A Health Insurance Guide For You And The Family

How Do I Find Out About Quality?

Quality is hard to measure, but more and more information is becoming available. There are certain things you can look for and questions you can ask. Whatever kind of plan you are considering, you can check out individual doctors and hospitals. For doctors, see "Tips on Choosing a Doctor."

Many managed care plans are regulated by Federal and State agencies. Indemnity plans are regulated by State insurance commissions. Your State Department of Health or insurance commission can tell you about any plan you are interested in. You can also find out if the managed care plan you are interested in has been "accredited," meaning that it meets certain standards of independent organizations.

Some States require accreditation if plans serve special groups, such as people in Medicaid. Some employers will only contract with plans that are accredited. Several national organizations review and accredit plans and institutions (see "Sources of Additional Information"). You can contact these organizations to see if a plan you are considering, or an institution in the plan, is accredited.

Another approach is to ask the plan how it ensures good medical care. Does the plan review the qualifications of doctors before they are added to the plan? Plans are supposed to review the care that is given by their doctors and hospitals. How does the plan review its own services, and has it made changes to correct problems?

How does the plan resolve member complaints? Some managed care plans survey members about their health care experiences. Ask the plan for a report of the survey results. Some plans and independent organizations are also beginning to produce "report cards."