Consumer rights and

responsibilities

Alternative Names

Health care consumer's rights; Rights of the health care consumer

Information

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 participate actively in their own health care.
• To strongly support the importance of a good healthcare 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 following section, Consumer Bill of Rights, was developed by the federal government. This has been used as a foundation for many health plans, including the federal-government-sponsored health plans.

Consumer Bill of Rights

I. Information Disclosure

You have the right to receive accurate and easily understood information about your health plan, health care professionals, and health care facilities. If you speak another language, have a physical or mental disability, or just don't understand something, assistance will be provided so you can make informed health care decisions.

II. Choice of Providers and Plans

You have the right to a choice of health care providers that is sufficient to provide you with access to appropriate high-quality health care.

III. Access to Emergency Services

If you have severe pain, an injury, or sudden illness that convinces you that your health is in serious jeopardy, you have the right to receive screening and stabilization emergency services whenever and wherever needed, without prior authorization or financial penalty.

IV. Participation in Treatment Decisions

You have the right to know all your treatment options and to participate in decisions about your care. Parents, guardians, family members, or other individuals that you designate can represent you if you cannot make your own decisions.

V. Respect and Nondiscrimination

You have the right to considerate, respectful and nondiscriminatory care from your doctors, health plan representatives, and other health care providers.

VI. Confidentiality of Health Information

You have the right to talk in confidence with health care providers and to have your health care information protected. You also have the right to review and copy your own medical record and request that your physician amend your record if it is not accurate, relevant, or complete.

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 waiting times, operating hours, the conduct of health care personnel, and the adequacy of health care facilities.

Consumer Responsibilities

In addition to outlining consumer rights for health care, the Advisory Commission on Consumer Protection and Quality in the Health Care Industry also outlined guidelines for the responsibilities that the consumer has with regard to their own healthcare. The responsibilities outlined are ways that the consumer can work together with the health care provider to achieve the best quality health outcome.

• Take responsibility for maximizing healthy habits, such as exercising, not smoking, and eating a healthy diet.
• Become involved in specific health care decisions.
• Work collaboratively with health care providers in developing and carrying out agreed-upon treatment plans.
• Disclose relevant information and clearly communicate wants and needs.
• Use the health plan's internal complaint and appeal process to address concerns that may arise.
• Avoid knowingly spreading disease.
• Recognize the reality of risks and limits of the science of medical care and the human fallibility of the health care professional.
• Be aware of a health care provider's obligation to be reasonably efficient and equitable in providing care to other patients and the community.
• Become knowledgeable about his or her health plan coverage and health plan options (when available) including all covered benefits, limitations and exclusions, rules regarding use of information, and the process to appeal coverage decisions.
• Show respect for other patients and health workers.
• Make a good-faith effort to meet financial obligations.
• Abide by administrative and operational procedures of the health plans and health care providers.
• Report wrongdoing and fraud to appropriate resources or legal authorities.

For more information visit the Office for Civil Rights - HIPAA website - www.hhs.gov/ocr/hipaa

References

President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry. Patients’ Rights and Responsibilities. Accessed August 1, 2009

Bernstein E, Bernstein J, James T. Multiculturalism and care delivery. In: Marx J, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 6th ed. St Philadelphia, Pa: Mosby Elsevier; 2006:chap 203.

• Hormone Therapy

  Hormone therapy (HT) is a medical treatment with a medication containing one or more female hormones, commonly estrogen plus progestin (synthetic progesterone), and sometimes testosterone. Some women, usually those who have had their uterus removed, receive estrogen-only therapy.
  HT is most often used to treat symptoms of menopause, such as hot flashes, vaginal dryness, mood swings, sleep disorders, and decreased sexual desire. Hormone therapy comes as a pill, patch, injection, or vaginal cream.

• CT Scan

  CT scans and other Many breast cancers are sensitive to the hormone estrogen. This means that estrogen causes the breast cancer tumor to grow. Such cancer is called estrogen receptor positive cancer or ER positive cancer.
  Breast cancer stages range from 0 to IV. Breast cancer that has not spread is called ductal carcinoma in situ (DCIS), or noninvasive breast cancer. If it spreads, the cancer is called invasive breast cancer. The higher the number, the more advanced the cancer.

• Breast Pain

  There are many possible causes for breast pain. For example, hormone level changes related to menstruation or pregnancy are often responsible for breast tenderness. Some degree of swelling and tenderness just before your period is normal.
  Boys and men have breast tissue. If a male has breast tissue that can be seen, the condition is called gynecomastia. Adolescent boys can have some breast swelling and tenderness as a part of normal development. This is due to hormone changes, and is similiar to breast tenderness in women.

• Abnormal Nipple Discharge

  Abnormal nipple discharge is abnormal fluid leakage from one or both nipples of the breast.
  While a milky nipple discharge is rare in men and in women who have never been pregnant, it does occur. When it does, it is likely to be caused by some underlying disease, particularly when accompanied by other changes in the breast.

• Breast Cancer

  
  Many breast cancers are sensitive to the hormone estrogen. This means that estrogen causes the breast cancer tumor to grow. Such cancer is called estrogen receptor positive cancer or ER positive cancer.

• Breast Feeding

  Breastfeeding is giving human breast milk to infants to meet their nutritional needs.
  Breast milk is the best source of nutrition for the first 6 months of life. It contains appropriate amounts of carbohydrate, protein, and fat, and provides the digestive proteins (enzymes), minerals, vitamins, and hormones that infants need. Breast milk also contains antibodies from the mother that can help the baby resist infections.