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New survey: 82 percent of Americans think health care system needs major overhaul

August 07, 2008

Americans are dissatisfied with the U.S. health care system and 82 percent think it should be fundamentally changed or completely rebuilt, according to a new survey released today by The Commonwealth Fund. Also today, The Commonwealth Fund Commission on A High Performance Health System released a report outlining what an ideally organized U.S. health care system would look like, and detailing strategies that could create that organized, efficient health care system while simultaneously improving care and cutting costs.

The survey of more than 1,000 adults was conducted by Harris Interactive in May 2008; and the vast majority of those surveyed - nine out of ten -- felt it was important that the two leading presidential candidates propose reform plans that would improve health care quality, ensure that all Americans can afford health care and insurance, and decrease the number of uninsured. One in three adults report their doctors ordered a test that had already been done or recommended unnecessary treatment or care in the past two years. Adults across all income groups reported experiencing inefficient care. And, eight in ten adults across income groups supported efforts to improve the health system's performance with respect to access, quality and cost.

"It is clear that our health care system isn't giving Americans the health care they need and deserve," said Commonwealth Fund President Karen Davis. "The disorganization and inefficiency are affecting Americans in their everyday lives, and it's obvious that people are looking for reform. With the upcoming election, there is great opportunity for our leaders to hear what the American people are saying they want from a health care system, and to respond with meaningful proposals."

The survey, Public Views on U.S. Health Care System Organization: A Call for New Directions, found that, in addition to respondents' overall dissatisfaction with the health care system, people are frustrated with the way they currently get health care. In fact, 47 percent of patients experienced poorly coordinated medical care in the past two years -- meaning that they were not informed about medical test results or had to call repeatedly to get them, important medical information wasn't shared between doctors and nurses, or communication between primary care doctors and specialists was poor.

Respondents pointed out the need for a more cohesive care system. Nine of 10 surveyed believe that it is very important or important to have one place or doctor responsible for their primary care and for coordinating all of their care. Similarly, there was substantial public support for wider adoption of health information technology, like computerized medical records and sharing information electronically with other doctors as a means of improving patient care. Nine of 10 adults wanted easy access to their own medical records, and thought it was important that all their doctors have such access as well.

Those surveyed also reported problems with access to health care-nearly three out of four (73%) had a difficult time getting timely doctors' appointments, phone advice, or after-hours care without having to go to the emergency room. Although the uninsured were the most likely to report problems getting timely care without going to the emergency room, 26 percent of adults with health insurance also said it was difficult to get same- or next- day appointments when they were sick. And 39 percent of insured adults said it was hard to get through to their doctors on the phone when they needed them.

The Commission report, Organizing The U.S. Health Care Delivery System For High Performance, outlines strategies that could help lead to a better health care system with higher quality and better efficiency:

* Payment Reform: Report authors recommend moving away from traditional fee-for-service payments to a system in which providers and hospitals are paid for high quality, patient-centered, coordinated health care.
* Patient Incentives: Patients should be given incentives to go to the health care professionals and institutions that provide the most efficient, highest quality health care. However, in order for this to work, health care providers and health care systems would need to be evaluated to determine if they are providing high quality, efficient health care and information on performance would need to be publicly available.
* Regulatory Changes: Regulations should remove barriers that prevent physicians from sharing information that is essential to coordinate care and ensure safe and effective transitions for patients.
* Accreditation: Providers and health systems should be accredited based on six attributes of an ideal health care system:
o Patient information is available to all providers and to patients at the point of care;
o Patient care is coordinated among multiple providers and transitions from one provider to another or from a hospital stay are actively managed;
o All health care providers involved in a patient's care have accountability to each other, review each other's work and collaborate to deliver good care;
o Patients can get the care and information they need when and how they need it, including after hours, and providers are culturally competent and responsive to patients' need;
o There is clear accountability for patient care;
o The health care system is continuously working to improve quality, value, and patients' experiences.
* Provider Training: Physicians and health care professionals should be trained to work in the type of team-based environment required for an organized health care system.
* Government Infrastructure Support: As appropriate, the government should support the infrastructure necessary for a well-organized health care system. For example, aiding with the adoption of health information technology or performance improvement activities.
* Health Information Technology: Providers should be required to implement and use electronic health records within five years.

Report authors analyzed health care systems around the country that are successfully employing these strategies and examined how positive gains could be achieved for the entire U.S. health care system. The report concludes that in order for the U.S. health care system to truly be higher-performing, reorganization will be needed at the practice, community, state and national levels.

"There is no one policy, or practice that will make our health care system run like an efficient, well-oiled machine," says Commission on A High Performance Health System Chair and Partners Health System CEO James J. Mongan, M.D. "This is going to take strong national leadership and a commitment from all of the players in our health care system, but with that and the strategies outlined in this report, real progress could be made."

Commonwealth Fund