Appendix F:

How Do I Choose a Primary Care Physician or Health Plan?

Deciding who helps you take care of your health is an important decision and requires serious consideration. You may decide to consider a primary care physician in his or her own private practice. Your physician may be affiliated with an independent group of physicians, or participate in one of several types of "managed care" plans such as a health maintenance organization. Although this information covers how to decide on a health plan, some of the suggestions are applicable to choosing a primary care provider, regardless to where the medical services are provided.

Things to Consider:

What is important to you?

Will you receive quality health care?

Where do I find information on a particular health plan?

What other things should I consider?

What is important to you ?

Four important factors should be considered in deciding on a health care plan.

1. Cost: Who pays for your medical care?
2. Coverage: What benefits are offered (covered)?
3. Convenience: Is the location convenient and easily accessible?
4. Choice: Can you choose a primary care physician or change to another physician if you are not satisfied? Are you comfortable with the hospital(s) the health plan uses? Does it have expertise in the kind of services you might need (i.e., heart, cancer, etc.)?

Will you receive quality health care ?

In assessing the quality of health care you expect to receive, you should seek information regarding:

1. Qualifications of doctors
2. Prevention and early detection
3. Patient satisfaction
4. Improvements in care and service

Where do I find information on a particular health plan?

Consider the following resource for answers to your questions about health plans:

1. Get the copy of benefits contract from your employer benefits office or the plan business office.
2. Contact the health plan's customer services office for answers to your questions.
3. Other agencies or offices can provide information on health plan quality, such as:
   • State Medicaid or Medicare office
   • Consumer protection organizations
   • State insurance board
   • Public health departments

What other things should I consider?

You may have questions or concerns about other factors such as:

1. Waiting time and appointment scheduling
2. Services the plan may not cover
3. Procedure for referrals to specialists and other health professionals
4. Appointments scheduled with same care provider

Adapted from: National Committee for Quality Assurance, (NCQA), 1996, pp. 1-6.