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Statement of Principles:
Health Care Consumers Need Quality Standards
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Consumers want and need choices in health care. Standards should define
how those choices are presented and guarantee an unbiased, factual basis
of comparison. Standards are also needed to ascertain how quality will
be monitored and complaints handled.
Choice and Consumer Information:
In order to make wise decisions, Americans need good information. Every
consumer should have:
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Useful and unbiased information to help them understand their alternatives
for coverage, providers, and treatment options.
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Easy access to information in simple, straightforward language, and in
a variety of formats that recognize diverse needs.
Quality Assurance:
High quality health care does not just happen. Systems are needed to:
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License and accredit providers, as well as plans.
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Upgrade the skills of frontline health care workers and encourage the involvement
of workers at all levels in quality improvement initiatives.
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Monitor and improve the quality of health care services delivered to the
consumer.
Consumer Protection:
Health care consumers have basic rights that must be protected. Therefore:
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Consumer rights must be clear, explicit, and known to all.
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Health plans must serve any insured consumer, regardless of health status,
gender, income, race, or similar factors.
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Individual problems, grievances, and appeals concerning benefits, services,
and quality should be addressed quickly and fairly.
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Enforcement of consumer protection and review of appeals should be independent
and external.
Public Accountability:
Systems for consumer information, quality assurance, and consumer protection
must be accountable to the public. Programs should:
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Be independent of providers and payers of health care and free of potential
conflicts of interest.
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Enable consumer control of the governance structures and provide appropriate
technical assistance.
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Maximize public access to financial and other information about health
plans.
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Collect and disseminate available information in standardized formats as
part of a uniform national data system.
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Be adequately funded to ensure that these critical responsibilities can
be fulfilled.
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