How do Americans rate health care quality overall, the job providers are doing, and their confidence in getting high-quality care when needed?

More than one-half (55%) of Americans polled in 2004 were dissatisfied with the overall quality of the health care in the U.S., and two of five (40%) thought that quality was getting worse. Confidence in health care providers and institutions ranged from 84 percent for nurses to 30 percent for managed care plans. In 2005, about one-third (29%) of nonelderly adults and one-half (53%) of the uninsured lacked confidence in their ability to get high-quality care when needed.

Why is this important?

Knowing what the public thinks about the performance of the health care system can offer insights to help make the system more responsive to patient needs.

Findings

In several national polls conducted from 1993 to 2006 that asked adults about their general satisfaction with the quality of health care in this country, the proportion who expressed dissatisfaction varied from 43 percent to 55 percent (KFF/AHRQ 2006).

In a 2005 national poll, the majority of respondents agreed that nurses (84%), doctors (69%), and hospitals (64%) are doing a good job. Less than one-half thought that drug companies (43%), nursing homes (35%), health insurers (34%), and HMOs/managed care plans (30%) were doing a good job (KFF 2005).

In a 2005 survey of community-dwelling, nonelderly adults (ages 19–64), one of three (29%) expressed a lack of confidence about their ability to get high-quality health care when needed. The rate was higher among those who had gaps in coverage in the past year (41%) and who were currently uninsured (53%) (Collins et al. 2006).

Implications

Many Americans have doubts about the quality of care and the performance of key players in a market-based system. A substantial minority are not confident that they will receive the best care. These perceptions might be influenced in part by access and coverage issues.

Improvement Ideas and Resources

The Commonwealth Fund Commission on a High Performance Health System offered the following preliminary recommendations as first steps for improvement:

1. expand health insurance coverage;
2. implement major quality and safety improvements;
3. work toward a more organized delivery system that emphasizes primary and preventive care that is patient-centered;
4. increase transparency and reporting on quality and costs;
5. reward performance for quality and efficiency;
6. expand the use of interoperable information technology; and
7. encourage collaboration among stakeholders.

The Commission concluded: "For each stakeholder, there needs to be a balance in which autonomy and choice foster innovation and efficiency, but also where greater accountability reduces mortality, morbidity, and costs" (CHPHS 2006).

Source:

Overall perceptions of quality were reported in the 2006 Update on Consumers' Views of Patient Safety and Quality Information, a joint project of the Henry J. Kaiser Family Foundation and the federal Agency for Healthcare Research and Quality (KFF/AHRQ 2006). The 2006 poll was conducted with a nationally representative sample of 1,216 respondents ages 18 years and older. The question was as follows: "Thinking about the country as a whole, are you generally satisfied or dissatisfied with the quality of health care in this country?" Historical data came from the following polls: Gallup/CNN/USA Today Poll May 1993; Gallup Poll Sept. 2000; ABC/Washington Post Poll Oct. 2003; KFF Health Poll Report surveys June 2004, Oct. 2004; KFF/AHRQ/Harvard School of Public Health July 2004. About 1–5 percent of respondents said they didn't know or refused to answer the question in a given year.*

Perceptions of stakeholders were taken from the Kaiser Family Foundation's Health Poll Report Survey conducted June 2–5, 2005 by telephone with a nationally representative random sample of 1,202 adults ages 18 and older. The overall margin of sampling error was plus or minus 3 percentage points (KFF 2005).*

* This information was reprinted with permission from the Henry J. Kaiser Family Foundation. The Kaiser Family Foundation, based in Menlo Park, California, is a nonprofit, private operating foundation focusing on the major health care issues facing the nation and is not associated with Kaiser Permanente or Kaiser Industries.

Consumer confidence was measured by the Commonwealth Fund 2005 Biennial Health Insurance Survey, a nationally representative telephone survey of 4,350 civilian, noninstitutionalized adults ages 19 and older living in the continental U.S. (the analysis is limited to 3,352 respondents ages 19 to 64) (Collins et al. 2006).

References:

*Indicates source of data used in the chart(s).

CHPHS (Commission on a High Performance Health Care System). 2006. Framework for a High Performance Health Care System for the United States. New York: The Commonwealth Fund.

* Collins, S. R., K. Davis, M. M. Doty et al. 2006. Gaps in Health Insurance: An All-American Problem. New York: The Commonwealth Fund.

* KFF (Kaiser Family Foundation). 2005. Health Poll Report May/June 2005. Washington, D.C.: Henry J. Kaiser Family Foundation.

* KFF/AHRQ (Kaiser Family Foundation and Agency for Healthcare Research and Quality). 2006. 2006 Update on Consumers' Views of Patient Safety and Quality Information. Washington, D.C.: Kaiser Family Foundation.