U.S. patients' bill of rights
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A patient's bill of rights is a list of guarantees for those receiving medical care. It may take the form of a law or a non-binding declaration. Typically a patient's bill of rights guarantees patients information, fair treatment, and autonomy over medical decisions, among other rights. In the United States there have been a number of attempts to enshrine a patient's bill of rights in law, including a bill rejected by Congress in 2001.
Bill of 2001
A patients' bill of rights was considered by Congress in 2001. Its proposed title was the "Bipartisan Patient Protection Act". It was known officially as Senate Bill S.1052 and informally as the "McCain-Edwards-Kennedy Patients' Bill of Rights". The bill was an attempt at providing comprehensive protections to all Americans covered by health insurance plans.
The House of Representatives and Senate passed differing versions of the proposed law. Although both bills would have provided patients key rights, such as prompt access to emergency care and medical specialists, only the Senate-passed measure would provide patients with adequate means to enforce their rights. The Senate's proposal would have conferred a broad array of rights on patients. It would have ensured that patients with health care plans had the right to:
- have their medical decisions made by a doctor;
- see a medical specialist;
- go to the closest emergency room;
- designate a pediatrician as a primary care doctor for their children;
- keep the same doctor throughout their medical treatment;
- obtain the prescription drugs their doctor prescribes;
- access a fair and independent appeals process if care is denied; and
- hold their health plan accountable for harm done.
The bill was passed by the US Senate by a vote of 59-36 in 2001, it was then amended the House of Representatives and returned to the Senate. However it ultimately failed.
Wendell Potter, former senior executive at Cigna turned whistle-blower, has written that the insurance industry has worked to kill "any reform that might interfere with insurers' ability to increase profits" by engaging in extensive and well-funded, anti-reform campaigns. The industry, however, "goes to great lengths to keep its involvement in these campaigns hidden from public view," including the use of "front groups." Indeed, in a 1998 effort to successfully kill the Patient Bill of Rights at that time,
"the insurers formed a front group
called the Health Benefits Coalition to kill efforts to pass a Patients Bill of Rights. While it was billed as a broad-based business coalition that was led by the National Federation of Independent Business and included the U.S. Chamber of Commerce, the Health Benefits Coalition in reality got the lion’s share of its funding and guidance from the big insurance companies and their trade associations. Like most front groups, the Health Benefits Coalition was set up and run out of one of Washington’s biggest P.R. firms. The P.R. firmprovided all the staff work for the Coalition. The tactics worked. Industry allies in Congress made sure the Patients’ Bill of Rights would not become law."
Some have cited differences between 'positive rights' and personal freedoms. Asserting that medical care "must be rendered under conditions that are acceptable to both patient and physician", the Association of American Physicians and Surgeons adopted a list of 'patient freedoms' in 1990 which was modified and adopted as a 'patients' bill of rights' in 1995:
All patients should be guaranteed the following freedoms:
- To seek consultation with the physician(s) of their choice;
- To contract with their physician(s) on mutually agreeable terms;
- To be treated confidentially, with access to their records limited to those involved in their care or designated by the patient;
- To use their own resources to purchase the care of their choice;
- To refuse medical treatment even if it is recommended by their physician(s);
- To be informed about their medical condition, the risks and benefits of treatment and appropriate alternatives;
- To refuse third-party interference in their medical care, and to be confident that their actions in seeking or declining medical care will not result in third-party-imposed penalties for patients or physicians;
- To receive full disclosure of their insurance plan in plain language, including:
- CONTRACTS: A copy of the contract between the physician and health care plan, and between the patient or employer and the plan;
- INCENTIVES: Whether participating physicians are offered financial incentives to reduce treatment or ration care;
- COST: The full cost of the plan, including copayments, coinsurance, and deductibles;
- COVERAGE: Benefits covered and excluded, including availability and location of 24-hour emergency care;
- QUALIFICATIONS: A roster and qualifications of participating physicians;
- APPROVAL PROCEDURES: Authorization procedures for services, whether doctors need approval of a committee or any other individual, and who decides what is medically necessary;
- REFERRALS: Procedures for consulting a specialist, and who must authorize the referral;
- APPEALS: Grievance procedures for claim or treatment denials;
- GAG RULE: Whether physicians are subject to a gag rule, preventing criticism of the plan.
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- "How Insurance Companies Hurt Policyholders - ABC News". Abcnews.go.com. 2009-06-24. Retrieved 2012-08-01.
- Potter, Wendell (2009-09-15). "How corporate P.R. works to kill healthcare reform". Salon.com. Retrieved 2012-08-01.
- American Iatrogenic Association "Promoting accountability for medical professionals and institutions"
- Summary of the McCain-Edwards-Kennedy Patients' Bill of Rights S.1052 2001. from the Senate Democratic Caucus.
- Consumer Patient Rights and Responsibilities Advisory Commission on Consumer Protection and Quality in the Health Care Industry
- American Hospital Association - Patient Care Partnership This plain language brochure replaces the AHA's Patients' Bill of Rights.