HEALTH REFORM: Time for a Change

The Commonwealth Fund and Harris Interactive have a new poll out on health care, showing 80 percent support for fundamental change or a "completely rebuilt" health system. The poll differs a bit from some surveys we've seen with its emphasis on how people get care, not just how it should be financed. The survey of 1,004 adults found that people across income brackets have difficult getting timely, efficient and well-coordinated care. And the frustration is not only among the uninsured.

Eight-of-ten adults (81percent) who were insured all year and nine-of-ten (89 percent) who were uninsured at some point during the year called for fundamental change or complete rebuilding. Although there's a widespread perception that patients demand unnecessary tests and procedures and things they saw on TV or heard from a neighbor or stumbled across on the Internet, this survey found that many people thought they were getting unnecessary and duplicative care. One-of-three adults said they had experienced inefficient or unnecessary care in the past two years.

People reported having trouble seeing their doctor quickly, having trouble getting same day or next day appointments even when they were sick (See the chart below). They cited problems getting medical advice on the phone during the day, or receiving after-hours care without having to go to the emergency room. We wrote about related problems with access to care and emergency room crowding earlier this week.

Commonwealth wrote, "High-quality care requires more than enhanced access; it also depends on the delivery of appropriate care, timely follow-up after medical tests, and the relay of information from one doctor to another. Yet, adults fre­quently reported breakdowns in the coordination of their care, either with their doctors or between differ­ent providers." People also reported all sorts of communication mishaps—medical histories and test results not getting where they were supposed to be, for instance—resulting from poorly organized care, and it was worse when multiple specialists were involved.

That frustration led to a strong embrace of health information technology. The poll didn't directly probe around either the privacy or cost issues that have entangled wider health IT adoption, but it did find that patients thought greater use of electronic medical records and e-prescribing is a good idea. They also wanted to be able to use email or computers to communicate with their doctors, access records, or make appointments online. The flip side—more than one-in-four reported that the amount of time they spend on paperwork relating to insurance or medical bills was a serious problem.

Commonwealth has been doing a lot of work depicting what a "High Performance Health System" should look like, and the survey found lots of support for large multi-specialty group practices and integrated delivery systems. Nearly nine-of-ten adults believe that it is " important for doctors and nurses to work together as teams, with an expanded role for nurses" and nearly seven-of-ten adults felt that group practices would benefit patient care.

Bottom line: As Commonwealth put it, "Adults want their health care to be more patient-centered and integrated, and see an important role for information technology and teamwork in improving care. Reflecting these shared concerns, there is strong support for the next president to address health care quality, coverage, and costs."