Patient Safety and Patients' Rights

Abstract

Adopting a uniform system that enhances patient safety.Upon initial examination, efforts toward achieving these 2 goals appear philosophically complementary. For example, both tout as a primary benefit improvement of access to health care services. However, closer inspection of these initiatives' more prominent features reveals seemingly irreconcilable demands. As described below, the push toward consumer-driven health plans as a way to offer affordable employer-based health coverage (and, hence, advance the first goal) requires that comprehensive information be available about individual physicians. The patient safety movement's advocacy for the creation of a confidential medical error reporting system (that would serve the second goal) requires safeguarding individual physician information from the public. Consumer-Driven Health CareWith more than 43 million Americans lacking health insurance and health insurance premiums for the insured rising by double digits year after year, we appear to be approaching the demise of the current structure of the employment-based health insurance system [1]. Employers, seeking both new ways to offer employees the valuable benefit of health insurance coverage and, at the same time, better ways to contain the financial risk they shoulder when providing such benefits, are increasingly turning to consumer-driven health benefit plans as a possible solution [2][3][4]. Recently approved by the Internal Revenue Service, consumer-driven (or consumer-directed) health plans continue the economic trend toward turning passive patients who may overutilize health services into savvy, frugal consumers of health services [5][6][7] by "putting patients in a position to say 'no' to themselves" [4]. While there are several different ways to structure a "consumer-driven" health plan [2-4], they generally offer individual employees an increased role in the design of their benefit package, including choice of physician and the opportunity to set the level of their financial risk. In a consumer-directed plan, patients shoulder a greater burden of the cost of health services.In addition to making cost-benefit analyses of particular interventions, individual patients will have a greater responsibility to research and analyze the quality of their clinicians and to weigh the relative merits of these providers' expertise in the particular interventions. There are grave concerns that patients are being moved into these plans with neither the requisite training to expertly assess quality data, nor even an adequate level of available data from which to base quality comparisons. Meanwhile, hundreds of thousands, if not millions, of consumers are already joining such plans, and they will need access to sophisticated data on the quality of