Problems cited included medical errors; duplicated tests; uncoordinated, inefficient or unsafe care involving unnecessary treatment; and a failure to communicate important information or test results, according to the report from the Commonwealth Fund Commission on a High Performance Health System.
"It's partly poor care in the sense of medical errors, but it's more than that," said Karen Davis, president of the Commonwealth Fund. "It's confusing, uncoordinated and fragmented care, so one party doesn't know what the other party is doing. A lot of the frustration is not only experiencing poor care or unsafe care, but also wasteful and poorly coordinated care."
For some, the survey results cast doubt on the value of "consumer-driven" choice in health care.
"To me, it shows that most of the premises driving consumer health care are faulty," said Carol Pryor, senior policy analyst at The Access Project in Boston. "The predominant notion has been that the reason health-care costs are rising so much is because people who have insurance get care for free and over-utilize services, and that we need to let people be good shoppers to get the most inexpensive care. Really, this report shows quite the opposite."
Others, however, found the data to be lacking. "The information should have been broken down by demographics and current coverage," said Greg Scandlen, founder and president of Consumers for Health Care Choices. "Most of the complaints seem to come from lower-income people -- some large number of whom are on Medicaid."
Previous research has found the U.S. health-care system to be lacking on several fronts.
One recent Commonwealth Fund report found that, even though the United States spends more than twice as much per capita on health care as some other western nations, it trails them in such measures as efficiency, equity, patient safety and access to care.
For this report, conducted in June, researchers surveyed 1,023 adults aged 18 and over around the United States.
Respondents strongly supported initiatives to improve coordination of care and expand the use of information technology. Ninety-two percent said it was very or somewhat important to have a "medical home," meaning one place or doctor responsible for providing or coordinating all their care.
"The thing that was most surprising was this deep-seated desire for coordinated care," Davis said. "Most of the rhetoric says people want choice but that's not really the message that's coming through here. They want one place that knows everything that's going on, that has complete medical records and that can help guide them through a complicated health-care system."
"We need incentives for providers to provide appropriate coordinated and quality care," Pryor added.
Financial problems are increasing plaguing the middle class, with 48 percent of adults in middle-income families ($35,000 to $50,000 yearly income) reporting serious problems paying for health insurance and medical care.
Better-off folk are feeling the pinch, too: One-third of adults with annual family incomes between $50,000 and $75,000 and one-fifth of those with incomes over $75,000 reported serious problems with medical bills, the survey found.
"The middle class is now registering difficulties with the cost of care and cost of insurance," Davis said. "That confirms earlier work, although seeing it go up into the $50,000-to-$75,000 class is a bit of an eyebrow-raiser, even for me."
More than three-quarters (76 percent) of all adults surveyed said the health-care system needed major changes or complete rebuilding. Twenty percent said it needed only minor changes.
Not surprisingly, people who had experienced problems with care were more likely to say the system needs a complete overhaul. Forty-three percent of respondents who had experienced a medical error in the past two years said the system needed to be rebuilt, compared with 27 percent of those who did not experience a medical error.
But the percentages may not be as striking as they seem. "These numbers are typical of English-speaking countries," Scandlen said.
The four top priorities in the area of health-care policy for the president and Congress were making sure all Americans have health insurance, controlling the costs of medical care, controlling the cost of prescription drugs, and ensuring that Medicare remains financially sound.
Americans are also increasingly insecure about the future, with half of adults with incomes up to $75,000 a year worrying that they won't get high-quality health care when they need it. Forty-eight percent of respondents were very or somewhat worried about being able to afford health care in the future.
"People want to know that the best of American medicine will be there when they need it and part of that is having a medical 'home,'" Davis said. "A lot of it is having guaranteed, affordable health insurance coverage. That's part of the insecurity that we see in this survey."
Others called the data faulty.
"It is sloppy research that hides more information than it reveals," Scandlen said. "There is no question that the current health- care system is badly flawed and needs profound change, but this study provides very little information on how to do that or what should be done. We need more accountability, more efficiency, more convenience for patients, better quality and lower costs. Ultimately, the only way to get there is to empower these consumers who are so dissatisfied to express their dissatisfaction in the marketplace, not just in surveys."
More information
For more on the report, visit The Commonwealth Fund. |
