How can I judge the quality of a health plan?
When judging a health plan, make sure that you don’t just base your decision on two factors: price and whether your family’s doctor will be included on the plan. There are other factors that you should base your judgment on.
When the health plan meets certain quality standards set by independent organizations, accreditation is earned. These organizations include the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
This organization is interested in reducing medical errors and evaluating health plans. According to Dr. Dennis O’Leary, JCHAO’s president, “Confusion in identifying patients, miscommunication among caregivers, wrong-site surgery, infusion pumps, medication mix-ups and clinical alarm systems will be the focus of our National Patient Safety Goals for 2003.”
O’Leary claims, “The know-how to prevent these errors exists. We now need to focus on making sure that health care organizations are actually taking these preventive steps.”
The three other major health care accrediting groups are: Accreditation Association for Ambulatory Healthcare, national Committee for Quality Assurance, and the URAC, the American Accreditation HealthCare Commission.
You should also judge your health care plan based on the financial strength ratings. There are several major companies that will be able to tell you how solvent your health plan is. However, they will not give you information regarding the health plan’s customer service or satisfaction. These companies are:
- Moody’s Inventors Service
- A.M. Best
- Fitch Ratings
- Weiss Ratings
- Standard and Poor’s (S&P)
Another great way to judge the quality of a health plan is to look at its report card. Several different consumer groups, state insurance officials and independent web sites will be able to issue these “report cards”.
The final and probably the best way to judge a health plan is to check the number of customer complaints and check the customer satisfaction. There are many state insurance departments that track the number of customer complaints filed against insurers (usually HMOs). Many consumers simply look at the affordability of a health care plan and whether or not it has enough coverage. Those are good factors, but you should take other things into consideration when picking a health plan to be a part of.