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3.1 Health care purchasers must be responsive to consumers and families and should develop means of ensuring their meaningful participation in treatment decisions, measurement of satisfaction, and measurement of treatment effectiveness.

3.2 Accreditation bodies should evaluate the extent of inclusion of consumers and families in treatment decisions and program planning.

3.3 The activities that are used to develop and review quality measures should include all stakeholders, including consumers, families, practitioners, and researchers.


  • Racial and ethnic minorities frequently lack access to culturally appropriate care.

  • In the effort to create smaller and more efficient provider networks, there is a risk of eliminating providers and groups who have special expertise with different cultures and different healing practices (e.g., Afrocentric counseling and Spanish-speaking services, sweat lodges for Native Americans, and American Sign Language services for individuals who are deaf).

  • Often, the reason given for exclusion of cultural practices is that accepted evidence of effectiveness does not exist. The committee observes, however, that controlled trials or other outcomes assessments have not been done for many, if not most, medical treatments.


4.1 Health plans and programs should be responsive to community demographics and to the cultural needs of the populations that they serve.

4.2 Practitioners of alternative and innovative treatments without an accepted research base should not arbitrarily be excluded from health plans. If these treatments are used, their effectiveness should be studied so that standards of quality improvement can be developed.

4.3 Health plans should have an explicit mechanism for evaluating new and innovative techniques and types of practitioners.

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