Consumer rights and responsibilities
Health care consumer's rights; Rights of the health care consumer
In March 1998, the Advisory Commission on Consumer Protection and Quality in the Health Care Industry issued its final report, which included the Consumer Bill of Rights and Responsibilities. The Commission was appointed by President Bill Clinton, and co-chaired by Donna Shalala, Secretary of the Department of Health and Human Services.
The purpose of the Bill of Rights is:
- To build up consumer confidence in the health care system, by making it easy for consumers to be involved in their own health care.
- To strongly support the importance of a good health care provider and that of a good provider-patient relationship.
- To emphasize and support the importance of the consumers' role in making sure they have rights and responsibilities with regard to health improvement.
The Consumer Bill of Rights was developed by the federal government. This has been used by many health plans, including the federal-government-sponsored health plans.
Consumer Bill of Rights
I. Information Disclosure
You have the right to receive accurate information you can understand about your health, treatments, health plan, providers, and health care facilities. If you speak another language, have a physical or mental disability, or just do not understand something, you will be helped so you can make informed health care decisions.
II. Choice of Providers and Plans
You have the right to choose your provider, within your health plan.
III. Access to Emergency Services
If you have severe pain, an injury, or sudden illness and you are concerned that you could be seriously ill, hurt, or could die, you have the right to get emergency services whenever and wherever needed, to be seen by a doctor and get services, even if you do not ask your health plan first, and you will not be charged a penalty.
IV. Participation in Treatment Decisions
You have the right to know all your treatment options, even if they are not covered by your health plan, and make decisions about your care. Parents, guardians, family members, or others that you choose can represent you if you cannot make your own decisions.
V. Respect and Nondiscrimination
You have the right to considerate, respectful care, and to not be discriminated against by your doctors, other health care providers, or health plan representatives.
VI. Confidentiality of Health Information
You have the right to talk in private with providers and to have your health care information protected. You also have the right to review and copy your own medical record and ask your doctor to make corrections to your record if it is not accurate or complete, or if it has information that does not relate to your health care.
VII. Complaints and Appeals
You have the right to a fair, fast, and objective review of any complaint you have against your health plan, doctors, hospitals, or other health care personnel. This includes complaints about wait times, hours available, health care facilities, and the conduct of health care personnel.
In addition to listing consumer rights for health care, the Advisory Commission on Consumer Protection and Quality in the Health Care Industry also listed the responsibilities of consumers. These are ways the consumer can work together with health care providers to get the best quality health outcome.
- Do your best to get well and stay healthy with habits such as exercising, not smoking, and eating a nutritious diet.
- Give your providers the information they need, and clearly communicate what you want and need.
- Be involved in making health care decisions with your health care providers.
- Work with providers to develop and carry out the treatment plans you choose.
- Use the health plan's internal complaint and appeal process to address concerns that may arise.
- Avoid knowingly spreading disease.
- Recognize the risks and limits of medical science, and know that providers are human and can make mistakes.
- Be aware of a provider's need to fairly provide care to other people and the community.
- Learn about your health plan's coverage and options (when available), including covered benefits, limits, services that are not covered, rules regarding information use, and how to appeal coverage decisions.
- Show respect for other people and health workers.
- Make a good-faith effort to pay your health care bills.
- Follow procedures outlined by your health plans and providers.
- Report wrongdoing and fraud to the right resources or legal authorities.
For more information, visit the Office for Civil Rights - HIPAA website -- www.hhs.gov/ocr/hipaa.
Centers for Medicare and Medicaid Services. The Center for Consumer Information and Insurance Oversight. Patient's Bill of Rights. Available at: www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/Patients-Bill-of-Rights.html. Accessed October 13, 2015.
Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.