Fair Health: One step forward, One step back

Fair Health was formed as the result of a settlement between a group of insurance companies and the District Attorney’s office of NY. The site provides a front end to its considerable pricing data, but the data is coded in CPT codes. Fair Health has taken the approach of licensing CPT descriptions from the AMA, as well as making agreements to get access to even more claims data than it was originally entitled to under the settlement. Specifically, from the Fair Health FAQ:

FAIR Health welcomes organizations to link to our website and download materials for consumer use. FAIR Health incurs fees from third parties such as the American Medical Association for use of healthcare codes in its Lookup tools, however, so links to www.fairhealthconsumer.org for commercial purposes require a license agreement and payment of nominal fees.  Such commercial purposes include, but are not limited to, links established by providers or third party payors in connection with participation on state or federal health benefit exchanges.  Please contact us at info@fairhealth.org for further information.

FAIR Health also licenses our consumer resources, including educational material, videos and cost lookup tools for use on organization websites and for other uses. To learn more about licensing opportunities and the associated costs, contact info@fairhealth.org.

(emphasis mine)

These agreements culminate in a service agreement that actually attempts to ensure that third parties that link to the site pay a fee. I would be hard pressed to find any other site on the Internet that makes such a stance in its Terms/Conditions/AUP, and I am a little surprised that Fair Health believes this is reasonable… Here it is in short:

Hyperlink Use and Disclaimer. If you or your company has accessed the FAIR Health Consumer Site through the use of a hyperlink, you agree and acknowledge that you will follow the rules set forth below:

a. All links shall link only to the FAIR Health Consumer site home page currently located at www.fairhealthconsumer.org (“Consumer Site”).

b. You shall not attempt to modify, alter or frame any content on the Consumer Site. We reserve the right to review your website at any time to ensure that the link is being used appropriately.

c. FAIR Health is a New York not-for-profit corporation qualifying under section 501(c) (3) of the Internal Revenue Code. Your use of a hyperlink shall not be construed to imply sponsorship or endorsement by FAIR Health of you, your website or your products.

d. We do not necessarily review or approve of the content displayed on all websites that have linked to the Consumer Site.

e. Your website shall not include any description of FAIR Health or its products without the prior written consent of FAIR Health.

f. You agree that all FAIR Health proprietary trademarks, service marks and logos (collectively, “Marks”), belong exclusively to FAIR Health and when you use these Marks on your website, you must comply with FAIR Health’s standards. Any such use must be approved in writing by FAIR Health.

g. If we object to the link between your website and the Consumer Site for any reason in our sole discretion, you agree to remove it within twenty-four (24) hours of receiving notice from us.

h. Your use of a hyperlink linking your website with the Consumer Site is at your own risk.

(emphasis mine)

You can read the whole Terms and Conditions here. It is not lost on us that Fair Health believes that providing a direct link to the Terms and Conditions, is in fact a contradiction of the Terms and Conditions in (a). Of course, given that we are writing this article without permission, we are also violating (e). We will obviously not be subjecting this article to approval from Fair Health, which means we are also contradicting (b) and (g). In the effort for full disclosure, we also submitted the FAQ and terms to the Internet Archive, so that we can tell if it has been changed. This would also contradict the terms, which would categorize this action as equivalent to uploading a virus to their servers. Given that we obviously cannot accept the Terms and Conditions, we will obviously not be using the website. However, I am not sure how Fair Health believes that given our outright rejection of these terms, they can control what we do or do not link to. Or how they expect to give Google and Yahoo access to their facts about their changing content, but to deny us the same privileges.  Most importantly, in Fair Health’s mind, our ability to read the terms, means that we have agreed to the terms.  Fascinating, no?

Their commitment to “reading but no parsing” goes so deep that Fair Health has disabled right mouse clicks using javascript. This prevents both copy and paste, but also “open in a new tab” etc etc. Normally when I see draconian steps like this, I also see a complete lack of attention to accessibility issues. To their credit, this is not the case with Fair Health. With the exception of some missing labels, their initial form was actually fairly accessible. While I am concerned that some users with disabilities might rely on right click menu items to enable their plugins, most of the standard screen reader technology should work just fine on the site.

This puts Fair Health into the interesting position of providing some transparency, without taking an open data approach. This is problematic because the “interests of the public” are only halfway met. Fair Health indeed enables patients to lookup cost data, but it does not allow for data journalists and data scientists to examine the trends and patterns in the same data. This halfway measure would not be such a problem were it not for the implicit endorsements that Fair Health seems to be getting from both industry and government, that this approach equates to transparency for the health insurance industry. It clearly does not.

Fair Health is obviously providing an important service for consumers, but I fear that in the long term this half measure may come at the expense of true transparency. It is easy enough to endorse them for working hard to move in the right direction. However much we dither about open data tactics: They deserve credit for the progress they have made! Obviously, the DocGraph project will never pay for access to data that comes with a caveat that it cannot be shared openly, and we certainly do not accept the terms of the Fair Health AUP. But in the spirit of not being needlessly confrontational, we can at least link you to Google Search results for Fair Health, rather than linking to them directly.

Great reference article about the settlement.

Comments on the aftermath of Fair Health

UPDATE April 29, 2015: Recently, Fair Health further restricted the number of searches that are available.