Americans Want their Health Care System Fixed

In May of this year, Harris Interactive conducted a phone survey, sampling 1,004 adults in the continental United States. This survey became the backbone of a report, "Public Views on U.S. Health Care System Organization: A Call for New Directions," issued by the Commonwealth Fund Commission on a High Performance Health System. The Commission first looked at problems in the current health care system; then offered strategies for the development of a more organized, efficient system.

Karen Davis, President of the Commonwealth Fund, a private foundation supporting independent research on health care policy reform and a high performance health system, hopes that the two presidential candidates will hear what Americans are saying about the disorganization and inefficiency of our nation's health care system, and that they will respond with meaningful proposals to fix it. Nine out of ten Americans want the presidential candidates to propose reform plans that will decrease the number of uninsured Americans, and improve health care quality for all Americans; they feel all Americans should be able to get affordable health care and health insurance. The survey found that 82 percent of Americans, across all incomes groups, support efforts to improve the quality, accessibility, and affordability of health care in the United States.

Clearly nine out of ten respondents felt that having one primary doctor, or one place responsible for coordinating all their health care needs, was important, or very important because 82 percent said they had experienced inefficient care, stating cases where doctors ordered tests that had already been done, or where doctors had recommended unnecessary treatment or care.

People without health insurance had the most trouble getting timely health care without going to an emergency room; however, three out of four insured respondents also reported having trouble getting timely doctor's appointments or after-hours care unless they went to the emergency room. 39 percent also said they had trouble getting through to their doctor via phone. Patients' reported having to make repeated calls to find out the results of their medical tests.

Many survey respondents felt that wider adoption of computerized health information technology was important for themselves and their doctors, and that the use of computerized technology would result in easier access to their medical records. 47 percent of respondents said that their medical information had not been appropriately shared, or efficiently communicated between their primary care doctor and the specialists they saw during the past two years.

Chairman of the Commission on a High Performance Health System, and CEO of Partners Health System, James J. Mongan, M.D., wants to see a strong national leadership and commitment to real progress in making our health care system run "like an efficient, well-oiled machine," and offered strategies to fix the troubled system.

In a related report issued in May 2008, "Organizing the U.S. Health Care System for High Performance," the authors recommend a different payment system, a breaking away from pay for service plan, more toward a system where providers and hospitals get paid for high quality, patient-centered and coordinated health care.

They propose a system where the performance of health care providers and health care systems are evaluated, and information on quality of care is made available to the public; a system where patients are given incentives to go to the most efficient, and highest quality, health care professionals and institutions.

The authors want to see removal of regulations preventing physicians from sharing information essential to coordination of care, and state that accreditation should be based on accessibility of patient information not only for all providers, but also for the patient at point of care, and provide active management and coordination between multiple providers, and smooth transitions between providers. Accreditation, they feel, should also require accountability of all health care providers to each other; providers should be reviewing each others work, and collaborating on patient care.

They feel the path to accountability for patient care should be clear, and the health care system should be continually working to improve quality, value, and the patients' experiences. The Commission suggests that physicians and health care professionals be trained to work in a team-based environment.

The authors of the study reached their conclusions after analyzing successful health care systems around the country and concluded that for positive gains to be made in the entire health care system reorganization is needed, not just at the practice level, but at community, state and national levels as well. They suggest that government support for electronic health records and performance improvement activities is necessary for to develop a well-organized health care infrastructure. They would like to see the use of electronic health records required within the next five years.