Americans are dissatisfied with the U.S. healthcare system and 82 percent think it should be fundamentally changed or completely rebuilt, according to a new survey released by The Commonwealth Fund.

The Commonwealth Fund Commission on a High Performance Health System also released a report outlining what an ideally organized U.S. healthcare system would look like. Detailed strategies that could create an organized, efficient healthcare system while simultaneously improving care and cutting costs were included.

High on the commission’s list is reforming the current payment system to stress quality.

The survey of more than 1,000 adults was conducted by Harris Interactive in May; and the vast majority of those surveyed — 9 out of 10 — felt it was important that the two leading presidential candidates propose reform plans that would improve healthcare quality, ensure that all Americans can afford healthcare and insurance and decrease the number of uninsured.

One in three adults reported 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, 8 in 10 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 healthcare system isn’t giving Americans the healthcare 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 healthcare system, and to respond with meaningful proposals."

The survey, Public Views on U.S. Healthcare System Organization: A Call for New Directions, found that, in addition to respondents’ overall dissatisfaction with the healthcare system, people are frustrated with the way they currently get healthcare. 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 out 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 out of 10 adults wanted easy access to their own medical records and thought it was important thatall their doctors have such access as well.

Those surveyed also reported problems with access to healthcare — nearly 3 out of 4 (73 percent) 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. Healthcare Delivery System For High Performance, outlines strategies that could help lead to a better healthcare 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 healthcare.

Patient Incentives: Patients should be given incentives to go to the healthcare professionals and institutions that provide the most efficient, highest quality healthcare. However, in order for this to work, healthcare providers and healthcare systems would need to be evaluated to determine if they are providing high quality, efficient healthcare 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 healthcare system:

• Patient information is available to all providers and to patients at the point of care;
• Patient care is actively managed to coordinateamong multiple providers and transitions from one provider to another or from a hospital stay;
• All healthcare providers involved in a patient’s care have accountability to each other, review each other’s work and collaborate to deliver good care;
• 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’ needs;
• There is clear accountability for patient care; and
• The healthcare system is continuously working to improve quality, value and patients’ experiences.

Provider Training: Physicians and healthcare professionals should be trained to work in the type of team-based environment required for an organized healthcare system.

Government Infrastructure Support: As appropriate, the government should support the infrastructure necessary for a well-organized healthcare 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 healthcare systems around the country that are successfully employing these strategies and examined how positive gains could be achieved for the entire U.S. healthcare system. The report concludes that for the U.S. healthcare system to truly be higher-performing, an organization will be needed at the practice, community, state and national levels.

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

Address: The Commonwealth Fund, 1 East 75th Street, New York, NY 10021; (212) 606-3800, www.cmwf.org.

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