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Health Insurance - Choosing Treatments
Research shows that millions of Americans receive treatments that are unnecessary, 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 widely—from region to region, State to State, and city to city. But there are even large differences in the use of treatments within a single health plan or hospital, or by a single doctor. That is why it is very important to work closely with your doctor when treatment decisions need to be made. Make sure your doctor knows your questions, concerns, and preferences. Ask your doctor if the treatments he or she recommends are based on the latest scientific evidence. Quick Check for Quality When choosing a treatment, make sure you understand:
If you understand and feel comfortable with your treatment plan, you are more likely to do your part to make it work. And, research shows that people who are actively involved in their own health care tend to get better results. Learning About the Problem 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: __________________________________________________ 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 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 don't 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? _________________________________________________ What's 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?
What about the test results?
Getting the Diagnosis Ask your doctor to explain what you have and how it might affect you and your family. What is the diagnosis? _________________________________________________ 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. Support 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. Looking at the Options
Not all treatments have been proven by research studies to work-or 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 treatment 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 organizations (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? _________________________________________________ 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):
What Can You Do to Help the Treatment Work?
Making Decisions About Surgery 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. 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 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. Ambulatory Surgery Centers
Health Insurance -
Choices Programs & Coverage Types For Quality Health Care
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