|New Survey: 82 Percent Of Americans Think Healthcare System Needs Major Overhaul
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
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 and detailing
strategies that could create that organized, efficient healthcare
system while simultaneously improving care and cutting costs.
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
— nine 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 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 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
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 that all their doctors
have such access as well.
Those surveyed also reported problems with access to
healthcare — nearly three out of four (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
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,
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
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 are;
- 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’ need;
- 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.