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The Commonwealth Fund Health Care Opinion Leaders Survey: Assessing Health Care Experts' Views on Policy Priorities

Country: United States

Survey Organization: Harris Interactive, Inc.

Field Dates: November 22, 2004–December 8, 2004

Sample: Peer-nominated experts in health care policy, finance, and delivery

Sample Size: 318 (survey successfully e-mailed to 1,155 potential respondents; 28% response rate)

Interview Method: Online/E-mail

The Commonwealth Fund Health Care Opinion Leaders Survey was conducted by Harris Interactive on behalf of the Fund, with a broad group of more than 300 opinion leaders in health policy and innovators in health care delivery and finance. The survey focused on health policy priorities for Congress over the next five years.

There is broad consensus among leaders that expanding coverage to the uninsured is the top priority that should to be addressed by Congress. This is the top priority for all groups represented in this study, with a large majority of academic/research institutions, health care delivery, business/insurance/other health care industry, and government/labor/advocacy identifying this issue as the top priority. There is also considerable agreement about the reforms that should be enacted in order to achieve this priority. Allowing individuals and small businesses to buy into the Federal Employees Health Benefits Program or similar federal group option receives the highest support overall and a majority of votes across all groups. Also, expanding existing state-based public insurance programs, Medicaid and the State Children's Health Insurance Program, is supported by more than half of leaders overall and across groups, except for the health care delivery sector. This suggests a more incremental approach, with a national health system (universal coverage) receiving very little attention as a priority now.

The issue of quality and safety emerges as a major health policy priority. Improving the quality and safety of medical care, including increased use of information technology, is ranked as the second most important priority (after expanding coverage) for Congress to address, with a large majority overall and within each constituency supporting this. Additionally, several specific issues related to quality and safety are named as top priorities for action in order to control costs and improve quality. These are: rewarding more efficient providers and effective disease management, increased and more effective use of information technology and, to a lesser degree (but still supported by a majority overall), making information on quality and costs of care available to the public. Given that these issues are not ideologically driven, quality and safety may represent an opportunity for parties in Congress to successfully work together.

By comparison, support for reforming Medicare is only moderate and more selective across groups, with about half of all constituencies, except for the government/labor/advocacy group (for whom it was not one of the five top priorities), identifying Medicare long-term solvency as their third top priority for Congress to address. Medicare payment reform to reward performance on quality and efficiency is also only moderately supported; only business/insurance/other health care industry consider it one of the top five priorities. However, specific Medicare reforms such as using Medicare's purchasing power to negotiate lower prescription drug prices and to a somewhat lesser degree linking increases in Medicare physician payments to quality performance are supported by the majority of respondents across all sectors.

Given the media and political attention devoted to the cost of medical care and prescriptions, it is somewhat surprising that enacting reforms to moderate the rising costs of medical care for the nation and controlling the rising cost of prescription drugs are ranked only as fourth and sixth top priorities for Congress to address, with fewer than half of respondents naming these options. Again, support varies by sector. Only in the academic/research institutions sector is enacting reforms to moderate the rising costs of medical care for the nation seen as a top priority by a small majority. About half of the respondents from the government/labor/advocacy sector support controlling the rising cost of prescription drugs, naming it as their third top priority.

Other options for reform that have been receiving a great deal of media and political attention—such as legalizing the importation of prescription drugs from abroad, encouraging competition among insurers and providers, and requiring consumers to pay more—receive only very limited support as priorities for actions to control costs and improve quality.

The topline results and a longer summary of the survey are attached at right. You may also be interested in a commentary by Fund President Karen Davis, or commentaries by two panel members, Christopher Jennings, a former Clinton White House health policy advisor, and Gail Wilensky, Ph.D., the senior fellow at Project Hope.

The online survey was conducted by Harris Interactive with 318 opinion leaders in health policy and innovators in health care delivery and finance between November 22, 2004, and December 8, 2004.

The sample for this survey was developed by using a two-step process. Initially The Commonwealth Fund and Harris Interactive jointly identified a number of experts across different industries and professional sectors, with a range of perspectives, based on their affiliations and involvement in various organizations and institutions. Harris Interactive then conducted an online survey with these experts asking them to nominate others within and outside their own fields whom they would consider to be leaders and innovators in the health care industry. Based on the results of the survey and after careful review by Harris Interactive, The Commonwealth Fund, and a selected group of health care experts, the sample for this poll was created. The final list included 1,255 people.

Harris Interactive sent out individual e-mail invitations containing a password-protected link to the entire sample. Of the 1,255 email invitations, 100 were returned as undeliverable. Steps were taken to attempt to correct the e-mail addresses and locate the individuals, however these efforts were unsuccessful. Harris Interactive determined that the undeliverable e-mail addresses appeared to be randomly distributed among the different sectors and affiliations. Data collection took place between November 22, 2004, and December 8, 2004. Two reminders were sent to any one who had not responded. The response rate was 28%. Typically, samples of this size are associated with a sampling error of +/- 6%.

Health Care Opinion Leaders Survey Part II, Assessing Health Care Experts' Views on Health Insurance Issues

Health Care Opinion Leaders Survey Part III, Assessing Health Care Experts' Views on Health Care Costs