Seven of 10 adults think the U.S. health care system needs to be fundamentally changed or completely rebuilt, according to a new Commonwealth Fund survey. The concerns reflect widespread experiences with access barriers, poorly coordinated care and growing costs. The survey also reveals strong support for more patient-centered care systems and innovative use of teams and information systems.
The new survey found that a large majority of U.S. adults have concerns about access, with 71 percent reporting problems gaining access to needed health care. These concerns included the inability to get timely doctors' appointments or advice from their doctor on the phone, or to obtain after-hours care without going to the emergency room. Nearly half experienced poorly coordinated care (47%), and more than half reported wasteful (54%) care. In addition, one in five reported they or a family member ended up with an infection or complication as a result of medical care, or said that a health care provider made a surgical or medical mistake. When asked about the future, three quarters of people surveyed (74 %) are worried they won't get high quality care when they need it, or that they won't be able to afford their medical bills if they become seriously ill.
"It's not surprising that people worry about the future, given the problems they are currently experiencing in the health care system," said report co-author and Commonwealth Fund Senior Vice President Cathy Schoen. "Health care is too often unaffordable, hard to get when needed, and wasteful or poorly coordinated. The good news is that the Affordable Care Act is focused on addressing many of these issues, with provisions encouraging the kind of health care people want -- care that is affordable, accessible, patient-centered, and well-coordinated, with clinicians working together in teams."
In the survey report, A Call for Change: The Commonwealth Fund 2011 Survey of Public Views of The U.S. Health System, the authors note that nearly all adults (85% or more) support policies that would make care better coordinated and would provide more transparent information about health care costs and quality. There was strong support for medical homes and a team approach to care, with 93 percent of people saying it was important or very important to have one place or doctor responsible for primary care and coordinating care, and 86 percent of people supporting doctors and nurses working in teams or groups with an expanded role for nurses.
A large majority of adults also want their doctors to use health information technology. The survey found that 88 percent thought it was important or very important for doctors to use electronic medical records, and 92 percent thought it was important or very important for doctors to be able to share information electronically with other doctors. In addition, survey respondents want to use technology to manage their own health care -- currently, only 14 percent of adults with Internet access report that they can access their medical records online and just one in five can schedule appointments electronically or email their doctors. Of those who can't do any of those things, half said they would like to have electronic access to records and more than half would like to schedule appointments online, and to be able to email their doctors.
The broad support in the survey for shifting the health care delivery system toward a more patient-centered model, in which care is well-coordinated and accessible, existed across geographic regions and political party affiliation.
"The message from this survey is clear: people want an accessible, better functioning health care system that delivers care they can afford," said Commonwealth Fund President Karen Davis. "One recent step in the right direction is the support for patient-centered medical homes and accountable care organizations included in the Affordable Care Act. If optimally designed and implemented, these new health care delivery models supported by modern health information systems have the potential to address many of the concerns the survey highlights."
The authors note that reforms included in the Affordable Care Act target areas of public concern such as costs, access problems, and wasteful and inefficient care. If successfully implemented, reforms in the new law would improve access, affordability, and coordination of care for patients across sites of care.
They note, however, that "addressing the public's concerns about costs and worries about the future will likely require intensified efforts that focus on prices paid by private and public payers and rising cost trends. The survey finds strong public support for allowing private and public payers to work together to negotiate prices and improve quality," concluding, "based on the survey, a majority of the public would endorse a more concerted effort by payers to act in the broad public interest to slow cost growth and to focus on quality and access."
The report will be available on April 6th at http://www.commonwealthfund.org/Content/Publications/Issue-Briefs/2011/Apr/Call-for-Change.aspx.
The survey was conducted by Harris Interactive, Inc. by telephone, with a representative sample of 1,011 adults ages 18 and older, living in households with telephones in the continental United States. Interviews took place between February 7 and February 11, 2011. Harris Interactive selected the sample using random-digit dialing -- a technique to ensure geographic representation of households with listed and unlisted telephone numbers. Samples of this size have an overall margin of sampling error of +/- 3 percent. The survey questions were included as part of ongoing surveys of the public conducted by Harris Interactive. Appendix tables provide the demographic characteristics of survey respondents and detail responses by demographic group.
The Commonwealth Fund is a private foundation supporting independent research on health policy reform and a high performance health system.
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