Report on Americans' Views on the Quality of Health Care
A new poll shows most Americans believe the quality of U.S. health care is average at best—sober news for the nation’s health care leaders. More than half of American adults surveyed (55%) barely give the quality of American health care a passing grade—a C or D on a standard report card scale. More than one in 10 (11%) give the quality of care an F. In addition, nearly half (47%) of Americans give the quality of hospital care in the country a rating of C, D or F.
The poll was commissioned by the Robert Wood Johnson Foundation and presented today at the American Hospital Association’s annual membership meeting in Washington, D.C. It was conducted by researchers at the Harvard School of Public Health, led by Robert J. Blendon, a noted expert in polling consumers on health care issues.
“The poll is a wake-up call for payers and the health care industry, both of which have been working steadily to improve the quality of care, but need to kick their efforts into overdrive toward accountability,” said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation. “American health care faces a crisis in quality. There is a dangerous divide between the potential for the high level of quality care that our health system promises, and the uneven quality that it actually delivers. Clearly, consumers are aware of it. There are too many errors, too much misuse of medical treatments and, too often, poorly coordinated care among a patient’s different health care providers.”
The results show that while many consumers think quality of care is low, they think more highly of their own care than they do about the health care system in general. Across the board, respondents rank the quality of the health care and hospital care they receive as markedly better than what they think the country as a whole receives.
Despite significantly more data comparing the quality of local health care providers becoming available to consumers in recent years, the poll shows that people still turn to the doctors and hospitals with which they are most familiar, not necessarily where evidence suggests care is best coordinated and delivered. When asked to choose between different hospitals—one where a person has been treated for years and another that rates much higher in quality—most respondents (57%) say they would choose the familiar, over those (38%) who would opt for a hospital that scores better in quality.
But when it comes to picking between two surgeons at a hospital, respondents are split. About half (48%) say they would pick a surgeon who successfully treated a friend or family member; the other half (47%) would pick an unknown surgeon with higher quality ratings.
The poll shows that some progress is being made in people thinking about choosing health care providers based on the provider’s performance. Polling going back to the mid-1990s shows that over time, people are less likely to rely on past experience when choosing hospitals, and increasingly likely to use ratings of quality.
“The pace of change in having consumers use independent expert ratings when they choose a hospital has been slower than anticipated,” said Blendon, professor of Health Policy and Political Analysis at the Harvard School of Public Health. “More can be done to encourage this.”
The federal health reform law calls for the performance of doctors and hospitals to increasingly be measured and reported publicly. The Robert Wood Johnson Foundation-supported Aligning Forces for Quality (AF4Q) initiative has helped 16 communities nationwide release public reports on the quality of care provided by local primary care physicians and hospitals.
“Consumers need to be more engaged in their health care, and that means taking responsibility for learning about their care, understanding whether it is as good as it could and should be, and acting on that knowledge,” said Lavizzo-Mourey. “Americans spend more for health care than people in any other nation, but the outcomes we achieve don’t measure up to our expectations that, for all that we spend, we should have the best health care in the world. If Americans want better health care, they need to evaluate the facts and make decisions that factor quality into thinking and acting, much like we do when buying cars or washing machines. Improving the quality of care demands that we hold providers accountable, and as patients and consumers, we ought to be the ones to do so and not rely on others to do so for us.”
Poll Shows Most Americans Do Not Perceive Racial/Ethnic Disparities in Quality of Hospital Care
Although many studies have pointed to racial and ethnic disparities in health care, the poll shows that a majority of Americans do not perceive this to be the case when it comes to the quality of hospital care. A majority of the public thinks that African Americans get the same (60%) or better quality of care (2%) as Whites do when they are hospitalized. Similarly, a majority believe that Hispanics get the same (56%) or better quality of care (3%) as Whites.
“Researchers have documented the extent of racial disparities in the health care system for many years,” said Lavizzo-Mourey. “All of the health policy experts are well aware of these disparities in care, but this poll tells us that many in the public are not aware. A lot of progress has been made in providing more equitable care, but more needs to be done by physicians and hospitals to identify and quickly address any disparities that occur in the care they provide.”
Poll Shows Sharp Income Differences in Americans’ Views of the Quality of Health Care They Receive
The poll shows a sharp difference by income when it comes to Americans’ perception of the quality of health care they receive. More than four in 10 Americans (43%) with household incomes of less than $50,000 give a grade of C, D or F to the quality of health care they receive. Only about one in five Americans (21%) with household incomes of $50,000 or more rate the quality of their health care with grades of C, D or F.
The poll was designed and analyzed by a team of researchers at the Harvard School of Public Health under Blendon’s direction. Interviews were conducted via telephone (landline and cell phone) by SSRS, an independent research company, with a representative national sample of 1,034 adults age 18 and over from March 9 to 18, 2011. The margin of error for the total sample is plus or minus 3.7 percentage points. Possible sources of non-sampling error include non-response bias, as well as question wording and ordering effects. Non-response in telephone surveys produces some known biases in survey-derived estimates because participation tends to vary for different subgroups of the population. To compensate for these known biases, sample data are weighted to the most recent Census data available from the Current Population Survey for gender, age, race, education, region and number of adults in the household. Other techniques, including random-digit dialing, replicate subsamples and systematic respondent selection within households, are used to ensure that the sample is representative.
The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For nearly 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime.
Harvard School of Public Health is dedicated to advancing the public’s health through learning, discovery and communication. More than 400 faculty members are engaged in teaching and training the 1,000-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children’s health to quality of care measurement; from health care management to international health and human rights.