Rights and Responsibilities of a Health Care Consumer

When you check into a hospital or see a doctor for the first time, you may be given a copy of the “Consumer Bill of Rights and Responsibilities.” 

This document was developed in 1998 by the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry. Many health plans, including all plans sponsored by the federal government, have adopted these general principles.

Most likely you glance at the document and put it aside. Taking time to read, understand and act on your rights and responsibilities, however, can help you proactively engage in the health care you receive.

The Consumer Bill of Rights has three goals:

• To strengthen consumer confidence by assuring that the health care system is fair and responsive. It provides consumers with effective ways to address their concerns, and encourages them to take an active role in improving and assuring their health.

• To reaffirm the importance of a strong relationship between patients and their health care providers.

• To reaffirm the critical role that consumers play in safeguarding their own health by establishing both rights and responsibilities for all participants.

Here is a summary of the eight areas of consumer rights and responsibilities.

Information disclosure

"You have the right to receive accurate and easily understood information about your health plan, health care professionals and health care facilities."

This information is included:

• Details from your health insurance plan about what is covered, how much you will pay and how to resolve complaints you may have

• Background on your health care providers, including their education, board certification, years of practice and experience

• Details about the health care facility, including experience in performing certain procedures and services; accreditation status; measures of quality and worker and consumer satisfaction; and procedures for resolving complaints

If you speak another language, have a physical or mental disability or don’t understand something, you can get assistance to help you can make informed decisions.

Choice of providers

“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.”

To ensure choice, your insurance plan should provide access to sufficient numbers and types of providers to assure that all covered services will be accessible without unreasonable delay. This includes access to emergency services 24 hours a day, seven days a week, and specialists for women’s health and serious medical conditions.

If you involuntarily change health plans, and are undergoing treatment for a chronic or disabling condition, or are in the second or third trimester of a pregnancy, you should be able to continue seeing your specialist for up to 90 days, or until postpartum care is completed.

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.”

To ensure the ability to participate in treatment decisions, health care professionals should discuss all treatment options, including the option of no treatment at all. Your health plan, providers and health care facility should tell you about any factors that could influence their advice or treatment decisions. These factors include methods of compensation, ownership of or interest in health care facilities, or matters of conscience.

Respect and nondiscrimination

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

You must not be discriminated against in the marketing, enrollment or delivery of health care services, based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation or source of payment.

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.”

To ensure this right, health care providers give consumers a HIPAA-approved form that spells out privacy considerations.

Complaints and appeals

“You have the right to a fair, fast and objective review of any compliant 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 a health care system that protects consumers' rights, it is reasonable to expect and encourage consumers to assume reasonable responsibilities."

These are example of consumer responsibilities:

• Adopting healthy habits, such as exercising and not smoking.

• Becoming involved in health care decisions. You should disclose relevant information and clearly communicate your wants and needs.

• Working with health care providers in developing and carrying out treatment plans.

• 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.