New Health Care Opinion Leaders Survey: Covering Uninsured, Improving Quality and Safety of Care Should Be Congress' Top Health Priorities

Majority Support Expanding Group Insurance Programs to Cover Uninsured, Public Availability of Quality Information; Less Support for Health Savings Accounts, Tax Credits, Malpractice Reform

New York City, January 7, 2005—Covering the uninsured should be Congress' top health care priority over the next five years, say 87% of respondents to the Commonwealth Fund Health Care Opinion Leaders survey, a new online survey of widely recognized experts in health care practice and policy. Other top priorities cited: improving quality and safety of care, including increased use of information technology (IT) (69%); and reforms to ensure Medicare's long-run solvency (50%).

Opinion leaders were nominated by their peers and included experts from four broad health care sectors: academia and research organizations; health care delivery; business, insurance, and other health industry; and government and advocacy groups. Elected officials and media representatives were excluded. The online survey, the first in a series conducted by Harris Interactive for the Commonwealth Fund, was delivered via e-mail to a panel of 1,155 experts with a diverse range of professional and ideological perspectives; 318 responded.

Top priorities for congress in next 5 years—ranking summary:

1. Expand coverage to the uninsured
2. Improv the quality and safety of medical care, including increased use of IT
3. Medicare reforms to ensure long-run solvency
4. Enact reforms to moderate the rising costs of medical care for the nation
5. Medicare payment reform to reward performance on quality and efficiency
6. Control rising cost of prescription drugs
7. Address racial/ethnic disparities in care
8. Malpractice reform
9. Administrative simplification and standardization
10. Medicaid reforms to improve coverage
11. Improve the quality of nursing homes and long-term care
12. Control Medicaid costs

"The results show broad consensus in a number of areas, a divergence of opinion in others, and a few surprises along the way….I consider the results of this inaugural opinion leaders survey to be an excellent starting point for a thoughtful discussion of the difficult issues our policymakers must address in the next few years," Fund President Karen Davis says in a commentary announcing the survey results today on www.commonwealthfund.org, along with commentaries by two panel members, Chris Jennings, a former Clinton White House health policy advisor, and Gail Wilensky, Ph.D., the Senior Fellow at Project HOPE.

Health Care Opinion Leaders to Congress: Focus on Uninsured
There is wide agreement on the top two policy solutions to cover the uninsured, with half to two-thirds of respondents in all four sectors-academia, health care delivery, business/insurance, and government/labor/consumer advocacy-ranking expanding access to group health insurance such as the federal employees' health program, or Medicaid/CHIP expansion, as a priority. In contrast, less than one-fourth of respondents say expanding health savings accounts (22%) and tax credits for the uninsured to buy into individual insurance (20%) are priorities for action.

Options other than expanding private and public group insurance to the uninsured received mixed ratings: nearly half of total respondents (48%) say allowing the near-elderly to buy into Medicare is a priority. Establishing a single-payer plan through a new program or Medicare is rated a priority by forty-five percent of the total respondents, but just twenty-nine percent in the business/insurance sector.

Rewarding Efficiency, Improving IT Use Top Ways to Control Costs
Respondents in all sectors ranked "pay-for-performance" methods such as rewarding efficient providers and effective disease management, and increased use of IT, as either the first or second priority for controlling health care costs and improving quality. Both of these options were ranked a priority by more than two-thirds of total respondents (69% and 67% respectively).

A majority (56%) rank as a top priority making information on comparative quality and cost of health care quality publicly available, with this method ranking third overall. Seventy percent of business/insurance respondents rank highly this method of reducing costs.

Other methods named for reducing costs include:

• Reduce administrative costs of insurers and providers (ranked a top priority by 42% overall, ranging from 56% for health care delivery to 29% for business/insurance/other health care industry).
• Create a national agency to set quality standards and practice guidelines (ranked a top priority by 32% overall; 43% for government/labor/consumer advocacy to 21% for business/insurance/other health care industry).
• Legalize importation of brand-name drugs from Canada (ranked a top priority by 18% overall; 26% for health care delivery to 10% for business/insurance).
• Require consumers to pay a substantially higher share of their health care costs (ranked a top priority by 13% overall; 15% of business/insurance to 6% of government/labor/consumer advocacy).

Negotiating Lower Drug Prices Named Most Important Next Step for Medicare Reform
Three-quarters of all respondents (75%) agree that allowing Medicare to use its purchasing power to negotiate lower drug prices is the most important next step for Medicare reform, ranging from two-thirds (66%) in the business/insurance sector to eighty percent in the government/labor/consumer advocacy sector. Linking increases in Medicare physician payments to quality performance was rated first by the business/insurance sector, and second in the other three.

"Our goal is to not only to gauge what the experts surveyed think about important health policy concerns but to stoke debate about how to address them by presenting a range of well-reasoned points of view on the issues and potential policy solutions," said Davis.