Attitudes Toward the United States’ Health Care System: Long-Term Trends.

In the more than twenty years since Harris Interactive first asked the American people what they thought of the nation’s health care system, there have been many changes, both up and down. And when other groups (physicians, employers, hospital managers and health plan managers), were asked the same questions, quite big differences were noted among the views of those different groups. This year these differences have narrowed; the level of support for radical change is somewhat
similar in all these groups.

The 2002 data are based on nationwide surveys conducted by Harris Interactive between April and June, with separate samples of 1013 adults, 406 physicians, 301 large, medium and small employers, 101 health plan managers and 301 hospital managers. The data from previous years are derived from similar surveys with similar designs and sample sizes. For a
downloadable pdf version of this Harris Interactive Health Care News, issue 17, please go to
http://www.harrisinteractive.com/news/newsletters_healthcare.asp.

The Question
All data in this issue of Health Care News are based on a question that asks respondents to state which one of the three phrases “comes closest to expressing their overall view of the country’s health care system” (see Table 1 for the three phrases). We first wrote this question for use in an unpublished survey in 1979. Since we first published it in 1982, several other survey firms have asked the
identical question.

Calculating a “radical change score”
Because there are three possible answers to the question, we have calculated a single “radical change score” with a minimum of zero and a maximum (most radical score) of one hundred. The first answer (“… only minor changes are necessary … “) gets a score of zero. The second (” … some good things but fundamental changes are needed … “) gets a score of
one-half (0.5). The third (” … we need to completely rebuild the system … “) gets a score of one (1.0). Using this one score number for each survey, it is much easier to compare different surveys of different populations at different points in time.

The Situation Now (in 2002)
This year there is remarkably little difference among the radical change scores of the five different populations we surveyed. The highest (most radical) score is 56 for the public. The lowest (least radical), only ten points lower, is 46 for physicians. Hospital managers (51), employers (48) and health plans (50) fall in the middle.

In all the previous years, when we had data for two or more of these populations, the gap was always wider than the ten-point gap we find this year.

One reason that the gap, or spread, is relatively small this year is that doctors, who used to be much happier with the health care system, became, and have remained, much more critical in 1999. Before 1999, physicians were always much less negative than the public in their views toward the health care system.

Another reason why the gap has narrowed is that health plan managers have become much more critical of the system now than they were three years ago.

Trends in Public Opinion Over 20 Years
The public’s attitudes toward the health care system have fluctuated over the last twenty years, touching a high point (i.e., the most negative or radical moment) in 1993, after Bill Clinton was elected but before the full debate on his proposal had developed, at which time the radical change score rose to 67.

The lowest point when the public was least negative about the health care system was in 1987 when the radical change score stood at only 43.

It is interesting to note that the radical change score for the public has remained unchanged at 56 for each of the last four years, which is somewhat higher than the average for the last twenty years, but not as high as it was for most of the period from 1991 to 1998.

Given what is happening, and is likely to happen over the next few years (e.g., higher out-of-pocket costs, an increase in uninsurance, continuing concern about drug prices), we would expect public dissatisfaction to increase.

Trends in Employer Attitudes Over the Last Nine Years
In the nine years since we first asked this question of a cross section of large, medium and small employers, the radical change score has changed very little. It was at its lowest point (i.e., employers were less unhappy) in 1995, just after the defeat of the Clinton health care bill. This year’s score of 48 is the highest recorded for employers by Harris Interactive, but it is not a strikingly high figure.

Trends in Physician Opinion Over the Last Eighteen Years
When first asked this question, in 1984, physicians supplied the most positive replies about the health care system ever recorded by Harris Interactive from any group sampled. Almost half thought the system worked pretty well. Their radical change score was only 27. Physicians’ attitudes toward the health care system fluctuated between 1984 and 1997, with a low point of 32 in 1994, the year when physicians contributed modestly to the defeat of the Clinton health care proposal. However, doctors became much more negative in 1999 and have remained more negative ever since — we believe, because of their anger about managed care. This is consistent with the modest decline in the radical change score from 49 in the year 2000 to 46 this year, as managed care companies have tended to reduce their micromanagement of physicians.

Trends in the Attitudes of Health Plan Managers Over the Last Three Years
We have only asked this question of health plan managers on three occasions, starting in 1999. At that time, their attitudes toward the system were remarkably positive, with a radical change score of only 31, the second lowest score ever recorded amongst any group (the physicians’ score of 27 in 1984 being the only one which was lower). Since then, however, their attitudes have become much more negative, with their radical change score rising to 42 in 2001 and 50 this year.

The Big Picture
While legislators in Washington are still deeply scarred by the 1994 debate and the defeat of the Clinton health care reform proposal, it is clear that only very small minorities of any of the five groups’ surveyed hold a good opinion of the health care system as it is now. Those who believe that “on the whole the health care system works pretty well and only minor changes are necessary” include only 19% of physicians and smaller percentages of all other groups surveyed.

If our survey data were to serve as our only guide, there are several other reasons why one might expect a big push for health care reform. Employers are more hostile toward the system now than they were in any of our previous surveys. So are health plan managers. While physicians’ attitudes are a little bit less negative than they were two years ago, they are more negative than they were at any time between 1984 and 1997.

The public also has a considerable appetite for health care reform, even if the radical change score is lower than it was in some previous years, particularly in the early 1990s. But only 17% of the public thinks that “the system works pretty well and only minor changes are necessary.” Almost twice as many (31%) think that “we need to completely rebuild the system,” with almost everyone else (49%) thinking that “fundamental changes are needed.” Overall, therefore, a stronger consensus for radical reform is building.

To view charts CLICK above on ‘More Images’.