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President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry

Consumer Bill of Rights and Responsibilities
Chapter Five
Respect and Nondiscrimination

Statement of the Right Consumers have the right to considerate, respectful care from all members of the health care system at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality health care system.

Consumers must not be discriminated against in the delivery of health care services consistent with the benefits covered in their policy or as required by law based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.

Consumers who are eligible for coverage under the terms and conditions of a health plan or program or as required by law must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.

Rationale

Consumers want to be treated with respect and they want to be treated fairly. An environment of mutual respect is essential to maintain a quality health care system. Incidences of discrimination -- real and perceived -- mar the relationship between consumers and their health care professionals, plans, and institutions. Multiple consumer surveys (Levinson et al., 1997; Davis et al., 1995; Edgeman-Levitan and Cleary, 1996) have found that many consumers' complaints about the current health care system have their root in the perception that people believe they are not being treated with respect.

Respect has been defined as recognizing a "person's capacities and perspectives, including his or her right to hold certain views, to make certain choices, and to take certain actions based on personal values and beliefs" (Faden and Beauchamp, 1986). Manifestations of disrespect in the health care setting described by consumers in recent research (Levinson et al., 1997) and interviews include: poor communication with their doctor, feeling rushed or ignored, lack of dignity during examinations, experiencing extensive waiting room delays, receiving inadequate explanations or advice, having inadequate time with the doctor during routine visits, feeling that complaints are not taken seriously by providers, and feeling that providers are more concerned with holding down the cost of medical care than with giving the best medical care. Conversely, consumers defined respectful treatment as that which takes into consideration the values, preferences, and expressed needs of the patient. In addition, consumers wanted providers to communicate well, to be respectful of the patient's time, and to give emotional support to alleviate the patient's fear and anxiety.

In order to extend consumers the respect they deserve, members of the health care industry should strive to:

A key element of respectful and fair treatment is protection against discrimination in the delivery of health care services, and in marketing and enrollment, for those eligible for coverage under the terms and conditions of a health plan or program, based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.

Implications of the Right

References and Selected Reading

AMA Council on Ethical and Judicial Affairs. Genetic Disparities in Clinical Decision-Making: Council Report. January 1991; 15(4):25-35.

American Associations of Physicians for Human Rights. Anti-Gay Discrimination in Medicine: Results of a National Survey of Lesbian, Gay and Bisexual Physicians. San Francisco; 1994.

Ayanian JZ, Kohler BA, Abe T, et al. "The Relation Between Health Insurance Coverage and Clinical Outcomes among Women with Breast Cancer." N Eng J Med 1992; 326:1102-1107.

Bame S, Petersen N, et al. "Variation in Hemodialysis Patient Compliance According to Demographic Characteristics." Soc Sci Med, Oct. 1993; 37(8):1035-1043.

Beery TA. "Diagnosis and Treatment of Cardiac Disease: Gender Bias in the Diagnosis and Treatment of Coronary Artery Disease." Heart & Lung. November 1995; 24(4):427-435.

The Commonwealth Fund. The Commonwealth Fund Survey of Women's Health. New York: July 1993.

Davis K, Collins KS, et al. "Choice Matters: Enrollees' Views of Their Health Plans." Health Affairs, Summer 1995; 9-112.

Edgeman-Levitan S, Cleary PD. "What Information Do Consumers Want and Need? A Synthesis of Research to Date, Plus Interviews with Health Plan Managers and Consumer Advocates." Health Affairs, Winter 1996; 15(4):42-56.

Faden R, Beauchamp T. A History and Theory of Informed Consent. New York: Oxford University Press, 1986; 8-9.

Giles WH, Anda RF, Casper ML, et al. "Race and Sex Differences in Rates of Invasive Cardiac Procedures in US Hospitals." Arch Intern Med 1995; 155.

Horton JA, ed. The Women's Health Data Book: A Profile of Women's Health in the United States. Washington, DC: Elsevier; 1995.

Kahn KL, Pearson ML, et al. "Health Care for Black and Poor Hospitalized Medicare Patients." JAMA 1994; 27(1).

Juncos LI. "Patient Compliance and Angiotensin Converting Enzyme Inhibitors in Hypertension." J Cardiovascular Pharmacol 1990; 15(3):S22-S25.

Levinson W, Roter DL, et al. "Physician-Patient Communication: The Relationship with Malpractice Claims among Primary Care Physicians and Surgeons." JAMA 1997; 277(7):553-559.

Nattinger AB, Gottlieb MS, Veum J, et al. "Geographic Variation in the Use of Breast-Conserving Treatments for Breast Cancer." N Eng J Med 1992; 326:1102-1107.

Office of Civil Rights. Fact Sheet. U.S. Department of Health and Human Services; 1990.

Osteen RT, Steele GD Jr, Menck HR, et al. "Regional Differences in Surgical Management of Breast Cancer." CA Cancer J Clin 1992; 42:39-43.

Patterson R, Greenberger PA, et al. "Potentially Fatal Asthma; the Problem of Noncompliance." Ann Allergy, Aug 1991; 67(2):138-142.

Rosenbaum S, Serrano R, et al. "Civil Rights in a Changing Health Care System," Health Affairs Jan-Feb 1997.

Savage E. U.S. Department of Justice. verbal communication; September 1997.

Smollar D. "Success of Indochinese Students May Vary with Ethnic Factors." Los Angeles Times, Feb 16, 1988.

Tobin JN, et al. Ann Internal Med. 1987;107.

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Last Revised: Thursday, June 25, 1998