The American Public on Health Care: The Missing Perspective

Health care is one of the most pressing issues on the minds of Americans today. It’s at the center of debate at every level of the political arena, and is one of the United States’ most critical public policy concerns.

The result of a close collaboration between Accenture, The Council for Excellence in Government and the Institute of Medicine of the National Academies—The American Public on Health Care: The Missing Perspective—crystallizes an extensive body of research that includes existing surveys of public attitudes and reform proposals and our own extensive Gallup polls at both the local and national levels. It also includes the results of a remarkable series of town hall meetings that brought together leaders from major health care stakeholder groups with citizens in three cities—Miami, Detroit and San Francisco.

From cost to quality to access, citizens’ call for broad reformation of America’s health care system comes across loud and clear. As the hard work ensues, we’re pleased to present the all-important missing perspective, and help focus the ongoing health care debate on citizens’ questions and concerns.

Read the report—The American Public on Health Care: The Missing Perspective [PDF, 2.7MB]

To learn more about the report and town hall meetings, visit the Accenture Health Care Town Hall

Visit Government Technology’s On the Scene: EMR Interest Grows for additional insight into the San Francisco Health Town Hall Forum.

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This report explores the challenges facing health care in America—the problems and the trade-offs—through the lens of the people most touched by it.

To get to the heart of Americans’ views on health care, a unique initiative—The American Public on Health Care: The Missing Perspective—was launched by the Council for Excellence in Government with support from the Accenture Institute for Public Service Value and expert guidance from the Institute of Medicine at the National Academies. Over the last eight months, we worked together to review survey data and other research on public attitudes and reform proposals from a variety of perspectives.

We also worked with Gallup to conduct new local and national survey research on the public’s views of health care. The results of our national poll echo the themes from community members across the country. With health care costs on the rise and more than 45 million uninsured Americans, there is a palpable anxiety over cost and access to care. There is widespread uncertainty over how plans for reform would affect regular people. And there is strong interest in the power of information to help transform the system.

While many worry about the unknown and unintended consequences of health care reforms, a majority of Americans voice support for a number of reform concepts:

• Portability—78 percent favor allowing Americans to take their health care coverage with them when they leave a job.

When it comes to the role of government in reforming the system, America’s voice is clear.

• Performance Ratings—81 percent agree that government should require that performance ratings on doctors and hospitals be publicly available (60 percent strongly agree).
  
  
• Public Menu of Costs—75 percent agree that government should require that health care providers publish their costs (58 percent strongly agree).
  
  
• Pre-Existing Conditions—75 percent agree that government should require health care providers to cover preexisting conditions (54 percent strongly agree).
  
  
• Employer-Based Care—72 percent agree that government should require all large employers to provide health insurance coverage to all fulltime employees (54 percent strongly agree).
  
  
• Competition Across State Lines—71 percent agree that government should create national or regional health care exchanges to allow insurance to be purchased across state lines (52 percent strongly agree).
  
  
• Assistance for Low-Income—69 percent agree that government should provide assistance to low-income individuals and families to buy health insurance (52 percent strongly agree).

Americans are also in favor of adopting electronic health records systems and are willing to share their health information, but only under certain conditions.

• Health Information Sharing—78 percent of Americans favor giving doctors the ability to share access to their medical records, if it is done with their permission.
  
  
• Evidence-Based Medicine—66 percent favor having health information shared in a large database to help researchers understand and compare the effectiveness and possible side effects of various treatments or prescription drugs, if no patient names were used in the database.

Americans have known for some time about the rising cost of health care and the tragically large number of uninsured people in the United States. We were, however, surprised by two main findings and the changes people want government to lead.

Anxiety About Cost

There is palpable anxiety about the affordability of health care among Americans from all walks of life, including people who have health coverage and those who do not. The bottom line is that the United States spends twice as much per person on health care than other developed countries and yet Americans have lower life expectancy, lower infant survival and higher death rates due to treatable diseases like diabetes.

Most uninsured Americans surveyed (57 percent) say they simply cannot afford coverage. Another 30 percent cite reasons having to do with employment: they’re not employed (14 percent), their employer does not offer coverage (9 percent), or they are between jobs (7 percent).

More than 1 in 4 Americans (26 percent) have put off medical treatment within the last 12 months because they could not afford it, including 58 percent of those who are currently uninsured. Even those who currently have health insurance are feeling the crunch, with 20 percent reporting that they too have put off treatment because they could not afford the out-of-pocket costs. Age is also a factor— just 11 percent of those over age 65 have put off treatment compared to 29 percent of those ages 18 to 39.

The Power of Information

The second surprising finding concerns the power of information. Health care consumers believe that information has the power to help improve the quality and efficiency of the health care system, and they want to know more about both the cost of care and the performance of their providers. They are willing to share their health information among their doctors and researchers to improve the quality of care.

Contrary to conventional wisdom about privacy concerns, most Americans see the benefits of sharing health data. Three-quarters of the public (78 percent) favor giving physicians the means to share access to their medical records, while two-thirds (66 percent) see the value in including their own information anonymously in a large database that would help researchers understand more about the effectiveness and possible side effects of various treatments or prescription drugs.

The public’s views on the power of information extend to their attitudes about electronic health records. While less than a quarter (23 percent) of Americans currently use an electronic health records (EHR) system, nearly twice as many (44 percent) would be interested in using EHR if it were available.

The public’s willingness to share health information for research could revolutionize the practice of “evidence-based medicine,” which enables health care providers to make diagnoses and recommend courses of treatment based on data about what has worked in thousands or even millions of cases.

Americans across the nation—including those who have health coverage—know the current system is on an unsustainable course. They are eager for pragmatic solutions that will address the realities of their lives.

Messages to Government Leaders—Americans want their government leaders to improve accountability, control costs through market improvements and expand coverage by helping those with low incomes obtain health insurance. Specifically, the public believes that government should:

• Require publicly available performance ratings of doctors and hospitals.
  
  
• Require health care providers to publish the costs of all services and procedures.
  
  
• Require all large employers to provide health coverage to full-time employees.
  
  
• Require health care providers to cover pre-existing conditions.
  
  
• Create national or regional health care exchanges so insurance can be purchased at competitive rates across state lines.
  
  
• Provide assistance to low-income individuals and families to buy health insurance.

Messages to Health Care Providers—Americans want health care value and believe that information has the power to improve the quality and efficiency of the health care system. They want access to understandable information about performance and costs to increase the accountability of their health care providers.

Messages to Insurers—Most Americans who are insured are satisfied with their coverage—with the exception of the cost. To improve the value proposition, insurers should:

• Work with employers, government and providers to address current and future customer concerns.
  
  
• Improve communications and information about costs, benefits and choices. This information should be clear, concise and consumer friendly.
  
  
• Increase accountability of providers for quality and performance, rather than the quantity of procedures and paperwork.
  
  
• Spread risks by expanding pools beyond state lines through national or regional health exchanges.
  
  
• Improve incentives for prevention and treatment based on the best evidence of effectiveness.

Messages to Employers—The American people believe in employer-based health care and most favor government involvement to require employer-based coverage. At the same time, they want to see the rising costs contained. Employers have an opportunity to engage employees in open, fact-based discussions about the trade-offs and choices in that context. Faced with costs that are rising at unsustainable rates, employees should have choices that reflect their values.

Messages to the Public—Faced with a health care system plagued by cost increases and significant gaps in coverage, it is up to the American people to take ownership of their “health care destinies” by becoming better informed consumers. Become a better consumer by requesting information from your providers about their performance and the costs of services.

It is imperative that your perspective—the missing perspective—be heard and heeded to achieve health care reform that reflects your priorities and fairly addresses your concerns.

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