How Americans Perceive the Health Care System

A Report on a National Survey Conducted for The National Coalition on Health Care By International Communications Research

January 1997

 Executive Summary

A nationally projectable poll of 1,011 American households conducted December 18-22, 1996, reveals a disturbing lack of confidence among the majority of Americans with the state and direction of health care and concern about health care quality, cost and coverage.

The telephone poll, conducted by International Communications Research, was commissioned by The National Coalition on Health Care. The survey findings from a representative cross section of American households have a range of variation of no greater than plus or minus three percentage points.

Their responses to a series of statements show that most people have little confidence in the ability of the system to care for people. The vast majority of Americans (79%) agree with the statement "there is something seriously wrong with our health care system," 87% agree that "the quality of medical care for the average person needs to be improved," and only 15% have "complete confidence" in hospital care. Less than half of people (44%) say they have "confidence in the health care system to take care of me."

Eight in ten Americans believe that the quality of medical care is being compromised in the interest of profit. They feel that "quality medical care has become unaffordable for the average American" (79% agree), that "hospitals have cut corners to save money" (74% agree), that "quality care is often compromised by health insurance companies to save money" (80% agree), and that "quality of medical care has gone down while costs have increased" (64% agree). These views are held by people in fee-for-service plans as well as those in managed care plans.

There is a hunger to be better informed: 83% say they "would like to be better informed about how to evaluate quality of medical care from doctors and hospitals," and 72% "would like more information so [they] would feel more confident about decisions about medical care."

People are frightened by stories they've heard of medical care "mistakes made that have hurt or even killed people" (75%).

More than half the respondents (57%) agree that "hospital care is not very good" and they risk being "made sicker or more injured by mistakes made by poorly trained or overworked staff."

While the majority feel confident that they could get quality medical care for themselves, they also believe there are serious problems with the quality of health care.

Contrary to the widely publicized view that government should stay out of health care, the vast majority of Americans feel that "the federal government can play an important role in making health care better" (69%) and "more affordable" (72%). These beliefs were shared by Republicans, Democrats, and Independents.

The poll reveals a divided population regarding peace of mind and satisfaction of health care. About two-fifths of Americans are strongly alienated from the health care system. Many of those with annual household incomes of $25,000 or less are highly troubled by their experiences with cost, coverage and treatment.

Even though they consider their current health care satisfactory, a large proportion of middle class respondents are also strongly troubled by what they see as serious flaws in the system related to quality, costs and access.

Four of every ten people polled have had reductions in coverage and are "worried that they may lose their health insurance" and feel they "cannot afford medical insurance."

On a positive note, four in every ten people "strongly agree" that their "medical plan makes good health care affordable" and over one-third (36%) "strongly agree" that they are "satisfied with the quality of [their] health care." Over one-quarter (28%) "strongly agree" that they "like the way their medical plan works" and that "[their] medical plan provides the best quality care they could want."

In general, people over sixty-five years of age, and therefore covered by Medicare, are more satisfied with quality and coverage than are those in their thirties and forties. Not surprisingly, higher income families ($50,000 annual income) express more confidence and satisfaction with their health care than do those from households with middle or lower incomes.

Four in ten Americans report having had a "bad" experience with treatment or care, don't have confidence in the system to take good care of them, or believe hospitals have cut corners to save money, thus endangering patients.

Focus group interviews recently completed in five cities prior to the survey amplify the findings of the polls. They reveal a depth of anger, fear and betrayal combined with a sense of frustration and pessimism for the future of health care. The prevailing view expressed in these interviews was that improvements in the health care system were being held hostage by partisan politics. Respondents in the focus groups displayed great cynicism about the motives and goals of the health care system.

The respondents showed impatience with the lack of progress in controlling costs, improving quality and access. Many of those who felt they were adequately protected by their insurance expressed concern and dismay at the plight of many people who they felt were unprotected and poorly cared for. Many had friends, neighbors and close relatives who lost their health insurance and were struggling to pay for or receive good health care. Their anxieties were underscored by the belief that even though they were currently protected, they could soon join the ranks without access to quality medical care.

For the full report, please visit the National Coalition On Health Care at:
http://www.nchc.org/perceive.html