Appendix 6-A: Quality and Consumers’ Rights

The Federal government’s concern with quality in the Nation’s health care system was expressed in President Clinton’s charge to the Advisory Commission on Consumer Protection and Quality in the Health Care Industry (March 26, 1997) “to recommend such measures as may be necessary to promote and assure health care quality and value and protect consumers and workers in the health care system.” In November 1997 the Commission recommended a Consumer Bill of Rights and Responsibilities (President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry, 1997).

The Consumer Bill of Rights and Responsibilities (Bill of Rights) is intended to meet three major goals:

• Strengthen consumer confidence by assuring that the health care system is fair and responsive to consumers’ needs; it gives consumers credible and effective mechanisms for addressing their concerns and encourages them to take an active role in improving and assuring their health.
• Reaffirm the importance of a strong relationship between consumers and their health care professionals.
• Underscore the critical role of consumers in safeguarding their own health by establishing both rights and responsibilities for all participants in improving health status.

The Bill of Rights addresses a number of issues that are particularly relevant to mental health care:

• Information disclosure of comparable measures of quality and consumer satisfaction from health plans, professionals, and facilities;
• Direct access to specialists of choice for consumers with complex or serious medical conditions who require frequent specialty care;
• Authorization, when required, for an adequate number of visits under an approved treatment plan;
• Vulnerable groups, including individuals with mental disabilities, require special attention by decisionmakers to protect their health coverage and quality of care;
• Confidentiality protections for sensitive services, such as mental health and substance abuse services, provided by health plans, providers, employers, and purchasers to safeguard against improper use or release of individually identifiable information.
• To move the mental health care system from a focus on providers to a focus on consumers, future care systems and quality tools will need to reflect person-centered values. This nascent trend is driven both by the consumer movement in American society and by a strong focus on consumer rights in a managed care environment. First steps include the voluntary adoption of the principles of the Consumer Bill of Rights by Federal agencies and passage of legislation requiring their national implementation.