order
to make sure that our privacy is being protected by the doctor or
hospital."
"The logic is that they need to invade our privacy to
protect our privacy," she added.
In addition, under both the Bush and Clinton versions of the
rule, medical records can be disclosed without patient consent for
oversight of the health care system, Food and Drug Administration
monitoring, public health surveillance, law enforcement activities,
research under certain conditions and other uses.
According to Thompson, however, the rule changes favored by
the administration would "strengthen notice provisions and remove
consent requirements hindering access to care."
"As written, the privacy rule's general requirement that
patients give prior consent on privacy practices before receiving
treatment created serious unintended consequences that interfere with
patients' access to health care. For example, patients could be required
to visit a pharmacy in person to sign paperwork before a pharmacist could
fill their prescriptions," said HHS, in its March 21 statement.
Thompson added that the proposed changes assure
"appropriate parental access" to a child's medical records and
"would explicitly require pharmacies, health plans and other covered
entities to first obtain the individual's specific authorization before
sending them any marketing materials."
"These are common-sense revisions that eliminate serious
obstacles to patients getting needed care and services quickly while
continuing to protect patients' privacy," Thompson said.
Patients losing control?
But ditching the consent requirement will destroy privacy,
advocates say, because it removes all control patients currently have over
their own medical records.
"For example, right now since there is patient consent
required before medical records are released, a patient can start over
fresh with a new doctor in a malpractice, misdiagnosis or personality
conflict situation with their doctor," Kaigh said.
However, "if the medical records flow freely from doctor
to doctor, that prior bad relationship will follow the patient as
well," she adds.
Also, other experts say, such information – which is highly
sought after by medical information and insurance firms – is subject to
errors, as well as abuse and misuse.
Sue Blevins, president of the Institute for Health Freedom,
said that unless lawmakers and the public oppose the new proposed rule en
masse, the abuse is likely to worsen.
"Citizens who are concerned about their rights to
medical privacy should let HHS know how they feel about this important and
timely issue," she said. "In a few years, patients' personally
identifiable health information is going to be flowing over the Internet.
But patients won't even know this is happening because they won't be able
to obtain an accounting of when and to whom their health information was
disclosed for most of their health care services."
Blevins added that the proposed changes "would allow use
and disclosure of health care information for treatment, payment, and
health care operations without prior written patient consent."
The privacy rule comes from the Health Insurance Portability
and Accountability Act of 1996. When it passed, Congress was supposed to
develop the privacy rules. When it didn't, the job fell to HHS.
Industry battles privacy rules
Industry is lobbying hard against strict federal privacy
rules. In meetings held Aug. 21-23, the National Committee on Vital Health
Statistics Subcommittee on Privacy and Confidentiality met in Washington,
D.C., supposedly to hear suggestions for minor modifications of the rule.
According to Kaigh, who attended some of the meetings, the
panels were stacked heavily in favor of industry, which has been trying
for years to chip away at patient privacy protections.
But instead, the discussion centered around "major
changes that were equal to rewriting the final rule," Kaigh told WND.
"Almost one hundred percent of the invited speakers were
from the health care industry – people who wanted to see changes that
made it easier for industry to get information," she said.
The NCVHS participant's list included Henry R. Desmarais,
M.D., senior vice president for policy and information for the Health
Insurance Association of America; Bernice Welles, M.D., senior director of
product development for Genetech, Inc.; Mary Henderson, of Kaiser
Permanente – the nation's largest not-for-profit HMO; Jacqueline M.
Darrah, M.A., J.D., in the office of general counsel for the American
Medical Association; Roy Bussewitz, R.Ph., J.D., National Association of
Chain Drug Stores; Susan C. Winckler, R.Ph., J.D., policy and advocacy,
American Pharmaceutical Association; Dan Rode, vice president, policy and
government relations, American Health Information Management Association;
Bruce Kelly, director of government relations, the Mayo Foundation, who
also testified on behalf of the Health Care Leadership Council; and
Melinda Hatton, vice president and chief Washington counsel, the American
Hospital Association.
The subcommittee members also were heavily stacked in favor
of industry, Kaigh said. They included Kathleen Fyffe, the federal
regulatory director of the Health Insurance Association of America; Kepa
Zubeldia, M.D., president of Claredi – "the definitive testing and
certification service for HIPAA transaction compliance"; Jeffrey S.
Blair, M.B.A., vice president of the Medical Records Institute; and Simon
T. Cohen, M.D., national director for health information policy for
Kaiser-Permanente medical care program.
The subcommittee initially was only supposed to discuss
"minimum" changes to the rule, but Kaigh said the result was
that major changes were considered, including "taking away the
patient's consent."
She also said she is baffled as to why the privacy rules are
not already written and why HHS has to have yet another commentary period.
"A true medical privacy rule would have only one
sentence," said Kaigh. "'The patient, through the use of a
patient consent form, should decide who can have access to his medical
information unless there is a true emergency situation, in which case only
the minimum necessary information should be released.'"
"A patient goes to a doctor to be healed, not
revealed," she told WND.
Patients oppose giving up consent
After the medical privacy rule was presented, about 50,000
people submitted comments to HHS regarding the privacy rule. An
overwhelmingly large number opposed giving up consent.
That view was substantiated by a separate Gallup survey,
released Sept. 26, 2000, conducted on behalf of the Institute for Health
Freedom, or IHF. According to the survey,
an overwhelming majority oppose giving information to federal, state and
local agencies.
"Opinion is no different when it comes to medical doctors other than ones given permission by the respondent. Seventy-one percent said they oppose giving doctors access to their medical records without permission," the survey said, adding that fully nine of ten (92 percent) "oppose giving government agencies access."
"It is important to note that the Clinton administration
initially proposed prohibiting doctors and hospitals from getting
patients' consent before releasing their medical information. But after
receiving more than 52,000 public comments, the Clinton administration
revised the rule and added a very weak, coercive consent provision,"
confirmed an analysis by the IHF.
"The Bush administration is legally permitting health
insurers, doctors and medical data-processing companies to release
patients' personal health information without asking patients for their
permission," the group said, in its analysis. "This is a major
shift away from the precious health care ethics that we have honored for
many years in this country: the ethics of consent and
confidentiality."
"The vast majority of Americans want and expect their
medical records to be kept strictly confidential," said Rep. Ron
Paul, R-Texas. "Recent polls show that Americans overwhelmingly
oppose giving government the power to create a national health database or
issue health ID numbers.
"The latest revision of the so-called medical privacy
rule makes the original Clinton administration regulation even worse, by
giving HMOs, insurance companies, medical researchers, and other
state-favored interests an enhanced right to view medical records without
patient consent," Paul said. "Rather than protecting the medical
privacy of the American people, HHS is stripping patients of the last
remnants of control over their health care."
Liberal, conservative coalition
A coalition of liberal and conservative lawmakers is forming
to not only oppose the current privacy rule but to potentially eliminate
it.
Rep. Bob Barr, R-Ga., is crafting a bill that would require a
medical privacy impact statement as part of all new federal regulations.
And Sen. Edward Kennedy, D-Mass., is planning to introduce a measure to
reverse the administration's confidentiality rules. Ironically, it was
Kennedy – along with former Sen. Nancy Kassebaum, R-Kan., who sponsored
the original HIPAA bill nearly six years ago. At that time, it was
commonly referred to as the "Kennedy-Kassebaum bill."
James C. Pyles, an attorney specializing in privacy issues,
says eliminating patient consent "has the potential to do the
greatest damage to privacy in my lifetime."
That damage "is done by having the federal government
provide regulatory permission on your behalf to permit the use and
disclosure of your information," he said at an April 2 briefing
sponsored by the IHF.
Pyles suggested that the "unprecedented notion of
regulatory permission" on patients' ability to consent may also be an
infringement on the right to consent to treatment.
Though it was the most substantial health care legislation in
the past two decades, "HIPAA has done little to improve consumers'
access to individual market coverage, and its regulatory provisions have
increased the overall cost of coverage," says a July 2001 CATO
Institute report, "Making a Federal Case out of Health Care: Five
Years of HIPAA."
The law's "medical privacy regulations obscure private
markets for health information under the cloud of complex, costly, and
contradictory commands," while its "regulatory structure creates
legal uncertainty and increases the risk of contradictory and duplicative
regulatory treatment for defined-contribution health plans," a
summary of the report said.
HIPAA "substantially expanded the role of the federal
government in controlling private health care arrangements," said
CATO.
No government protection?
Meanwhile, even former officials say the government is doing
too little to protect patient privacy.
"'Privacy' may seem an overused word these days, but the
demand for honoring secrets between a patient and doctor is one that
transcends discipline, time and place," Bernadine Healy, former
director of the National Institutes of Health, wrote in a July 24, 1998
New York Times op-ed.
"There is perhaps no greater invasion of privacy than
what occurs when people, because of mortal need, allow doctors to intrude
into every facet of their lives, ask sensitive and deeply probing
questions about their emotional and physical health and that of their
families and examine their naked bodies from head to toe," Healy
wrote. "Personal medical records should be for private, not public,
use. Perhaps we should focus on rooting out the medical record abuses that
allegedly exist in the private sector rather than mandate that our …
histories become shared government property."
"It is time for Congress to reverse this dangerous trend
toward complete government intrusion into private medical records,"
Paul said.
"HHS is clearly siding with the special interests,"
added Blevins, of the IHF.
The administration's decision to eliminate the consent rule
could even become a campaign issue this fall.
"We know (medical privacy) is an issue the American
people think is absolutely critical and the Democratic Party has
championed this issue for years," one DNC spokeswoman told the Bureau
of National Affairs this month in Washington, D.C. "This is yet
another example of the Bush administration catering to special interests
at the expense of the American people."
According to the Center
for Responsive Politics, health care industry donors who oppose
privacy rules favor donations to Republicans. The DNC, on its website,
claimed the insurance industry donated more than $1.6 million to Bush's
campaign in 2000.
The Health Insurance Portability and Accountability Act of 1996 is the most significant federal health care legislation in more than 20 years. Although marketed as a modest attempt to address health insurance portability and job lock for insured workers, HIPAA in fact substantially expanded the role of the federal government in controlling private health care arrangements. Prior to HIPAA, the federal government had largely avoided direct regulation of private health insurance and had deferred to the states. Essentially, HIPAA made it somewhat easier for currently insured workers to retain their access to group health insurance coverage when they changed jobs, provided they were employed by other firms that also offered group health coverage. How HIPAA Has Failed HIPAA has done little to improve consumers' access to individual market coverage, and its regulatory provisions have increased the overall cost of coverage. HIPAA threatens physicians with potential prosecution for loosely drawn "federal health care offenses." HIPAA's medical privacy regulations obscure private markets for health information under the cloud of complex, costly, and contradictory commands. HIPAA's highly restrictive pilot project for medical savings accounts (MSAs) may well have set back the overall private MSA market. HIPAA's regulatory structure creates legal uncertainty and increases the risk of contradictory and duplicative regulatory treatment for defined-contribution health plans. About This Conference Our keynote speaker will be Rep. Dick Armey, House Majority Leader, who will compare the promises and performance of HIPAA, after five years of evidence. Panel One will review the effects of HIPAA's portability reforms on the availability and affordability of health insurance in small group and individual markets. Panel Two will examine the development of HIPAA's medical privacy regulations, their likely effects on the market for health care information, and policy alternatives. Our luncheon speaker will be Richard Epstein, interim dean of the University of Chicago Law School and author of Mortal Peril: Our Inalienable Right to Health Care. Panel Three will assess the growing "criminalization" of medical practice in the name of fraud and abuse control and will analyze HIPAA's effects on the quality of health care. The final panel will explore how HIPAA has reshaped health insurance regulation, outline the barriers it has created to health care innovation, and offer alternatives to greater federal control. Introduction
This report is based on the results of a survey
conducted by The
Gallup Organization on behalf of the Institute for Health Freedom. The
opinions of a national cross-section of adults in telephone owning
households, 18 years of age or older, concerning access and the
confidentiality of their medical records were obtained. A national cross-section of telephone households was systematically selected using random digit dialing techniques to ensure the inclusion of households with both listed and unlisted telephone numbers. Everyone was interviewed between August 11, 2000 to August 26, 2000. A total of 1,000 interviews were completed. Results based on the entire sample are accurate with a plus or minus 3-percentage point margin of error at the 95% confidence level. The sampling tolerances will be found in the technical appendix of this report. Overview
of Survey Findings
For most adults the confidentiality of their medical records is very important, and only the confidentiality of financial information is judged very important by a greater proportion. Over eight in ten adults (84%) report it is very important that their financial information be kept confidential. Almost as many (78%) feel it is very important that their medical records be kept confidential. While important to many adults, less than half (39%) feel it is very important that their employment history be kept confidential, and fewer (30%) feel it is very important that their educational history be kept confidential. Women are more likely than men to feel it is very important their medical records should be kept confidential (81% and 74%, respectively). In addition, older adults, particularly those 35 to 49, are more likely than adults 18 to 34 years of age to say it is very important that their medical records be kept confidential. Given the importance attached to keeping their medical records confidential, it is not surprising that many adults oppose access by any group. Asked if they favored or opposed allowing various groups to see their medical records without permission there is no group that a majority of adults would favor allowing access to their medical records without their authorization. The most "acceptable" group would be pharmacists, four in ten adults (40%) would favor allowing pharmacists to see their medical records without permission while 59% would be opposed. There is strong opposition to non-medical groups gaining access to their medical records. Nine out of ten (92%) oppose giving government agencies access. About as many (88%) oppose the police or lawyers, or employers (84%) being allowed to see their medical records. Similarly, 82% oppose letting insurance companies see their medical records without permission. Over nine in ten (95%) oppose allowing banks to see their medical records without permission. Local and state health departments are acceptable to a larger proportion compared to government agencies overall, nevertheless, 71% oppose giving these agencies access to medical information without permission. Opinion is no different when it comes to medical doctors other than those given permission by the respondent. Seven in ten (71%) oppose giving doctors access to their medical records without permission. Medical researchers would be denied access too – two-thirds (67%) oppose allowing researchers permission to see their medical records without permission. While controlling access to their medical records is important to many, relatively few adults (16%) have heard or read anything recently about new federal regulations that would change the rules regarding access to medical records. Adults, age 50 or older (20%) and college-educated adults (19%) are more likely than others to say they have heard about the issue. Asked their opinion of keeping their medical records in a national computerized database, most adults (88%) are opposed. Only 10% would favor keeping records in a national database. Adults, ages 35 to 49 are more likely than younger or older adults to oppose a national database for medical records. Similarly, college educated adults are more likely than those with fewer years of formal education to oppose a national database (93% and 83%, respectively). Few adults (12%) have seen or heard anything recently about a proposal to assign medical identification numbers. Even fewer (8%) adults support a plan that requires every American to be assigned a medical identification number. Adults 35 years of age or older are more likely than younger adults to be aware of the medical identification proposals. Over nine in ten adults (95%) say doctors and hospitals should have to obtain their permission before releasing medical records to a national database. In addition, only 4% believe personal information told a doctor in confidence and entered into their medical records should be included in the national database. Most adults (86%) feel a physician should ask permission first before running additional tests, during the course of regular testing, for genetic factors that may be related to possible health problems. Approximately one in seven (14%) feel the physician should be allowed to run the additional tests without asking permission. Over nine in ten adults (93%) feel medical and government researchers should obtain permission before studying a person’s genetic information. Less than one in ten (6%) feel it isn’t necessary to obtain the person’s permission. Detailed
Findings Importance of Confidentiality of
Information Question 1 How important is it to you that information in the following areas be kept confidential; that is, no one can see it without your permission - very important, somewhat important, not too important, or not at all important?
·
Financial information
·
Employment history
·
Medical records
·
Educational history Over eight in ten adults (84%) report it is very important that their financial information be kept confidential. Almost as many (78%) feel it is very important that their medical records be kept confidential. While important to most adults, less than half (39%) feel it is very important that their employment history be kept confidential, and fewer (30%) feel it is very important that their educational history be kept confidential.
IMPORTANCE
OF CONFIDENTIALITY (n=1000)
Awareness of Federal Regulations Regarding
Access to Medical Records Question 2 Have you heard, read or seen anything recently about new federal regulations that would change the rules regarding who is allowed to see your medical records? Relatively few adults (16%) have heard or read anything recently about new federal regulations that would change the rules regarding access to medical records. Adults, age 50 or older (20%) and college-educated adults (19%) are more likely than others to say they have heard about the issue.
AWARE OF
NEW FEDERAL REGULATIONS REGARDING MEDICAL RECORDS (n=1000) Favor or Oppose Access to Medical Records
by Selected Groups Question 3 Who do you think should be allowed to see your medical records without your permission? I am going to read you a list of some groups; for each, please tell me whether you favor or oppose allowing them to see YOUR medical records without FIRST obtaining YOUR permission. How about . . .?
·
Medical doctors OTHER than the ones you have given
permission
·
Pharmacists
·
Medical researchers
·
The police or lawyers
·
Local and state health departments
·
Banks
·
Insurance companies
·
Employers
·
Government agencies Asked if they favored or opposed allowing various groups to see their medical records without permission there is no group that a majority of adults would favor allowing access to their medical records without their authorization. The most "acceptable" group would be pharmacists. Four in ten adults would favor allowing pharmacists to see their medical records without permission while 59% would be opposed. In contrast, the least "acceptable" group would be banks, only 5% would favor allowing banks to see their medical records without permission. There is strong opposition to other non-medical groups seeing their medical records. Nine out of ten (92%) oppose giving government agencies access. About as many (88%) oppose the police or lawyers, or employers (84%) being allowed to see their medical records. Similarly, 82% oppose letting insurance companies see their medical records without permission. Local and state health departments are acceptable to a larger proportion compared to government agencies overall, however, 71% oppose giving these agencies access to medical information without permission, too. Opinion is no different when it comes to medical doctors other than ones given permission by the respondent. Seven in ten (71%) oppose giving doctors access to their medical records without permission. Medical researchers fare no better than doctors -- two-thirds (67%) oppose allowing researchers permission to see their medical records without permission.
PROPORTION
OPPOSED TO ALLOWING GROUP TO SEE MEDICAL RECORDS (n=1000) Attitude Toward National Database Question 4 There has been a lot of discussion lately about REQUIRING that all patient medical records be stored in a national computerized database. The database would store medical records on patients over their lifetime. Others would be able to use the information without first obtaining a patients' permission. Would you favor or oppose keeping your medical records this way? Most adults (88%) are opposed to keeping their medical records in a national computerized database. Only 10% would favor the plan described to them.
FAVOR/OPPOSE
STORING MEDICAL RECORDS IN COMPUTERIZED DATABASE (n=1000)
Awareness and Support for Medical
Identification Numbers Question 5 Have you heard, read or seen anything recently about a federal proposal to assign medical identification numbers, similar to a social security number, to you and all other Americans to create a national database of medical records? Question 6 Would you support a plan that REQUIRES every American, including you, to be assigned a medical identification number, similar to a social security number, to track your medical records and place them in a national computer database without your permission? One in eight adults (12%) have seen or heard something recently about a proposal to assign medical identification numbers. Somewhat fewer (8%) adults support a plan that requires every American to be assigned a medical identification number.
AWARE OF
FEDERAL PROPOSAL REGARDING MEDICAL ID NUMBERS (n=1000)
SUPPORT
PLAN THAT REQUIRES ASSIGNED MEDICAL ID NUMBER (n=1000)
Should Permission Be Obtained Before
Releasing Information to National Database? Question 7 Do you think doctors and hospitals should have to obtain your PERMISSION before they could release your medical records to a national computerized database? Question 8 If you tell a doctor personal things about yourself in confidence, and the doctor records that information in your medical records, should the doctor be required to include that information in a national database without your permission? Over nine in ten adults (95%) say doctors and hospitals should have to obtain their permission before releasing medical records to a national database. In addition, only 4% believe personal information told a doctor in confidence and entered into their medical records should be included in the national database.
PERMISSION
SHOULD BE OBTAINED BEFORE RELEASING MEDICAL RECORDS (n=1000)
SHOULD
PERSONAL INFORMATION TOLD TO MEDICAL DOCTOR IN CONFIDENCE BE INCLUDED IN
NATIONAL DATABASE? (n=1000) Should Physicians be Allowed to Test for
Genetic Factors Without Permission? Question 9 If you go to a DOCTOR to have your blood tested for sugar or for high cholesterol, should your doctor also be allowed to test your blood for genetic factors that, for example, could reveal whether you are prone to cancer later in life, without first obtaining your permission, or do you feel your doctor should first obtain your permission? Most adults (86%) feel a physician should ask permission first before running additional tests, during the course of regular testing, for genetic factors that may be related to possible health problems. Approximately one in seven (14%) feel the physician should be allowed to run the additional tests without asking permission.
SHOULD
DOCTOR TEST FOR GENETIC FACTORS WITHOUT PERMISSION? (n=1000)
Should Researchers be Allowed to Study
Genetic Information Without Permission? Question 10 Should medical and government RESEARCHERS be allowed to STUDY your genetic information (for example, to identify genes thought to be associated with various medical conditions) without first obtaining your permission, or do you feel they should first obtain your permission? Over nine in ten adults (93%) feel medical and government researchers should obtain permission before studying a person’s genetic information. Less than one in ten (6%) feel it isn’t necessary to obtain the person’s permission.
SHOULD
RESEARCHERS BE ALLOWED TO STUDY GENETIC INFORMATION WITHOUT PERMISSION?
(n=1000)
In interpreting
survey results, it should be borne in mind that all sample surveys are
subject to sampling error, that is, the extent to which the results may
differ from what would be obtained if the whole population had been
interviewed. The size of such sampling errors depends largely on the
number of interviews. The following tables
may be used in estimating the sampling error of any percentage in this
report. The computed allowances have taken into account the effect of the
sample design upon sampling error. They may be interpreted as indicating
the range (plus or minus the figure shown) within which the results of
repeated samplings in the same time period could be expected to vary, 95
percent of the time, assuming the same sampling procedures, the same
interviewers, and the same questionnaire. The first table shows
how much allowance should be made for the sampling error of a percentage:
Recommended Allowance for Sampling Error
of a Percentage
In Percentage Points
(at 95 in 100 confidence level)*
Sample Size
1000 800
600 400
300 200
PERCENTAGES
NEAR 10
2
2
3 3
4
5
PERCENTAGES
NEAR 20
3
3
4 4
5
6
PERCENTAGES
NEAR 30
3
3
4 5
6
7
PERCENTAGES
NEAR 40
3
4
4 5
6
7
PERCENTAGES
NEAR 50
3
4
4 5
6
8
PERCENTAGES
NEAR 60
3
4
4 5
6
7
PERCENTAGES
NEAR 70
3
3
4 5
6
7
PERCENTAGES
NEAR 80
3
3
4 4
5
6
PERCENTAGES
NEAR 90
2
2
3 3
4
5
*
THE CHANCES ARE 95 IN 100 THAT THE SAMPLING ERROR IS NOT LARGER THAN THE
FIGURE SHOWN.
The table would be
used in the following manner: Let us say a reported percentage is 33 for a
group which includes 1000 respondents. Then we go to row "percentages
near 30" in the table and go across to the column headed
"1000". The number at this point is 3, which means that the 33
percent obtained in the sample is subject to a sampling error of plus or
minus 3 points. Another way of saying it is that very probably (95 chances
of 100) the true figure would be somewhere between 30 and 36, with the
most likely figure the 33 obtained. In comparing survey
results in two samples, such as, for example, men and women, the question
arises as to how large a difference between them must be before one can be
reasonably sure that it reflects a real difference. In the tables below,
the number of points which must be allowed for in such comparisons is
indicated. Two tables are
provided. One is for percentages near 20 or 80; the other for percentages
near 50. For percentages in between, the error to be allowed for is
between those shown in the two tables.
Recommended Allowance for Sampling
Error of the Difference
In Percentage Points
(at 95 in 100 confidence level)*
TABLE A Percentages
near 20 or percentages near 80
1000 800
600 400
300 200
1000
4
800
4
4
600
4
5
5
400
5
5
6
6
300
6
6
6
7
7
200
7
7
7
7
8
9
TABLE B Percentages
near 50
1000
800 600
400 300
200
1000
5
800
5
5
600
6
6
6
400
6
7
7
8
300
7
7
8
8 9
200 8 9 9 9 10 11 |
