January 10, 2000 
 
 
 
Dear State Medicaid Director: 
 
I enclose a copy of Your Guide to Choosing Quality Health Care, which was developed by the 
Agency for Health Care Policy and Research (AHCPR).  The guide is directed to consumers of 
health care.  It is intended to help consumers in choosing health plans, doctors, treatments, 
hospitals and long-term care providers.  While AHCPR developed the guide for a general 
audience, you may also find it useful as you develop materials for Medicaid beneficiaries. 
 
                Sincerely, 
 
 
 
                Timothy M. Westmoreland 
                Director 
 
Enclosure 
 
cc: 
 
All HCFA Adminstrators 
 
All HCFA Associate Regional Administrators for  
  Medicaid and State Operations 
 
Lee Partridge 
Director, Health Policy Unit 
American Public Human Services Association 
 
Joy Wilson 
Director, Health Committee 
National Conference of State Legislatures 
 
Matt Salo 
Senior Health Policy Analyst 
National Governors Association  QUALITY 
CHOICES
Your Guide to
CChhoooossiinngg
Quality
Health Care
Health Plans
Doctors
Treatments
Hospitals
Long-Term Care
Agency for Healthcare Research and Quality On December 6,1999,under Public Law 106-129,the Agency for Health Care 
Policy and Research (AHCPR) was reauthorized and renamed the Agency for
Healthcare Research and Quality (AHRQ). The law authorizes AHRQ to
continue its research on the cost,quality,and outcomes of health care,and 
expands its role to address patient safety and medical errors.
Visit our Web site at www.ahrq.gov for more information about AHRQ.
This guide was developed by the Agency for Healthcare Research and Quality
(AHRQ), formerly the Agency for Health Care Policy and Research (AHCPR), in
cooperation with other agencies of the U.S. Department of Health and Human
Services, and other public- and private-sector health organizations.  AHRQ is the
lead Federal agency charged with sponsoring and conducting research on the quality
and outcomes of health care services, as well as the cost, use, and access to those
services.  For more information on AHRQ-sponsored research and products, call 
1-800-358-9295, or visit AHRQs Web site at http://www.ahrq.gov/.  For information
on resources available from the U.S. Department of Health and Human Services,
visit the Departments gateway Web site, http://www.healthfinder.gov/. A Message from the Director of AHRQ
Health care quality varies in this countrya lot. For example, some health plans and
doctors simply do a better job than others of helping you stay healthy and getting you better
if you are ill.  
Research shows that Americans want and value quality health care.  And thats a good
thing.  Because when you make health care choices that offer the best possible care, you
are most likely to get the best possible results.
So when it comes to making major health care decisionsabout health plans, doctors,
treatments, hospitals, and long-term carehow can you tell which choices offer quality
health care, and which do not? 
Fortunately, more and more public and private groups are working on ways to measure
and report on the quality of health care. This means there is more and more information
to help you make choices that improve the quality of your own care.  
The goal of this guide is to help you find and use such information to choose quality
health care.  It can also help you measure quality for yourself according to what is most
important to you.  You can trust the information in this guide because it is based on
research about what people want and need in order to make quality health care choices.
Here are some important things to remember as you make such choices:
Quality matters.  It can be measured, and it can be improved.
Take part in every decision about your health. 
See yourself and your doctor as a team.  You need to work together to 
get the best care.  
Ask questions, and make sure you understand the answers.  The only bad 
question is the one you wish you had asked.
Remember that more is not always better.  It is always a good idea to find 
out why a test or treatment is needed and how it can help you.
Find and use reliable health care information.  Ask your doctor or nurse, use 
your library, explore the Internet....  This guide has many resources for 
you to try.
I urge you to keep and use this guide.  It can help you and your family answer many of
the health care questions you will have.
Make quality health care choices. Your good health,and your familys,depends on it.
John M. Eisenberg M.D. Before
Begin
you
High-quality health care is something we all want.  But research shows that
many people do not have the information they need to make informed health
care choices.  The first step is to understand what quality means and how it is 
measured.  To find out, read:
A Quick Look At Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
This guide can help you find and use information about quality that is based on
research.  You can use this information as you make five important health care
decisions:
1 Choosing a Health Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2 Choosing a Doctor  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3 Choosing Treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
4  Choosing a Hospital  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
5 Choosing Long-Term Care  . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
It also tells how you can:
 Improve communication with your doctor  . . . . . . . . . . . . . . . . 17
 Keep track of your personal health history . . . . . . . . . . . . . . . . 20
 Get only the tests you need, and the most 
accurate results  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
 Find self-help groups for the support you need  . . . . . . . . . . . . 26
 Make informed decisions about elective 
(non-emergency) surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
 Find reliable health information on the Internet  . . . . . . . . . . . . 46
Each section also has a Quick-Check for Quality checklist, which summarizes
the major ways you can check for quality health care.  If you want more detailed
information, refer to the resources at the end of each section.  A convenient tear-
out page of all five Quick-Check for Quality checklists is on page 47.
Please note that this guide is not meant to be read cover-to-cover,all at
once. Save it,and use it as a reference when you need it.
Also, it isnt necessary or practical for any one person to do everything this guide
suggests.  Pick and choose what you need and what feels comfortable for you to try. A Quick look
Quality
at
Quality health care means doing the right thing, at the right time, in the right
way, for the right personand having the best possible results.
Although we would like to think that every health plan, doctor, hospital, and
other provider gives high-quality care, this is not always so.  Quality varies, for
many reasons. 
Fortunately, there are scientific ways to measure health care quality.  These tools,
called measures, have mostly been used by health professionals.  They use 
measures to check up on and improve the quality of care they provide.  
But there is some quality information you can use right now to help you com-
pare your health care choices.  And more and more is becoming available all the
time.  Many public and private groups are working to improve and expand health
care quality measures.  The goal is to make these measures more reliable, 
uniform, and helpful to consumers in making health care choices. 
What is Measured?
There are two main types of quality measures that can help you choose quality
health care: consumer ratings and clinical performance measures. Both types
are based on outcomes research.
Outcomes research measures the end results of health care practices and treat-
ments.  For example, after treatment, is the pain gone?  Can the patient carry out
his or her daily activities?  Is he/she satisfied with his or her care?
1.Consumer ratings (or consumer satisfaction information). These
look at health care from the consumers point of view.  For example, do
doctors in the plan communicate well?  Do members get the health services
they need?
Many consumer ratings of health plans are based on a survey called the
Consumer Assessment of Health Plans (CAHPS) and on the HEDIS mem-
ber satisfaction survey, which includes CAHPS questions (read on for more
about HEDIS).  For more information on CAHPS, see pages 4-5 in the
Choosing a Health Plan section. 
1 A Quick look
Quality
at
2.Clinical performance measures (also sometimes called technical
quality measures). An example of some widely used clinical perfor-
mance measures is the Health Plan Employer Data and Information Set
(HEDIS).  These measures look at how well a health care organization pre-
vents and treats illness.  For example, one HEDIS clinical performance
measure looks at whether children get the immunizations (shots) they need
when they need them.  
See pages 5-6 in the Choosing a Health Plan section for more
information on HEDIS.  
What Should I  Look For?
Quality Reports. You may be able to find consumer ratings, clinical perfor-
mance measures, or both in quality reports.  Quality reports go by different
names, including performance reports and report cards.  Quality reports dont tell
you which health care choices are the best.  But they can help you decide which
are best for you, based on the things that are most important to you. 
See pages 5-7 in Choosing a Health Plan and pages 34-35 in Choosing a
Hospital for more information about quality reports.
Accreditation Reports. Another way to compare quality is to use information
about accreditation.  Accreditation is a seal of approval.  It is mainly used for
health care organizations such as health plans, hospitals, and nursing homes.  
To earn accreditation, organizations must meet national standards, often includ-
ing clinical performance measures.  Organizations choose whether to participate
in accreditation programs.  Therefore, you will not find accreditation information
on every nursing home, for example.
For more information on accreditation, see pages 7-8 in Choosing a Health
Plan, page 25 in Choosing Treatments, page 33 in Choosing a Hospital, and
pages 42-44 in Choosing Long-Term Care.
2 Choosing
Health Plan
a
Today there are more health plans to choose from than ever before.  Not every-
one has a choice.  But if you do, this section can help you choose the plan that
offers the best quality for you and your family.  
The quality of health plans varies widely.  In 1997, a study pub-
Quick-Check

lished by the National Committee for Quality Assurance
for Quality 
(NCQA) showed differences in the ways managed care
Look for a plan that:
organizations provide access to care, keep people healthy,
(cid:3)(cid:3) Has been rated highly by its 
members on the things that are treat illness, deliver high-quality service, and satisfy
important to you.
patients.  For example, studies show that treating heart
(cid:3)(cid:3) Does a good job of helping people
attack patients with beta blocker drugs saves lives.
stay well and get better.
The NCQA found that in some health plans, most
(cid:3)(cid:3) Is accredited,if that is important 
to you. heart attack patients got beta blockers.  In other health
(cid:3)(cid:3) Has the doctors and hospitals you  plans, only one in three did.  
want or need.
Research shows that Americans say that quality is the
(cid:3)(cid:3) Provides the benefits you need.
most important thing they think about when choosing a
(cid:3)(cid:3) Provides services where and 
when you need them. health plan.  But research also shows that few people under-
(cid:3)(cid:3) Meets your budget. stand their options well enough to make an informed choice.
Your Health Plan Affects Many Things:
 Who will care for you (doctors and other health care providers), and how
much choice you will have.
 What kind of care you will receive (for example, which preventive services
are covered?).
 Where you will receive your care (which hospitals, for example).
 When you will receive your care (will you receive it when you need it?).
 How you will be cared for (the quality of care you receive).
 How much you will pay.
What Are Your Choices?
The two major types of health plans are fee-for-service and managed care.
Managed care plans can go by many names: Health Maintenance Organization
(HMO); Preferred Provider Organization (PPO); Individual Practice Association
(IPA); and Point of Service (POS) plan, to name a few.  But different groups do
not always define these names the same way.
3 Choosing
Health Plan
a
Do not be confused by whether the plan is a fee-for-service plan, or whether the
plan is one of the many kinds of managed care plans.  What you need to under-
stand is not the plans label, but the characteristics of the plan.  Research shows
that it is important to understand your options and how they affect your choice
of providers and services, costs, and quality of care.
How to Make Decisions Based on Quality.
The next section lists several questions you may want to consider when choosing
a health plan.  These questions are based on research about what consumers want
to know when choosing health plans.  Under each question you will find more
information to help you choose the plan that is right for you.  You also will find a
way to compare the health plans you are looking at.  Heres how:
 Read the questions.  Which are most important to you in choosing ahealth
plan?
 Under each question you have chosen, write the names of the plans.  Space 
is provided for comparing three plans.
 Read and think about the information under each question.  Then ask your-
self the question.  If the answer is yes for a plan, check the box under its
name.
Of course, the answers to these questions may not be as simple as yes or
no.  Still, these questions should help you to think about and 
compare your health plan choices.
 Do this for all the questions you have chosen.  Which plan or plans have
the most check marks?
Rate Your Health Plan Choices.
1. Do members rate the plan highly on things that are important to me?
Plan: _________ Plan: _________ Plan: ___________
Yes   Yes   Yes  
Before you join a plan, it is hard to know what kind of care you will get.  One
way to find out is to learn what members of the plan say about it.  This kind of
information is called consumer ratings or consumer satisfaction information.
More and more States, businesses, health plans, Medicare, and even the Federal
Governments personnel office are starting to use a survey called Consumer
4 Choosing
Health Plan
a
Assessment of Health Plans (CAHPS).  It tells them what members think of the
plans they are in.  CAHPS was designed by national experts in health care quali-
ty, under a project funded by the Agency for Healthcare Research and Quality.
Also, NCQA has added CAHPS survey questions to its own member satisfaction
survey.  The NCQA survey is part of its performance measurement program,
called HEDIS (see page 6 for more information). 
The information from the CAHPS surveys is summarized in reports to help you
compare health plans and decide which one is best for you.  Here are examples
of the kind of information you will find in a report that is based on CAHPS 
survey questions:
Do members get the health services they need?  Without long waits?
How easy is it for members to get a doctor they are happy with?
How easy is it to see a specialist?
Do doctors in the plan listen carefully?
Do they explain things well?
Are office staff polite and helpful?
Is the health plans customer service goodat giving information and helping
with problems?
Do members have too many forms to fill out?
How do members rate the care from the doctors and other health care
providers in the plan?  How do they rate their plan overall?
Find out where the survey information came from.  Is it CAHPS, HEDIS, or anoth-
er source?  Are you satisfied that it is a reliable source?  Who collected the data?
How can you find consumer ratings?  Ask your employer, Medicare or Medicaid
office, or the health plan if a CAHPS or HEDIS survey report is available.  If
not, ask if there are other consumer ratings.
You also may want to check your phone book for your States department of
health, or the insurance commissioners office.   For more help in finding your
State health insurance contact,  write or call the National Association of
Insurance Commissioners, Executive Headquarters, 2301 McGee, Suite 800,
Kansas City, MO 64108-2604; telephone 816-842-3600 or, if busy 816-374-
7175.  The information also is available at its Web site: http://www.naic.org.  
5 Choosing
Health Plan
a
2a. Does the plan provide preventive services to help keep people well?  
Plan: _________ Plan: _________ Plan: ___________
Yes   Yes   Yes  
2b. Does it do a good job of helping them get better when they are sick?
Plan: _________ Plan: _________ Plan: ___________
Yes   Yes   Yes  
The Health Plan Employer Data and Information Set (HEDIS) uses various
types of quality measures.  The HEDIS clinical performance measures are
based on information such as membersmedical records.  These measures help
to compare how well plans prevent and treat illness.  For example, one HEDIS
measure looks at how many adult smokers or recent quitters were advised to
quit by a health professional in the plan.  Another looks at whether two-year-
olds are up to date on recommended shots.  Some other HEDIS measures look
at breast cancer screening, prenatal care, and at eye exams to prevent blindness
in people with diabetes. 
States, employers, health plans, and groups like the California-based Pacific
Business Group on Health use HEDIS performance measures to prepare reports
for consumers.  These reports are known as performance reports, report cards,
or various other names.  They also may include HEDIS member satisfaction
ratings or other consumer ratings.  
To find out if there is performance measure information available on the plans
you are looking at, ask your employer, Medicare or Medicaid office, or the
health plan.  Or, call your State department of health or the insurance commis-
sioners office.
When you read the report, check to see where the measures came from.  Are
you satisfied that it is a reliable source?
3. Is the plan accredited?
Plan: _________ Plan: _________ Plan: ___________
Yes   Yes   Yes  
Many health plans choose to be reviewed and accredited (given a seal of
approval).  Contact the following organizations to find out if the plans you are
looking at are accredited, or find out from the plans.
6 Choosing
Health Plan
a
The National Committee for Quality Assurance (NCQA) evaluates and
rates managed care plans using more than 50 standards.  The standards
focus on efforts to continuously improve quality of care; doctorscreden-
tials (training, licensing, and other background information); members
rights and responsibilities; preventive health services; and whether appro-
priate health care services are provided.
Visit NCQAs Web site http://www.ncqa.org to generate a report card on
one of hundreds of health plans.  You can also call 1-888-275-7585 or 
1-800-839-6487 to ask for the following information: 
An Accreditation Status List, which lists all the health plans NCQA has
reviewed.  (No charge)
A copy of a 2-page Accreditation Summary Report for any health plan
reviewed since July 1995.  ($3 per report by mail; free on the Web)
The Joint Commission on Accreditation of Healthcare Organizations
(JCAHO) evaluates and accredits all types of health care organizations.
JCAHO standards focus on patient-related areas it views as most closely
related to improving health outcomes.  The standards cover: rights,
responsibilities, and ethics; continuity of care; education and communica-
tion; health promotion and disease prevention; leadership; management of
personnel and health information; and continuous quality improvement.
Call 630-792-5800 to ask for information on specific accredited managed
care or other organizations.  Or visit the JCAHO Web site:
http://www.jcaho.org.  Information on accredited organizations is free of
charge.
The American Accreditation HealthCare Commission/URAC develops
accreditation standards and programs for managed care.  Its Network
Standards address five general areas:  network management, utilization man-
agement (checking to see that health care resources are used appropriately),
quality management, credentialing, and member participation and protection.
Call 202-216-9010 for information on accredited organizations.  Or, for a
free list of accredited organizations, visit the Commission/URACs Web
site at http://www.urac.org/directory/default.htm.
7 Choosing
Health Plan
a
4. Does the plan have the doctors and hospitals I want or need?
Plan: _________ Plan: _________ Plan: ___________
Yes   Yes   Yes  
Here are some questions to think about:
Are you happy with your current doctors?  
Call their offices to find out which plans they are in.  You may 
be able to choose a plan that will allow you to keep seeing those 
doctors without paying extra.
Do you want to make sure the plan includes the kinds of doctors you 
will want to see?  
Call the plans you are looking at to get a list of their doctors and 
other providers.  Or, ask your employers benefits manager.
And remember, the hospital you go to often depends on the plan you are in and
where your doctor has privileges.  If going to a certain hospital is very important
to you, keep that in mind when choosing a plan.
5. Does the plan provide the benefits I need?
Plan: _________ Plan: _________ Plan: ___________
Yes   Yes   Yes  
Which health care services are most important to you and your family?   On the
next page, mark the boxes next to those services that you want or need.  There are
extra spaces in which to write other services.  Then, check the health plan materi-
als from your employer or the plans.  Or, ask your employers benefits manager or
the plans customer service office.  Do the plans provide the services that you
checked? 
8 Choosing
Health Plan
a
ARE THESE SERVICES COVERED? PLAN A PLAN B PLAN C
Cancer screening (colorectal cancer 
tests, mammograms, Pap smears, etc.)
Cholesterol screening
Immunizations (shots)
Prenatal care
Well-baby care
Care for a pre-existing condition (one 
you have before joining the plan)
Diabetes supplies
Dental exams/treatments
Eye exams/glasses/contact lenses
Hearing exams/hearing aids
Outpatient prescription medicines
Medical equipment for use at home
Mental health services
Physical therapy
Hospice care
Counseling to stop smoking
Drug and alcohol counseling
Alternative treatments (such as
acupuncture or chiropractic services)
Home health care
Adult day care
Nursing home care
9 Choosing
Health Plan
a
6. Do the doctors,pharmacies,and other services in the plan have 
convenient times and locations? 
Plan: _________ Plan: _________ Plan: ___________
Yes   Yes   Yes  
Here are some questions you may want to call the plan to find out:
Are the services close enough to home or work?
Are they on convenient routes for public transportation?
Is parking available?
Are offices open in the evenings and on weekends?
7. Does the plan meet my budget?
Plan: _________ Plan: _________ Plan: ___________
Yes   Yes   Yes  
Use the health plan materials from your employer or the plans to answer these
questions:
PLAN A  PLAN B PLAN C
How much will the premium cost me 
each month?
If there is a deductible, how much will I 
have to pay before the plan starts to pay 
for medical care? 
For prescription medicines? 
How much will I have to pay 
(co-payment) each time I use a service?
Doctor visit 
Hospital visit
Prescription 
How much more will I need to pay if I go 
outside the health plans network of 
doctors, hospitals, and other providers to 
10 get services? Choosing
Health Plan
a
SOURCES OF ADDITIONAL INFORMATION  
Choosing and Using a Health Plan. Choosing Quality:Finding the Health
Details health plan choices, benefits, costs, Plan Thats Right For You. Helps con-
and suggestions for getting the most from sumers evaluate health plans.  Covers what to
your plan.  29 pages.  Free.    look for, plan accreditation, report cards, and
Agency for Healthcare Research  ways to evaluate quality.  Glossary.  4 pages.
and Quality Free.  
Publications Clearinghouse  National Committee for Quality 
P.O. Box 8547  Assurance, Publications Center
Silver Spring, MD  20907 1-888-275-7585
1-800-358-9295 Web site: http://www.ncqa.org
Web site: http://www.ahrq.gov/consumer/
Nine Ways to Get the Most from Your
Medicare Compare. Managed Health Care Program. Topics
http://www.medicare.gov/MPHCompare/ include referrals, prescription drug coverage,
Home.aspis an interactive database with getting care when you are seriously ill, legal
detailed information on Medicares health plan rights and protections, and grievances.  40
options.  Medicare offers a variety of free pages.  Free.  
guides on its Web site, American Association 
http://www.medicare.gov of Retired Persons (AARP)
or call the Medicare Hotline:1-800-633-4227 601 E. St., N.W.
Washington, DC  20049
How to Choose a Health Plan and 1-800-424-3410
Straight Talk About Health Plans. Free.  Web site: http://www.aarp.org
American Association of Health Plans.  
Pacific Business Group on Health Web
202-778-3200
Site. Offers helpful information about
Web site: http://www.aahp.org (click For
choosing a health plan and evaluating HMOs.
Consumers)
Includes consumer and physician ratings of
California HMOs. 
Guide to Health Insurance. Covers dif-
Web site: http://www.healthscope.org
ferent kinds of plans and coverage, changing
jobs, and answers frequently asked health
Your Guide to Managed Care. A 15-
insurance questions.  15 pages.  Free. 
page on-line guide to choosing health care
Health Insurance Association
coverage. Part of an on-line series published
of America
by Health Pages.  
1201 F Street, N.W., Suite 500
Web site: http://www.thehealthpages.com
Washington, DC  20004-1204
202-824-1600 Families USA. Offers an in-depth resource
Web site: http://www.hiaa.org list and information clearinghouse on man-
aged care.
Putting Patients First. Contains a guide Web site: http://www.familiesusa.org
to patientsrights and responsibilities, lists
resources for 170 conditions and diseases,
and has a consumers checklist for evaluating
health plans.  24 pages.  Free.  
Healthfinder
National Health Council
http://www.healthfinder.govprovides
1730 M St., N.W., Suite 500
links to reliable health information from
Washington, DC 20036-4505 the Federal Government and its many
202-785-3910 partners.
Web site: http:www.nationalhealthcouncil.org
11 Choosing
Health Plan
a
NOTES
12 Choosing
Doctor
a
It is important to choose your doctor with care, because quality varies.  For
example, the Pacific Business Group on Health asked patients of California doc-
torsgroups how they rated their care.  The results?  More than 80 per-
cent of the patients said they were satisfied with their care.
Quick-Check

But fewer than two-thirds were happy with the ease of
for Quality 
getting that care.
Look for a doctor who:
This chapter can help you choose a primary care
(cid:3)(cid:3) Is rated to give quality care.
doctor who will meet your needs and give you
(cid:3)(cid:3) Has the training and back-
ground that meet your needs. quality care.  The information also may be useful
(cid:3)(cid:3) Takes steps to prevent illnessfor  in choosing any specialists you might need.
example,talks to you about 
quitting smoking. Primary care doctors are specially trained to
(cid:3)(cid:3) Has privileges at the hospital   serve as your main doctor over the long term.
of your choice.
They provide your medical and health care, help
(cid:3)(cid:3) Is part of your health plan,unless 
you can afford to pay extra. you stay healthy, and help to manage your care.
(cid:3)(cid:3) Encourages you to ask questions. Your primary care doctor can refer you to special-
(cid:3)(cid:3) Listens to you. ists (doctors who treat only certain parts of the body,
(cid:3)(cid:3) Explains things clearly. conditions, or age groups) if you need them.
(cid:3)(cid:3) Treats you with respect.
Internists and family physicians are the two largest groups
of primary care doctors for adults.  Many women see obstetri-
cians/gynecologists for some or all of their primary care needs.  Pediatricians and
family practitioners are primary care doctors for many children.  
Physician assistants, nurse practitioners, and certified nurse midwives are
trained to deliver many aspects of primary care.  Physician assistants must 
practice in partnership with doctors.  Nurse practitioners and certified nurse
midwives can work independently in some States, but not others.
Doctors and Health Plans
If you already are in a health plan, your choices may be limited to doctors
who participate in the plan.  But if you have a choice of plans, you may want
to first think about which doctor(s) you would like to use.  Then, you may be
able to choose a plan that has your choice of doctor(s).
13 Choosing
Doctor
a
Decide What You Want and Need in a Doctor.
What is most important to you in a doctor?  A few ideas are listed below.  Add
your own to create a list that will help you choose a doctor who is right for you.
(cid:3)(cid:3)
My doctor must be highly rated by a consumer or other group.  (You will 
want to find out who did the ratings.  Is the information reliable?  Who 
collected it?  Does thegroup have something to gain from the ratings?) 
(cid:3)(cid:3)
My doctor needs to have experience with my condition(s):  (Research shows 
that doctors who have a lot of experience with a condition tend to have 
better success with it.)
(cid:3)(cid:3)
I want a doctor who has privileges (is permitted to practice) at the hospital 
of my choice:
(cid:3)(cid:3)
My doctor must be part of my health plan.
(cid:3)(cid:3)
Make a List of Doctors.
 If you are in a managed care plan, check the plans list of doctors first.
 Ask doctors or other health professionals who work with doctors, such as  
hospital nurses. 
 Check the Physician Select service of the Web site of the American Medical 
Association.  This can give you lists of doctors, by specialty, who practice near 
you.  You can also check on training and board certification:
http://www.ama-assn.org.
 Call a doctor referral service at a hospital.  But keep in mind that these 
services usually refer you to any of the doctors on the staff of that hospital.
The services do not have information on the quality of care these 
doctors provide.
 Some local medical societies offer lists of doctors who are members.  Again,
these lists do not have information on the quality of care these doctors provide.
 Ask family, friends, neighbors, and co-workers.
14 Choosing
Doctor
a
Write your list here. 
NAME PHONE #
Check on Quality.
Once you have a list of doctors, there are several ways to check on their skills
and knowledge, and the quality of care they provide:
 Find out if a consumer or other group has rated doctors in the area where
you live.  (Again you will want to find out how reliable the ratings are.)
 Information on doctors in some States is available on the Internet at
http://www.docboard.org.  This Web site is run by Administrators in
Medicinea group of State medical board directors.
 The American Board of Medical Specialties (800-733-2267) can tell you if
the doctor is board certified.  Certified means that the doctor has com-
pleted a training program in a specialty and has passed an exam (board) to
assess his or her knowledge, skills, and experience to provide quality
patient care in that specialty.  Primary care doctors also may be certified
as specialists.  You can also check the Web site at
http://www.certifacts.org.  (Note:  While board certification is a good
measure of a doctors knowledge, it is possible to receive quality care from
doctors who are not board certified.)
 Call the American Medical Association (AMA) at 312-464-5000 for infor-
mation on training, specialties, and board certification about many
licensed doctors in the United States.  This information also can be found
in Physician Select at AMAs Web site: http://www.ama-assn.org. 
Contact the Doctors Offices.
When you have found a few names of doctors you might want to try, call their
offices.  The first thing to find out is whether the doctor is covered by your
health plan and is taking new patients.  If the doctor is not covered by your
plan, are you prepared to pay the extra costs?
Below are some questions you might want to ask the office manager or other
staff.  You may have some additional questions.  Note that some of these items
15
might have more to do with the health plan than with the doctors office. Choosing
Doctor
a
Things to find out from
office staff: Doctor A Doctor B Doctor C
Which hospitals does the
doctor use?
What are the office hours 
(when is the doctor available 
and when can I speak to 
office staff)? 
Does the doctor or someone 
else in the office speak the 
language that I am most 
comfortable speaking?
How many other doctors 
cover for the doctor when 
he or she is not available?
Who are they?
How long does it usually take
to get a routine appointment?
How long might I need 
to wait in the office before
seeing the doctor?
What happens if I need to
cancel an appointment?  Will
I have to pay for it anyway?
Does the office send 
reminders about prevention 
testsfor example, Pap smears?
What do I do if I need 
urgent care or have 
an emergency?
Does the doctor (or a nurse
or physician assistant) give
advice over the phone for 
common medical problems?
16 Choosing
Doctor
a
You may also want to talk briefly with the doctor by phone or in person.
Ask if you are able to do this and if there is a charge.
The next step is to schedule a visit with your top choice.  During that first visit
you will learn a lot about just how easy it is to talk with the doctor.  You will also
find out how well the doctor might meet your medical needs.  Ask yourself:  Did
the doctor...
(cid:3)(cid:3) (cid:3)(cid:3)  
1. Give me a chance to ask questions? YES NO
(cid:3)(cid:3) (cid:3)(cid:3)  
2. Really listen to my questions? YES NO
(cid:3)(cid:3) (cid:3)(cid:3)  
3. Answer in terms I understood? YES NO
(cid:3)(cid:3) (cid:3)(cid:3)  
4. Show respect for me?  YES NO
(cid:3)(cid:3) (cid:3)(cid:3)  
5. Ask me questions?  YES NO
(cid:3)(cid:3) (cid:3)(cid:3)  
6. Make me feel comfortable? YES NO
(cid:3)(cid:3) (cid:3)(cid:3)  
7. Address the health problem(s) I came with? YES NO
(cid:3)(cid:3) (cid:3)(cid:3)  
8. Ask me my preferences about different kinds of treatments?  YES NO
(cid:3)(cid:3) (cid:3)(cid:3)  
9. Spend enough time with me? YES NO
Trust your own reactions when deciding whether this doctor is the right one 
for you.  But you also may want to give the relationship some time to develop.  
It takes more than one visit for you and your doctor to get to know each other.
Talking with your Doctor
Research has shown that patients who have a good relationship with their 
doctors tend to be more satisfied with their careand to have better results.
Here are some tips to help you and your doctor become partners.
Give information. Dont wait to be asked!   
 You know important things about your symptoms and your health 
history.  Tell your doctor what you think he or she needs to know.
 It is important to tell your doctor personal informationeven if it makes
you feel embarrassed or uncomfortable. 
 Bring a health history list with you (and keep it up to date).  You can
use the form on page 20 of this guide.  You might want to make a copy
of the form for each member of your family.
 Always bring any medicines you are taking, or a list of those medicines
(include when and how often you take them).  Talk about any allergies or
reactions you have had to your medicines.  
17 Choosing
Doctor
a
 Tell your doctor about any natural or alternative medicines or treatments. 
 Bring other medical information, such as x-ray films, test results, and
medical records. 
Get information.
 Ask questions.  If you dont, your doctor may think you understand
everything that was said.
 Write down your questions before your visit.  List the most important
ones first to make sure they get asked and answered.
 You might want to bring someone along to help you ask questions.  This
person can also help you understand and/or remember the answers.  
 Ask your doctor to draw pictures if that might help to explain something.
 Take notes.
 Some doctors do not mind if you bring a tape recorder to help you
remember things.  But always ask first.
 Let your doctor know if you need more time.  If there is not time that
day, perhaps you can speak to a nurse or physician assistant on staff.  
Or, ask if you can call later to speak with someone.
Take information home.
 Ask for written instructions.  
 Your doctor also may have brochures and audio and videotapes that can
help you.  If not, ask how you can get such materials.
Once you leave the doctors office,follow up.
 If you have questions, call.
 If your symptoms get worse, or if you have problems with your medicine,
call.
 If you had tests and do not hear from your doctor, call for your
test results.
 If your doctor said you need to have certain tests, make appointments at
the lab or other offices to get them done.
 If your doctor said you should see a specialist, make an appointment.
18 Choosing
Doctor
a
Urgent or Emergency Care Centers
What if you get sick at night, on a holiday, or over the weekend?You cant get to your
doctor, but youre not sick enough to go to the emergency room.  There may be an urgent
or emergency care center near you.  These centers are open long hours every day to han-
dle problems that are not life threatening.  But they are no substitute for a regular primary
care doctor.
To make sure an urgent or emergency care center provides quality care, call your health
plan or visit the center to find out:
 If your health plan will cover your care there.
 If it is licensed.  Then check to see if it is accredited by a group such as the Joint
Commission on Accreditation of Healthcare Organizations (telephone 630-792-5800;
Web site http://www.jcaho.org) or the Accreditation Association for Ambulatory
Healthcare (telephone 847-676-9610, Web site http://www.aaahc.org).  The accreditation
certificate should be posted in the facility.
 How well trained and experienced the centers health care professionals are.
 If the center is affiliated with a hospital.  If it is not, find out how the center will handle
any emergency that could happen during your visit.
SOURCES OF ADDITIONAL INFORMATION
Talking With Your Doctor:A Guide Personal Health Guide and Child
for Older People. Suggests ways to dis- Health Guide. Put Prevention Into
cuss health concerns, medicines, and issues Practice (PPIP) encourages Americans to get
important to older people. 29  pages.  Free.   the preventive care they need. Two patient
National Institute on Aging  booklets help you keep track of preventive
Information Center services:  Free.
Building 31, Room 5C27 Agency for Health Care Policy 
31 Center Drive MSC 2292 and Research
Bethesda, MD  20892-2292 Publications Clearinghouse
301-496-1752; TTY 1-800-222-4225  P.O. Box 8547
Web site: http://www.nih.gov/nia 1-800-358-9295
Web site: http://www.ahcpr.gov/consumer
Talking With Your Doctor. Focuses on a
healthy doctor-patient relationship and  Personal Health History. A confidential
suggests questions for patients to ask their  form that you can fill out and use to track
doctor. Written for cancer patients but also your health and medicine history is on the
helpful to others. 6 pages.  Free. American Medical Association Web site.
American Cancer Society Web site: http://www.ama-assn.org
1-800-ACS-2345 (Click on Search, and enter personal health
Web site: http://www.cancer.org  history.)
Health Cares Front Line:Primary
Healthfinder
Care Physicians. Discusses choosing a
http://www.healthfinder.govprovides
primary care doctor and making the most of
links to reliable health information from
the first visit.  Part of a series published by
the Federal Government and its many
the Health Pageson-line magazine.  
partners.
Web site: http://www.thehealthpages.com
19 Choosing
Doctor
a
Your Personal Health History
Use this form to keep track of your health history.  Take it with you to your doctor appointments 
to help keep your doctor up-to-date.
1.  I WAS IN THE HOSPITAL FOR (List conditions): Date
1. I was in the hospital for:
2.2 I.  h Ia vHeA hVadE t hHeAseD s uTrHgeEriSeEs: SURGERIES: Date
3.  I HAVE HAD THESE IInNjuJrUyR/CIoEnSd/iCtiOonNDITIONS/ILLNESSES: DYeaater
4.  I HAVE THESE ALLERGIES (List type of allergyfood, medicine, etc.and reaction):
20 Choosing
Doctor
a
Your Personal Health History
5.  I HAVE HAD THESE IMMUNIZATIONS (SHOTS):
(Note: In the list below, the names of the shots follow the names of the diseases they prevent.) 
For children: Suggested age Date(s) received
Hepatitis B  (HBV) Dose 1: Birth to 2 months
Dose 2: 2 months to 4 months
Dose 3: 6 months to 18 months
Dose 1 or 3: 11 years to 12 years
Polio (IPV) Dose 1: 2 months
Dose 2: 4 months
Dose 3: 6 months to 18 months
Dose 4: 4 years to 6 years
Haemophilus Influenzae type B (Hib) Dose 1: 2 months
Dose 2: 4 months
Dose 3: 6 months
Dose 4: 12 months to 15 months
Diphtheria, Tetanus, and
Pertussis ( DTaP, Td) Dose 1: 2 months
Dose 2: 4 months
Dose 3: 6 months
Dose 4: 15 months to 18 months
Dose 5: 4 years to 6 years
Td Once: 11 years to 16 years
Measles, Mumps, Rubella (MMR) Dose 1: 12 months to 15 months
Dose 2: 4 years to 6 years 
or Dose 2: 11 years to 12 years
Chickenpox (Varicella) (VZV) Once: 12 months to 18 months
or once: 11years to 12 years
21 Choosing
Doctor
a
Your Personal Health History
Pneumococcal Disease (PrevnarTM) Dose 1: 2 months
Dose 2: 4 months
Dose 3: 6 months
Dose 4: 12 months to 15 months
Hepatitis A Once: 2 years to 12 years 
in selected areas
For adults: Suggested age Date(s) received
Influenza Every year starting at age 65
Pneumococcal Once at age 65
Tetanus (Td) Every 10 years
6. I  TAKE THESE MEDICINES/SUPPLEMENTS (Bring with you, if possible):
7. MY FAMILY MEMBERS (PARENTS, BROTHERS, SISTERS, GRANDPARENTS) 
HAVE/HAD THESE MAJOR CONDITIONS:
8. I SEE THESE OTHER HEALTH CARE PROVIDERS:
Name Why I see them
22 Choosing
Treatments
Research shows that millions of Americans receive treatments that are unnec-
essary, costly, and even harmful to their health.  On the other hand, millions of
Americans do not get the treatments they need.
Study after study has found that the use of certain treatments varies
Quick-Check widelyfrom region to region, State to State, and city to city.

for Quality  But there are even large differences in the use of treatments
When choosing a treatment,  within a single health plan or hospital, or by a single doctor.  
make sure you understand:
That is why it is very important to work closely with
(cid:3)(cid:3) What your diagnosis is.
your doctor when treatment decisions need to be made.
(cid:3)(cid:3) Whether treatment is really 
Make sure your doctor knows your questions, con-
needed at this time.
(cid:3)(cid:3) What your treatment options are. cerns, and preferences. Ask your doctor if the treat-
(cid:3)(cid:3) Whether the treatment options are  ments he or she recommends are based on the latest
based on the latest scientific   scientific evidence.
evidence.
(cid:3)(cid:3) The benefits and risks of each  If you understand and feel comfortable with your treat-
treatment.
ment plan, you are more likely to do your part to make it
(cid:3)(cid:3) The cost of each 
work.  And, research shows that people who are actively
treatment.
involved in their own health care tend to get better results.
Learning About the Problem.
The first step in getting the right treatment is to tell your doctor whats going on.
This information might include:
 Your symptoms:
 When they first started:
 When they occur:
 Are they getting better?  Worse?
 What makes them better?  Worse?
 Are they affecting eating, sleeping, or other activities?   How?  
 Medicines you take: 
.
23 Choosing
Treatments
Before a treatment decision is made, your doctor needs to make a diagnosis.
Medical tests are an important way to help your doctor learn about the problem.  It is
important to make sure that any tests your doctor suggests are appropriate for you.
Medical Tests
Doctors order blood tests, x-rays, and other tests to help diagnose medical
problems.  Perhaps you do not know why you need a particular test or you
dont understand how it will help you.  Here are some questions to ask:
 How is the test done?
 What kind of information will the test provide?
 Is this test the only way to find out that information?
 What are the benefits and risks of having this test?
 How accurate is the test?
 What do I need to do to prepare for the test?  (What you do or dont do may 
affect the accuracy of the test results.)
 Will the test be uncomfortable?
 How long will it take to get the results, and how will I get them?
24 Choosing
Treatments
Medical Tests (continued)
 Whats the next step after the test?
One study found that anywhere from 10 percent to 30 percent of Pap smear test
results that were called normal were not.  Errors such as this can lead to a
wrong or delayed diagnosis.  
You want your tests to be done the right way, and you want accurate results.
What can you do?  
 For tests your doctor sends to a lab, ask which lab he or she uses, and why.
You may want to know that the doctor chooses a certain lab because he or she
has business ties to it.  Or, the health plan may require that the tests go there.
 Check to see that the lab is accredited by a group such as the College of
American Pathologists (800-323-4040) or the Joint Commission on
Accreditation of Healthcare Organizations (telephone 630-792-5000; Web
sitehttp://www.jcaho.org).  
 If you need a mammogram, make sure the facility is approved by the Food
and Drug Administration.  You can find out by checking the certificate in
the facility.  Or, call 800-4-CANCER 9:00 a.m.-4:30 p.m. EST to find out
the names and locations of certified facilities near you.
What about the test results? 
 Do notassume that no news is good news.  If you do not hear from your
doctor, call to get your test results.
 If you and your doctor think the test results may not be right, have the test
done again.
Getting the Diagnosis.  
When your doctor has decided what your problem is, he or she will give you a
diagnosis.  But you should know that reaching a diagnosis can be hard.  Sometimes
it can take a long time.  And sometimes it is hard to find out exactly what is
wrong.
Ask your doctor to explain what you have and how it might affect you and your
family.  
 What is the diagnosis?
25 Choosing
Treatments
 What is my prognosis (outlook for the future)? 
 What changes, if any, will I need to make in my daily life?
 Is there a chance that someone else in my family might get the same condition?
 Will I need special help at home for my condition?  If so, what type of help?
Ask for materials you can take home.  You also might want to find out if there
are any support groups for people with your condition. 
Looking at the Options.
The next step is for you and your doctor to look at your treatment options.  
Your doctor may recommend one or more of the following: 
 Behavior change (for example: eating a healthier diet, getting more 
exercise, quitting smoking).
 Prescription medicine.
 Non-prescription (over-the-counter) medicines.
 Surgery.
 Rehabilitation (such as physical therapy).
Support
Self-help groups offer support to people with disabilities, cancer, and many other health
problems.  The groups are made up of people who have been there and who share experi-
ences and information.  
Call the American Self-Help Clearinghouse for information on national groups.  It also can
refer you to any State or local self-help clearinghouses in your area.  If you want to start
your own self-help group, the Clearinghouse has information to help you.
To contact the American Self-Help Clearinghouse:
Call: 973-625-3037
or, if calling from New Jersey only, 1-800-367-6274
Write: American Self-Help Clearinghouse
St. Clares Health Services
25 Pocono Road, Denville, NJ 07834-2995
Visit Web site:  http://www.mentalhelp.net/selfhelp/
26 Choosing
Treatments   
Other treatments (for example, chiropractic services, massage, or acupuncture).
 Watchful waiting. (You and your doctor keep track of your symptoms and watch
for any changes.  If there are changes, then treatment might be the next step.)
Not all treatments have been proven by research studies to workor to be the best
treatment for what you have.  Clinical practice guidelines can help doctors and
patients make the right treatment choices for some conditions.  Some of these
guidelines are based on scientific evidence about which treatments work for 
certain conditions and which do not.  Ask your doctor if there are evidence-
based guidelines on treatments for your condition. 
Ask about any books or special materials that can help you decide which treat-
ment is best for you.  For example, shared decisionmaking programs use
video, audio, and computer graphics to help patients make decisions based on
science and on their own values and preferences.  Self-help groups, patient orga-
nizations (such as the American Cancer Society and the American Diabetes
Association), the Internet, and your library are other sources of information.
All treatments have benefits and risks.  To learn more about them you may want
to ask your doctor:
 What is the recommended treatment?  Are there other choices?
 What are the chances the treatment will work?
 What are the expected results?  When will I see them?
 What are the risks?
 What are the benefits?
 Are there any side effects?  (Most treatments have them.)  What can be done 
about them?
 Is the treatment painful?  How can the pain be controlled?
27 Choosing
Treatments
 What happens if I choose to have no treatment at all?
 How much does the treatment cost?  Will my health plan pay?
Once you have the answers to these questions, you might want to make a chart of
Benefits and Risks or Pros and Cons to help you decide if the treatment is
right for you.  Here is a sample chart:
BENEFITS (PROS) RISKS (CONS)
Treatment has worked well for  Some minor side effects (rash, 
others with my condition. stomach upset) could be troubling.
The medicine only needs to be taken  The medicine is costly.
once a day.
No major side effects are expected.
What Can You Do to Help the Treatment Work?
 Ask about anything you do not understand.
 Follow the doctors directions.  If you have a problem with the directions, tell
the doctorthe sooner, the better.
 If you have made any changes in the treatment plan, tell the doctor.
 If you feel worse, have new symptoms, or have side effects from the treat-
ment, call your doctor.
Making Decisions About Surgery
Some surgery has to be done right away.  But most surgery is not an emer-
gency.  That means you have time to talk with your doctor and decide what is
best for you.
No surgery,not even minor surgery,is risk-free. To decide if a procedure is
right for you, learn about it and its possible benefits and risks.  Research shows
that patients who know the facts about surgery and other treatments can better
work with their doctors to make decisions based on science and on what the
patient prefers.  The result?  A more satisfied patient.
28 Choosing
Treatments   
Here are some questions you may want to ask your doctor or surgeon:
 Do I really need this surgery?  Is there some other way to treat my condition?
 What will happen if I wait until later to have surgery?  Or never have it at all?
 How often does this type of surgery help my kind of problem? How much 
does it help?
 Where will the surgery be performed?
 Does the surgeon, hospital, or surgery center have a lot of experience 
with this kind of procedure?
 Is the surgeon experienced and qualified to perform the surgery?
 What complications or side effects might I have?
 What kind of pain might I have?  How will it be treated?
 How long will it take me to recover?  Will I need help at home?  What kind 
of help?
 How much does the surgery cost?  
 Will my health plan pay?
Getting a Second Opinion
A second opinion is when another doctor gives his or her views about what
you have and how it should be treated.  A second opinion can help you
decide whether the surgery is right for you at this time.  Your doctor and sur-
geon should welcome your request for a second opinion.  Your health plan
may even require one for some types of surgery.  
You can ask your doctor, health plan, a local medical school, or local medical
society for help in finding someone to give you a second opinion.  But first
check to see if your health plan covers second opinions.
29 Choosing
Treatments   
Ambulatory Surgery Centers
Today more and more surgeries are done in places other than hospitals.  These are in and
out (ambulatory) surgery centers, where you may stay for a few hours or up to one night.
If you plan to have surgery at such a center, call your health plan or visit the center to find
out:
 If your health plan will cover your care there.
 If it is licensed.  Then check to see if it is accredited by a group such as the Joint
Commission on Accreditation of Healthcare Organizations (telephone 630-792-5800;
Web site http://www.jcaho.org) or the Accreditation Association for Ambulatory
Healthcare (847-676-9610).  The accreditation certificate should be posted in the facility.
 How well trained and experienced the centers health care professionals are.
 If the center is affiliated with a hospital.  If it is not, find out how the center will handle
any emergency that could happen during your visit.
SOURCES OF ADDITIONAL INFORMATION
Be Informed:Questions to Ask Your FDA Guide to Choosing Medical
Doctor Before You Have Surgery. A list Treatments. Designed to help consumers
and in-depth discussion. 12 pages.  Free.   avoid fraud and deception when choosing med-
ical treatment.  Use publication number (Reprint
Prescription Medicines and You.
95-1223) when ordering.  6 pages. Free. 
Prepared by the Agency for Healthcare
Food and Drug Administration
Research and Quality and the National
Office of Consumer Inquiries:  HFE-88
Council on Patient Information and
5600 Fishers Lane
Education.  Includes tips for getting involved
Rockville, MD  20857
in your treatment, asking the right questions
301-443-3170
about your prescriptions, and keeping track of
Web site: http://www.fda.gov
your medicines.  17 pages. Free. 
Taking Part in Clinical Trials:What
The National Guideline Clearinghouse will
Cancer Patients Need to Know. This
make clinical practice guidelines available to
booklet by the National Cancer Institute
the public via the World Wide Web.  The
describes how clinical trials work, and their pos-
Clearinghouse was developed by AHCPR,
sible benefits and drawbacks.  18 pages. Free.
the American Medical Association, and the
Cancer Information Service: 
American Association of Health Plans. 
1-800-4-CANCER (1-800-422-6237) 
Web site: http://www.guideline.gov.
9:00 a.m.-4:30p.m. EST.  Also available on
the new Clinical Trials Web site: 
http://cancertrials.nci.nih.gov
30 Choosing
Treatments   
When You Need an Operation. This Information about womens health, mens
brochure by the American College of health, and treatments for arthritis, diabetes,
Surgeons covers how to assess a surgeons and other conditions is available from the
qualifications, whether to seek a second opin- Health Pageson-line magazine.  Web site:
ion, and informed consent and cost issues. It http://www.thehealthpages.com/article5.htm
and 12 other informational brochures are
available free from:
The American College of Surgeons
Office of Public Information
633 N. Saint Clair Street
Chicago, IL60611-3211
312-202-5391
Web site: http://www.facs.org
The Web site of the American Medical
Association offers a helpful on-line guide to
common radiology tests.  Included are
descriptions and actual images of a CT scan, Healthfinder
fetal ultrasound, MRI, mammography, and  http://www.healthfinder.govprovides
links to reliable health information from
x-ray.  
the Federal Government and its many
Web site:http://www.ama-assn.org/insight/
partners.
gen_hlth/rad/rad.htm
NOTES
31 Choosing
Treatments   
NOTES
32 Choosing
Hospital
a
How can you choose the best quality hospital for the care you need?  It is impor-
tant to consider quality, because research shows that some hospitals simply do a
better job than others.  For example, we know that hospitals that do a greater
number of the same surgeries have better outcomes for their patients.  The fol-
lowing questions can help you make the best choices.
NOTE:  You may not have a choice right now because of your health
plan or doctor.  But keep these questions in mind for when
Quick-Check you might make a change.

for Quality  
1. Does the hospital meet national quality 
Look for a hospital that:
(cid:3)(cid:3) Is accredited by the Joint Commission  standards? (cid:3)(cid:3) YES (cid:3)(cid:3) NO
on Accreditation of Healthcare 
Organizations. Hospitals can choose to be surveyed by the
(cid:3)(cid:3) Is rated highly by State or consumer  Joint Commission on Accreditation of
or other groups.
Healthcare Organizations (JCAHO) to make
(cid:3)(cid:3) Is one where your doctor has 
sure they meet certain quality standards.  The
privileges,if that is important to you.
(cid:3)(cid:3) Is covered by your health plan. standards address the quality of staff and
(cid:3)(cid:3) Has experience with your condition. equipment, andmost recentlythe hospitals
(cid:3)(cid:3) Has had success with your condition. success in treating and curing patients.  If a hospi-
(cid:3)(cid:3) Checks and works to improve  tal meets those standards, it becomes accredited
its own quality of care.
(gets a seal of approval).  Reviews are done at least
every 3 years.  Most hospitals participate in this program.
The JCAHO prepares a performance report on each hospital that it surveys.  The
report lists:
 Accreditation status (six levelsfrom the lowest, Not Accredited, to the
highest, Accredited with Commendation).
 Date of the survey.
 Evaluation of the key areas reviewed during the survey.
 Results of any followup activity.
 Areas needing improvement.
 Comparison with national results.
You can order JCAHOs performance reports free of charge by calling 
630-792-5800.  Or, check the JCAHOs Web site at http://www.jcaho.org for a
hospitals performance report or for its accreditation status.
33 Choosing
Hospital
a
2. How does the hospital compare with others in my area? 
One important way to learn about hospital quality is to look at hospital report
cards developed by States and consumer groups.  A recent study about such
reports found that besides helping consumers make informed choices, they also
encourage hospitals to improve their quality of care.  This is a very good reason
to look for and use consumer information about hospitals.  Here are some ways
to find such information:
 Some Statesfor example,  Pennsylvania, California, and Ohiohave laws
that require hospitals to report data on the quality of their care.  The infor-
mation is then given to the public so consumers can compare hospitals.
 Some groups gather information on how well hospitals perform and how
satisfied their patients are.  An example is the Cleveland Health Quality
Choice Program, which is made up of businesses, doctors, and hospitals.
 Consumer groups publish guides to hospitals and other health care choices
in various cities.  
Find out what kind of information is available where you live by calling your State
department of health, health care council, or hospital association.  Also, ask your
doctor what he or she thinks about the hospital.
3. Does my doctor have privileges (is permitted to admit patients) at the 
(cid:3)(cid:3) (cid:3)(cid:3)  
hospital?  YES NO
If not, you would need to be under the care of another doctor while at the hospital.
(cid:3)(cid:3) (cid:3)(cid:3)
4. Does my health plan cover care at the hospital?  YES NO
If not, do you have another way to pay for your care?
If going to a certain hospital is important to you, keep that 
in mind when choosing a doctor and/or health plan. In 
general, you will go to the hospital where your doctor has 
privileges.
34 Choosing
Hospital
a
(cid:3)(cid:3) (cid:3)(cid:3)  
5. Does the hospital have experience with my condition? YES NO
For example, general hospitals handle a wide range of routine conditions, such as
hernias and pneumonia.  Specialty hospitals have a lot of experience with certain
conditions (such as cancer) or certain groups (such as children).  You may be able to
choose General Hospital X for gallbladder surgery, Specialty Hospital Y if you
need care for a heart condition, and Specialty Hospital Z for your children.
You also may want to find out if the hospital has a special team of health profession-
als that works with people with your condition or treatment.
(cid:3)(cid:3) (cid:3)(cid:3)  
6. Has the hospital had success with my condition? YES NO
Research shows that hospitals that do many of the same types of procedures tend
to have better success with them.  In other words, practice makes perfect.  Ask
your doctor or the hospital if there is information on:
 How often the procedure is done there.
 How often the doctor does the procedure.
 The patient outcomes (how well the patients do).
Also, some health departments and others publish reports on outcomes studies
about certain procedures.  These studies show, for example, how well patients do
after having heart bypass surgery.  Such studies can help you compare which
hospitals and surgeons have had the most success with a procedure.
7. How well does the hospital check and improve on its own 
quality of care?
More and more hospitals are trying to improve the quality of their care.  One
way is to keep track of patient outcomes for certain procedures.  Another way is
to keep track of patient injuries and infections that occur in the hospital.  By
finding out what works and what doesnt, the hospital can improve the way 
it treats patients.
Ask the hospital quality management (or assurance) department how it monitors
and improves the hospitals quality of care.  Also, ask for any patient satisfaction
surveys the hospital has done.  These will tell you how other patients have rated
the quality of their care.
35 Choosing
Hospital
a 
SOURCES OF ADDITIONAL INFORMATION
Hospital Select.An on-line hospital loca- All Hospitals Are Not Created Equal.
tor that has basic information on all U.S. Information and questions to ask to help you
hospitals: size, capabilities, accreditation. choose the hospital that best suits your
The site also has links to the American needs.  Part of a series published by Health
Medical Association home page that lists Pageson-line magazine.   
physicians and specialists. Web site: http://www.thehealthpages.com/
Web site: http://www.hospitalselect.com articles/ar-hosps.html
Choosing a Hospital and Hospital
A Patients Bill of Rights.Available from Quality Checklist. On-line Web site
the American Hospital Association.  Free. offered by the Pacific Business Group on
Telephone: 312-422-3000 Health .
Web site: http://www.aha.org  (Click on Web site: http://www.healthscope.org/
Resource Center; go to Search at bottom of hospital/quality.asp
page; type in Patients Bill of Rights.)  Also
available from Fax on Demand, at 312-422- Healthfinder
2020; document number 471124. http://www.healthfinder.govprovides
links to reliable health information from
the Federal Government and its many
partners.
NOTES
36 Choosing
Long-Term Care
Long-term care means helping people of any age with their medical needs or
daily activities over a long period of time.  Long-term care can be provided at
home, in the community, or in various types of facilities.  This section deals 
mainly with older people who need long-term care.  However,
the information also may be useful for younger people with
Quick-Check  disabilities or illnesses that require long-term care.

for Quality  
When you look for long-term care, it is important
Look for long-term care that: to remember that quality varies from one place or
(cid:3)(cid:3) Has been found by State caregiver to another.
agencies,accreditors,or others to 
provide quality care. It is also important to think about long-term care
(cid:3)(cid:3) Has the services you need. before a crisis occurs.  Making long-term care
(cid:3)(cid:3) Has staff that meet your needs. decisions can be hard even when planned well
(cid:3)(cid:3) Meets your budget. in advance.
Research shows that to make the best choices, you
need to think about:
  What your options are.
  Whether they meet your or your family members needs (physical, medical,
emotional, financial, etc.).
  How to find the highest quality care.  
Types of Long-Term Care
Research shows that many people do not know about or understand long-term care
options.  Following are brief descriptions of the major types of long-term care:
Home carecan be given in your own home by family members, friends,
volunteers, and/or paid professionals.  This type of care can range from help with
shopping to nursing care.  Some short-term, skilled home care (provided by a nurse
or therapist) is covered by Medicare and is called home health care.  Another type
of care that can be given at home is hospice care for terminally ill people.
Community services are support services that can include adult day
care, meal programs, senior centers, transportation, and other services.  These
can help people who are cared for at homeand their families.  For example,
adult day care services provide a variety of health, social, and related support
services in a protective setting during the day.  This can help adults with impair-
mentssuch as Alzheimers diseasecontinue to live in the community.  And it
can give family or friend caregivers a needed break. 37 Choosing
Long-Term Care
Supportive housing programs offer low-cost housing to older people
with low to moderate incomes.  The Federal Department of Housing and Urban
Development (HUD) and State or local governments often develop such housing
programs.  A number of these facilities offer help with meals and tasks such as
housekeeping, shopping, and laundry.  Residents generally live in their own
apartments. 
Assisted living provides 24-hour supervision, assistance, meals, and
health care services in a home-like setting.  Services include help with eating,
bathing, dressing, toileting, taking medicine, transportation, laundry, and house-
keeping.  Social and recreational activities also are provided.
Continuing care retirement communities (CCRCs) provide a full range
of services and care based on what each resident needs over time.  Care usually
is provided in one of three main stages: independent living, assisted living, and
skilled nursing.
Nursing homes offer care to people who cannot be cared for at home or
in the community.  They provide skilled nursing care, rehabilitation services,
meals, activities, help with daily living, and supervision.  Many nursing homes
also offer temporary or periodic care.  This can be instead of hospital care, after
hospital care, or to give family or friend caregivers some time off (respite care).
Another type of long-term care takes place in home-like settings called
Intermediate Care Facilities for the Mentally Retarded.  They provide a wide
variety of services to mentally retarded and developmentally disabled people
from youth to old age.  Services include treatment to help residents become as
independent as possible, as well as health care services.
You can learn about long-term care options in your area by contacting:
 The Eldercare Locator (1-800-677-1116, weekdays, 9.00 a.m. to 8.00 p.m.,
EST).  This service can refer you to your Area Agency on Aging.
 Area Agencies on Aging provide information on a wide variety of 
community-based services.  Examples are meals, home care, adult day care,
transportation, housing, home repair, and legal services.
 Your State or local Long-Term Care Ombudsman (call the Eldercare
Locator for the number).  Ombudsmen visit nursing homes and other long-
term care facilities to check on and resolve complaints, protect residents
rights, and give emotional support to lonely older people.  A call to your
area Ombudsman can give you information on:
38 Choosing
Long-Term Care
- The most recent State survey (inspection) report of the facility.
- The number of outstanding complaints.
- The number and nature of complaints lodged in the last year.
- The results of recent complaint investigations.
 Nursing Home Compare
http://www.medicare.gov/nhcompare/home.aspa Web site created by the
Health Care Financing Administration, which runs Medicare and Medicaid.
This site helps you locate nursing homes in your area.  It also has inspec-
tion records for nursing homes that receive Medicare or Medicaid funds.
 Hospital discharge planners.
 Social workers (some can be case managers or care managers, 
who can help you coordinate long-term care services).
 Doctors and other health care professionals.
 Local nursing facilities.
 Volunteer groups that work with older people.
 Clergy or religious groups.
 Family and friends.
There are three important questions to ask yourself when deciding
about long-term care for yourself or a loved one:
1. What kind of services do I need?
2. How will I pay for these services?
3. How can I choose the best quality services?
What kind of services do I need?  
Think of long-term care as a menu of services.  A person may need only one or a
few kinds of services.  Or, several kinds may be needed over the course of a 
persons older years.
To help find out what kind of services you or a loved one need, check the items
below that apply.  Keep in mind that these needs may change over time.
Do you or your loved one need help with daily activities?  Health care needs?
Both?  You can use the chart on page 40 to help you identify the type(s) of long-
term care that meet your needs.
This chart shows which types of long-term care services offer which kinds of
help.  The Relative Costs information shows how costly the settings can be
39
when compared with each other. Choosing
Long-Term Care
Help With Daily Activities
(cid:3)(cid:3) (cid:3)(cid:3)
Shopping Dressing
(cid:3)(cid:3) (cid:3)(cid:3)
Preparing meals Grooming
(cid:3)(cid:3) (cid:3)(cid:3)
Eating Going to the bathroom 
(cid:3)(cid:3) (cid:3)(cid:3)
Laundry and other housework Remembering to take medicines
(cid:3)(cid:3) (cid:3)(cid:3)
Home maintenance Walking
(cid:3)(cid:3) (cid:3)(cid:3)
Paying bills and other 
money matters (cid:3)(cid:3)
(cid:3)(cid:3)
Bathing (cid:3)(cid:3)
Health Care Needs ( as recommended by a doctor or other health 
care provider)
(cid:3)(cid:3) (cid:3)(cid:3)
Physical therapy Alzheimers disease care
(cid:3)(cid:3) (cid:3)(cid:3)
Speech therapy Health monitoring (for diabetes, 
(cid:3)(cid:3) for example)
Occupational therapy 
(cid:3)(cid:3)
(cid:3)(cid:3) Pain management
Rehabilitation 
(cid:3)(cid:3)
(cid:3)(cid:3) Nursing care services
Medical nutritional therapy 
(cid:3)(cid:3)
(cid:3)(cid:3) Other medical services provided
Oxygen
by a doctor or other clinician
(cid:3)(cid:3)
Care for pressure 
(cid:3)(cid:3)
ulcers or other wounds
Supportive
Home Community Housing Assisted Nursing
Care Services Programs Living *CCRC Homes
Help with 
daily       
activities
Help with 
health care    
needs
Relative  Low to Low to Low to Medium High High
Costs High Medium Medium to High
*Continuing Care Retirement Communities
40 Choosing
Long-Term Care
How will I pay for these services?
Long-term care can be very expensive.  In general, health plans and programs do
not routinely cover long-term care at home or in nursing homes.  Here is some
general information about long-term care coverage:
 Medicare is the Federal health insurance program for people age 65 and
older and for some disabled younger people.  Medicare generally does not
pay for long-term help with daily activities.  Medicare pays for very limited
skilled nursing home care after a hospital stay.  If you need skilled care in
your home for the treatment of an illness or injury, and you meet certain
conditions, Medicare will pay for some of the costs of nursing care, home
health aide services, and different types of therapy.
 Medicaid is a Federal-State program that pays for health services and long-
term care for low- income people of any age.  The exact rules for who is
covered vary by State.  Medicaid covers nursing home care for people who
are eligible.  In some States, Medicaid also pays for some home and com-
munity services. 
 Private Insurance. Medicare beneficiaries may supplement their policy
with insurance purchased from private organizations.  Most of these poli-
ciesoften called Medigap insurance or by a similar name will help pay
for some skilled care, but only when that care is covered by Medicare.
Medigap is not long-term care insurance.
Commercial insurers offer private policies called long-term care insurance.
These policies may cover services such as care at home, in adult day care,
in assisted living facilities, and in nursing homes.  But plans vary widely.  If
you have such a policy, ask your insurer what it covers.  If you think you
may need long-term care insurance, start shopping while you are relatively
young and healthy, and shop carefully.   
 Personal Resources. You may need to use resources such as savings or life
insurance to pay for long-term care.  Most people who enter nursing homes
begin by paying out of their own pockets.  As their personal resources are
spent, many people who stay in nursing homes for a long time eventually
become eligible for Medicaid.
41 Choosing
Long-Term Care
Your State Health Insurance Program (SHIP) can give you general information
about Medicare, Medicaid, managed care plans, and the types of health insurance
that can supplement Medicare, including Medigap and long-term care insurance.
Counselors also can help you with questions about your medical bills, insurance
claims, and related matters.   These services are free.  To find the phone number
of the SHIP office in your State, call the Medicare Hotline at 1-800-633-4227.
Or, look at the consumer Web site for MPedicare services,
http://www.medicare.gov.
How can I choose the best quality services?
Here are some tips for choosing the kinds of long-term care people most often
use: home care (including home health care) and nursing homes.
Home Care
 In many States, home care agencies must be licensed.  Check with your
State health department to see if your State requires it.  If so, be wary if an
agency is not licensed. 
 Ask if the agency is certified by Medicare.  Medicare inspects home health
care agencies to assure they meet certain Federal health and safety require-
ments.  Medicare will pay for services only if the agency is Medicare-
approved and if the services are covered by Medicare.
 If the home health care agency is certified by Medicare, you can review its
survey report.  Call the Medicare Hotline at 1-800-633-4227 and ask to be
referred to the Home Health Hotline for your State.  You can request a copy
of the report from that hotline.
 Find out if the agency has been accredited (awarded a seal of approval)
by a group such as the Joint Commission on Accreditation of Healthcare
Organizations (630-792-5800); http://www.jcaho.org) or the Community
Health Accreditation Program (1-800-669-1656; http://www.chapinc.org).
 Contact your State or local consumer affairs office to see if any complaints
have been filed against a home care agency.  Also ask about the outcome of
any complaint investigations.
 Whether you work with an agency or hire someone yourself, carefully check
the backgrounds of the people who will be coming into your home.  Ask for
references who have worked with the agency or person. Call them, and ask
about their experiences.  Would they use the agency or person again?
42 Choosing
Long-Term Care
 Does the home care worker have the necessary skills and training for your
needs?  Ask to see training certificates.  Make sure the worker knows how
to safely assist and care for patients.
 Does the agency have supervisors who check on the quality of care its
workers provide?
 How does the agency follow up on and resolve complaints?
Nursing Home Care
 All nursing homes that participate in Medicare or Medicaid are visited about
once a year by a team of trained inspectors.  They check the home and the
care provided and prepare a survey report.  You have a right to review the
report, which must be posted in the nursing home.  Speak to the nursing
home administrator to learn more about any problems that appear on the
report.  Ask if the problems have been corrected.
 Call your State or local Long-Term Care Ombudsman.  Ombudsmen visit
nursing homes on a regular basis and know about each nursing home in
their area.  You can ask about the latest survey report and about complaints
that have been filed.  You can also ask what to look for when visiting local 
nursing homes.
 Compare the inspection records of your top choices by visiting the
Nursing Home Compare Web site:
http://www.medicare.gov/nhcompare/home.asp.
 Some nursing homes have been accredited by a national group such as the
Joint Commission on Accreditation of Healthcare Organizations 
(630-792-5800).  It may be helpful to find out if the home participates in
this voluntary process and to learn the results.
 Location is very important.  Is the nursing home close enough so that 
family and friends can visit?  Close enough for the residents personal 
doctor to visit?
 The most important step is to visitmore than onceand look around.  Go
at different times of the dayfor example, first thing in the morning and at
mealtimes.  
 Do residents seem to enjoy meals?  Is there help for those who cannot eat
on their own?  If possible, eat a meal at the facility.
 Is the home clean and free of odors?  Is it pleasant?
43 Choosing
Long-Term Care
 Are residents clean, well groomed, and dressed appropriately for the season
and time of day?  Are they involved in activities?
 Are staff friendly, helpful, and respectful?
Talk to staff, residents, and families to find out what they think of the facility.
 Ask to see the area where physical therapy and other rehabilitation services
are provided.
 Is the nursing home experienced with special needsfor example, problems
with swallowing?
 Who provides the medical care?
 Which hospital(s) does the nursing home use?
NOTES
44 Choosing
Long-Term Care
SOURCES OF ADDITIONAL INFORMATION
A Guide to Choosing a Nursing Myths and Realities of Living in a
Home.Has sections on gathering informa- Nursing Home,How to Pay for
tion, visiting nursing homes, and residents Nursing Home Care,What
rights and quality of life.  Includes phone Consumers Need to Know About
lists for State ombudsmen, State survey Private Long-Term Care,and Circle of
agencies, and insurance counseling.  47 Care.  A series of six pamphlets on select-
pages.  Free.  Medicare: 1-800-633-4227 ing and paying for long-term care. Free.
Web site:  For more than one copy: 1-800-663-7387
http://medicare.gov/Publications/Search/ (packets of 25).
View/ViewPubList.asp?Language=English The American Health Care Association
1201 L St., NW
Resource Directory for Older People.
Washington, DC 20005-4014
The Administration on Aging and National
202-842-4444
Institute on Aging offers lists of hundreds of
Web site: http://www.ahca.org
organizations, names, and phone numbers,
(Click on Consumer Information)
including State agencies on aging and State
long-term care ombudsmen  programs.  Not Nursing Home Life:A Guide for
available in print.  Web site:   Residents and Families. Includes first-
http://www.aoa.gov/default.htm hand accounts from residents and family
members. Topics include adjusting to nurs-
American Association of Homes and
ing home life; services and staff; getting
Services  for the Aging.Offersa series of
what you need; and dealing with poor care.
pamphlets on nursing homes, assisted living,
Has useful appendices and resource lists. 
continuing care retirement communities,
44 pages.  Free.  
community services, housing options for
The American Association of Retired Persons 
older people, and understanding Medicare
601 E. St., N.W.
managed care.  Free.
Washington, DC  20049
1-800-675-9253
1-800-424-3410
Web site: http://www.aahsa.org
Web site: http://www.aarp.org
How to Choose a Home Care Provider.
Choosing a Nursing Home andAll
Explains who provides what kind of care, the
About Home Healthare available on-line
various services offered, who pays for ser-
from Health Pages.Web sites:
vices.  Has billing and payment information.
http://www.thehealthpages.com/articles/
Lists patientsrights, accrediting agencies,
ar-nrshm.html
and State resources and information.  Free. 
http://www.thehealthpages.com/articles/
National Association for Home Care
ar-homeh.html
202-547-7424
Web site: http://www.nahc.org   
Healthfinder
http://www.healthfinder.govprovides
links to reliable health information from
the Federal Government and its many
partners.
45 Health
Information
Internet
on the
Are you looking for health information on the Internet but dont know where to
start?  Try Healthfinder at http://www.healthfinder.gov.  The Healthfinder site
offers reliable consumer health information from the Federal Government and its
many partners.  The site was developed by the U.S. Department of Health and
Human Services.
The Healthfinder site can help you quickly find the health information you want
by linking you to:
 Hundreds of Web sites with consumer health information.
 On-line publication catalogs and ordering information.
 On-line brochures and other documents.
 FAQS (frequently asked questions) on important health issues.
 Databases and search engines (Web sites that help you find information).
You may want to list some other helpful Web addresses that you find in this guide:
46 Quick-Check

for Quality 
When choosing a treatment, 
make sure you understand:
(cid:3)(cid:3) What your diagnosis is.
Quick-Check (cid:3)(cid:3) Whether treatment is really 
for Quality  needed at this time.
(cid:3)(cid:3) What your treatment options are.
Look for a plan that:
(cid:3)(cid:3) Has been rated highly by its  (cid:3)(cid:3) Whether the treatment options are 
based on the latest scientific  
members on the things that are
evidence.
important to you.
(cid:3)(cid:3) Does a good job of helping people (cid:3)(cid:3) The benefits and risks of each 
treatment.
stay well and get better.
(cid:3)(cid:3) Is accredited,if that is important  (cid:3)(cid:3) The cost of each 
treatment.
to you.
(cid:3)(cid:3) Has the doctors and hospitals you 
want or need.
(cid:3)(cid:3) Provides the benefits you need.
Quick-Check
(cid:3)(cid:3) Provides services where and  
when you need them. for Quality  
(cid:3)(cid:3) Meets your budget.
Look for a hospital that:
 (cid:3)(cid:3) Is accredited by the Joint Commission 
on Accreditation of Healthcare 
Organizations.
(cid:3)(cid:3) Is rated highly by State or consumer 
Quick-Check or other groups.

(cid:3)(cid:3) Is one where your doctor has 
for Quality 
privileges,if that is important to you.
Look for a doctor who: (cid:3)(cid:3) Is covered by your health plan.
(cid:3)(cid:3) Is rated to give quality care. (cid:3)(cid:3) Has experience with your condition.
(cid:3)(cid:3) Has the training and back- (cid:3)(cid:3) Has had success with your condition.
ground that meet your needs.
(cid:3)(cid:3) Checks and works to improve 
(cid:3)(cid:3) Takes steps to prevent illnessfor  its own quality of care.
example,talks to you about 
quitting smoking.
(cid:3)(cid:3) Has privileges at the hospital  
of your choice.
(cid:3)(cid:3) Is part of your health plan,unless 
you can you afford to pay extra. Quick-Check 

(cid:3)(cid:3) Encourages you to ask questions. for Quality  
(cid:3)(cid:3) Listens to you. Look for long-term care that:
(cid:3)(cid:3) Explains things clearly. (cid:3)(cid:3) Has been found by State
(cid:3)(cid:3) Treats you with respect. agencies,accreditors,or others to 
provide quality care.
(cid:3)(cid:3) Has the services you need.
(cid:3)(cid:3) Has staff that meet your needs.
(cid:3)(cid:3) Meets your budget.
47 U.S. Department of Health and Human Services
AHCPR Pub. No.99-0012
Updated July 2001