The Commonwealth Fund Health Care Opinion Leaders Survey: Assessing Health Care Experts' Views on Medicare and Its Future

Country: United States

Survey Organization: Harris Interactive, Inc.

Field Dates: June 9–June 22, 2005

Sample: Peer-nominated experts in health care policy, finance, and delivery

Sample Size: 230 (survey successfully e-mailed to 1,289 potential respondents; 18% response rate)

Interview Method: Online/E-mail

The latest Commonwealth Fund Health Care Opinion Leaders Survey was conducted by Harris Interactive on behalf of The Commonwealth Fund, with a broad group of 230 opinion leaders in health policy and innovators in health care delivery and finance. This was the fourth in a series of six bimonthly surveys designed to highlight leaders' perspectives on the most important and timely health policy issues facing the nation. This survey focused on Medicare and its future. Potential respondents for this series of surveys were identified through a two-step process involving 1) a "nomination" survey with a core group of experts in multiple fields to nominate additional leaders both within and outside their areas of expertise and 2)a review of published lists and directories of recognized health experts. Detailed methodology is provided in the Appendix.

Summary
As Medicare celebrates its 40th anniversary, public health experts and politicians are debating the program's success and failures as well as what new directions should be explored. Depending on one's political affiliations and interests, views within this ongoing debate vary substantially. We asked respondents from our leaders' panel to share their opinions by rating the overall success of Medicare as well as the success of specific aspects of the program. Panelists also were given a list of suggested program changes and asked to indicate if they would favor or oppose each proposal.

Has Medicare Been a Success?
Overall, the vast majority of panelists from all sectors—academia, health care delivery, business/insurance/other health care industry, and government/labor/consumer advocacy—believe that Medicare is a successful program. Respondents also expressed overall enthusiasm when asked about specific features of Medicare; however, clear preferences emerged when respondents were asked to comment on the success of these individual aspects of the program. Medicare's main goal, to provide beneficiaries with stable, predictable coverage over time and guaranteed access to basic medical care for seniors and qualifying disabled, is the clear favorite among panelists, having been rated a success (net ratings of extremely successful, very successful, or successful) by nearly all (92%). One other aspect—providing support for medical education and training programs—also received high ratings, with more than three-quarters of leaders (80%) considering it successful.

Features of the program not rated as highly as these two aspects of the program, but still endorsed by clear majorities (71% to 60%), include providing financial protection for those vulnerable due to low income or poor health, improving the health status of beneficiaries, stimulating and spreading new technology and treatments, helping decrease racial disparities, and helping ensure the financial stability of health care providers.

Fewer than half of the panelists, but still a substantial minority (41%), say they believe that providing home care, allowing frail elderly and disabled to live independently is a successful feature of Medicare. Opinion leaders also agree that the program has not been successful in using Medicare's purchasing leverage to improve quality of care and encouraging healthier lifestyles and preventive care—only small minorities of respondents consider these aspects of the program a success (21% and 12%, respectively).

Medicare Advantage Plans vs. Medicare Fee-for-Service
Opinion leaders are almost equally divided (35% to 27%, not statistically different) in their views on which of the two types of plans—Medicare Advantage or Medicare Fee-for-Service (FFS)—buys more value for the money spent. A substantial minority indicated that they are not sure. Only respondents from the business/insurance/other health industry clearly favor Medicare Advantage over Medicare FFS, by a 52 percent to 14 percent margin.

Medicare's Future
When asked about a number of policy changes for Medicare, a majority of respondents favored nearly all of the proposed changes. Three options emerged as the most favored by panelists regardless of sector. These were: 1) using Medicare leverage to accelerate adoption of electronic medical records and health information technology, followed closely by 2) using Medicare's leverage to reward providers for performance on quality and efficiency and 3) having Medicare beneficiaries designate a primary care medical home and reward providers for coordinating care and ensuring receipt of preventive care.

Only one policy change was strongly opposed across sectors. Two-thirds of panelists overall opposed the idea of capping federal spending per Medicare beneficiary through premium support or other means.

Some proposed changes highlighted divergent interest of sectors. For example, about half of all panelists say they favor eliminating extra payments for private health plans, but only a quarter of those representing business/insurance/other health industry favors this option.

The topline results and a longer summary of the survey are attached at right. You may also be interested in a commentary by Fund President Karen Davis, or commentaries by two panel members, Joseph R. Antos, Ph.D. the Wilson H. Taylor Scholar in Health Care and Retirement Policy at the American Enterprise Institute, and Bruce Vladeck, East Coast director for Ernst & Young's Academic Medical Center service group.

The goal for this survey is to expand and inform a healthy public and professional debate. As part of that effort to keep the discussion going, we invite you to take the survey yourself.

Methodology
The online survey was conducted by Harris Interactive with 230 opinion leaders in health policy and innovators in health care delivery and finance between June 9th, 2005, and June 22nd, 2005.

The sample for this survey was developed by using a two-step process. Initially, The Commonwealth Fund and Harris Interactive jointly identified a number of experts across different industries and professional sectors with a range of perspectives, based on their affiliations and involvement in various organizations and institutions. Harris Interactive then conducted an online survey with these experts asking them to nominate others within and outside their own fields whom they consider to be leaders and innovators in health care. Based on the result of the survey and after careful review by Harris Interactive, The Commonwealth Fund, and a selected group of health care experts, the sample for this poll was created. The final list included 1,290 people.

Harris Interactive sent out individual e-mail invitations containing a password-protected link to the entire sample. Of the 1,290 e-mail invitations, one was returned as undeliverable. Steps were taken to attempt to correct the e-mail address and locate the individual, but these efforts were unsuccessful. Data collection took place between June 9th, 2005 and June 22nd, 2005. A total of three reminders were sent to anyone who had not responded. The response rate was 18 percent. Typically, samples of this size are associated with a sampling error of +/- 6.5%.