1. 1. Primary care as the foundation of a system that provides consumers a full range of quality providers, including physicians, nurses, pharmacists, dentists, nutritionists, and mental
   health workers;
2. Attention to populations with special needs such as children, pregnant women, the poor, people with HIV and AIDS, the elderly, people with mental and physical disabilities, and non-English speakers;
3. Strong emphasis on the development of physician practice guidelines and nursing research based on health outcomes;
4. A network of care available to persons living in underserved urban and rural areas to coordinate fragmented delivery systems, often complicated by inadequate communications and transportation; and development of more effective methods to correct the shortage of medical and health personnel in medically underserved areas–both rural and urban;
5. Long-term care integrated with acute health care services and available in the most appropriate setting;
6. Progressive health care financing based on a uniform payment system with community rating. Deductibles, co-insurance, and co-payments are obstacles to full access to the health care system and should be eliminated or at least held to a minimum;
7. Specific published prices for health care services and the prohibition against providers requiring consumers to pay additional fees;
8. Consumer access to comprehensive and accurate information and education about the range and implications of available health care options;
9. Managed care organizations, including health maintenance organizations, as a choice for consumers with participation on a voluntary basis;
10. Requirement for a safe environment in workplaces, including the proper disposal of industrially related toxics and research on occupational health hazards.  Workplaces that are dangerous or expose employees to long-term health risks impose substantial burdens on the system;
11. The requirement that when new medical technologies are disseminated that there be adequate assessment of the effectiveness and requirements for training and teaching so that these technologies do not harm quality of medical care and possibly greatly add to the cost;
12. Careful monitoring and regulating of promotion and advertising of prescription drugs;
13. Consumers’ right to an appeals process to contest unfair administrative or medical decisions;
14. Unrestricted access of consumers to their medical records, and their right to correct inaccurate information and control dissemination of confidential information; and
15. Consumer representation in either an administrative, advisory, or advocacy capacity at every level and in every sector of health care.

1. Endorses the concept of comprehensive health care as a universal right and joins with other groups in health coalitions to support a national health plan.  Proposals should include dental care, prescription drugs, psychiatric care, and long-term care to the extent that it is medically necessary;
2. Calls for health-care cost containment policies, both state and federal, as well as voluntary efforts to restrain health costs through broad community coalitions,
   labor/management cooperation, and collective bargaining negotiations;
3. Opposes cuts in Medicare and Medicaid which are of vital importance to the elderly, disabled, and poor; and supports all efforts to make these programs more responsible to the health-care needs of these groups by expanding covered services, and, in Medicaid, expanding eligibility to all the poor and indigent;
4. Supports expanding Medicare services to include eyeglasses, hearing aids, foot care, preventive care, and long-term care in all appropriate settings, including home health care, assisted living, hospices, and intermediate and skilled nursing homes. Financial barriers to participation in Medicare, such as high deductibles, coinsurance, and premiums should be reduced or eliminated;
5. Calls for expanding Medicare to include a voluntary, comprehensive, affordable, and guaranteed prescription drug benefit available to all beneficiaries;
6. Expresses concern about the rapid takeover by giant, for-profit conglomerates of health care services of all kinds – hospitals, nursing homes, home health care, HMOs, managed care organizations, and other health care services – and calls for financial and other support for continuing, strong, and community-oriented non-profit health care institutions;
7. Urges, in response to the misdistribution of primary care physicians and other health personnel, substantially increased federal assistance to medical, public health, and allied health professional schools and to economically disadvantaged students, in order to encourage better distribution of health professionals to meet consumer demand; and
8. Believes health professionals should adhere to a high standard of ethical behavior.  This includes avoiding conflict of interest or undue influence by marketing appeals in decision-making.

Adopted December 13, 2000 

1. Right to Privacy — An individual has a right to privacy with respect to individually identifiable health information. The individual should have the right to decide to whom, and under what circumstances, their individually identifiable health information will be disclosed.
2. Informed Consent and Notice — Health information that identifies a specific individual should not be disclosed without that individual’s explicit consent, unless authorized by law. Individuals should be notified about how their medical records are used and when their individually identifiable health information is disclosed to third parties.

• Informed consent is a process, which ensures that patients understand a proposed treatment or procedure, and can intelligently share in responsible decision making. Implicit in this principle is the right of a patient to decline the proposed treatment or procedure. Included among the basic elements of informed consent must be a statement describing the extent to which the confidentiality of the patient’s medical records will be maintained. Use or disclosures without informed consent should be permitted only under exceptional circumstances; for example, if a person’s life is endangered, if there is a threat to the public health, or if there is a compelling law- enforcement need. Disclosure of individually identifiable health information to someone other than the patient or the caregiver solely for marketing or commercial purposes should never be permitted without informed consent.
• Individuals should be given written, easy-to-understand notice of how information will be used, so that they can make informed, meaningful decisions about uses and disclosures of their health information.

1. Security Safeguards and Penalties — Safeguards, including computerized “walls” and electronic audits, should be utilized to prevent the unauthorized release and possession of computerized medical information.

• The increased use of electronic health record data storage creates opportunities for greater protection of health information through a number of computer security methods, many of which already are utilized by other industries. Providers, health plans, and other users of health information should seek to incorporate electronic security measures, such as passwords, electronic audits, and encryption, to avoid unnecessary access and possible misuse of health information. There should be penalties for violation and private right of action for individuals harmed by a breech in the security of their health information. States should adopt common operating standards for data security and patient privacy protection, including clearly established penalties for violations not covered by HIPAA (such as identity theft), and an accountable means for monitoring, enforcement, and prosecution of violations.

1. Individual Right to Access–Health care consumers should have access to their medical record and the ability to propose corrections or amendments to the record.

• In order to be an active participant in health care, consumers should be able to obtain, inspect, and, if necessary, offer corrections or amendments to their medical record. Erroneous information contained in the medical record can result in discrimination with respect to insurance and employment.
• No personal health information should be available to a provider or health professional that is not also available to the patient (with exception for cases of danger to the patient).
• Unreasonable or unaffordable fees should not impair the ability of each person to access, review or supplement their personal health information.
• People must be able to receive complete paper copies of any of their information.
• Right to Private Action — For violations of the right to privacy and security of health information, consumers should have a right to private action.

1. Research Access — Certain needs for health information, such as research and public health interests, should be recognized and met to the extent possible through access to unidentifiable data. Access to identifiable health data for properly constituted institutional review board (IRB)-approved studies should be available, when necessary.

• Research that will improve the health and reduce health risks of all Americans should be supported. In certain research settings, medical information should be made available to researchers without prior written authorization, under certain conditions. Such conditions should include a determination by a properly constituted IRB that the research involves minimal risks to participants, the absence of consent would not adversely affect the rights or welfare of participants, the research could not practicably be carried out if consent were required.
• Researchers should be responsible for removing the personal identifiers and for providing the IRB with assurances that the information will be protected from improper use and unauthorized additional disclosures. In a GAO report published in February 1999 (GAO/HEHS-99-55, Medical Records Privacy), it was stated “IRB review does not ensure the confidentiality of medical information used in research because the provisions of the Common Rule related to confidentiality have limitations.” It is suggested in the report that organizational policies be in place, which restrict access to personally identifiable information to authorized individuals, and that organizations impose data security safeguards and encryption policies to ensure confidentiality.

1. Education–The public and users of health information should be educated about the need to maintain the confidentiality of medical record information (See NCL Consumer Education policy).

• As overwhelming opportunities exist for the public, health professionals, clinicians, insurers, employers, and other users of health information to access private medical records, it is important that there be a national, systemic approach to educating these users about the importance of protecting medical records.

1. Consumer Information Programs–NCL supports pharmaceutical care and pharmacy programs, which provide useful information to consumers about their prescription drugs; however, health information privacy must be protected (See NCL Consumer Education policy). Inappropriate or suboptimal uses of prescription medicines result in needless deaths and suffering, as well as billions of dollars of added hospitalization costs and loss of productivity. Armed with greater and better knowledge about the medicines they take, consumers will be empowered to make more informed decisions about their health and health care. NCL strongly supports programs to provide consumers with truthful and
   accurate information on prescription drugs. NCL participated in developing and supports HHS’s “MedGuide Action Plan,” which calls for uniformly structured, “consumer friendly” information about the risks and uses of a prescription drug, to be provided to the patient by the pharmacist, at the time a drug is dispensed.

• NCL has also actively supported the concept of pharmaceutical care and pharmacy programs which provide information about appropriate medication regimes, self-monitoring and self-reporting, refill reminders, disease state information programs, and drug therapy education, including information about alternative therapies to help the consumer understand treatment and to assure better health.
• Any consumer information programs should provide the consumer, at the outset, with a complete description of the program, its potential benefits, and an explanation of how the program works. If possible, this information should be provided by the physician or other health care provider. At a minimum, this information should be provided by the pharmacist before the patient becomes involved in the program. Pharmacies, to the best of their knowledge, should fully inform consumers about the intended use of any confidential health care information in pharmacy records at the time they receive their prescription. Participation in these programs should be entirely voluntary, and consumers should have easy-to-exercise options to withdraw from any information program at any time.

  ––Adopted December 9, 2005

In order to achieve better health for all consumers, it is important that all consumers have access to affordable pharmaceuticals that are safe and effective.  Restrictions should not be placed on drug research so long as consumers are not exposed to drugs of questionable safety and efficacy. We recognize that drugs have both risks and benefits; only by easy access to complete information can consumers make rational decisions regarding prescription drugs and informed choices on over-the-counter drugs.  Consumers should have access to the price of pharmaceuticals.

We deplore the over- and under-medication of consumers, especially those in institutional situations.  Our goal is to assure the appropriate use of drugs and to educate consumers so that they are able to make informed decisions in the marketplace.

1. Drugs with chemically identical active ingredients be marketed under generic labeling with assurance by the Food and Drug Administration that they are also therapeutically equivalent and may therefore be used interchangeably.  Pharmacists should be able to dispense through appropriate channels, including regulated mail order and the Internet, a lower-priced generic equivalent for prescribed drugs where available and appropriate;
2. Vigorous regulatory action be undertaken on advertising drugs to eliminate deceptive and misleading efficacy claims.  Advertising and promotional materials should provide a fair balance of risk and benefit and independent resources for the consumer to obtain information about the product.  Such information should be in consumer-friendly language;
3. Written information that is understandable to the consumer be provided to consumers when they receive a prescription along with the offer to counsel by a pharmacist.  Such information should include use, directions, precautions and side effects, as well as indication of any possible hazards of mixing the prescribed medication with other drugs, food, dietary supplements, or alcohol.  Statements should include a list of inactive ingredients and the generic name of the drug;
4. Research be conducted on dietary supplements regarding their safety and efficacy;
5. FDA should be adequately funded to properly perform its public health and safety functions.  Resources should be available for post-market surveillance as well as pre-market approval of pharmaceuticals;
6. Post-market surveillance of drugs be carried on for as many years as needed, provided that such surveillance is not substituted by drug companies for pre-market testing, and provided that such surveillance is needed to determine the safety and efficacy of the drugs;
7. Payment of reasonable expenses to experts willing to represent public interest while studying and analyzing drug information or speaking on behalf of drug consumers be provided;
8. No drugs be permitted for export unless approved for use in the United States;
9. All adverse reaction data available to a drug company (including foreign adverse reaction data) continue to be required by the Food and Drug Administration when the company applies for a new drug application and thereafter, as long as the company’s drug is produced and marketed; and
10. Prescriptions for medications be typewritten or printed by computer on forms in order to reduce errors in dispensing.

    ––Adopted December 13, 2000