Country: United States
Survey Organization: Harris Interactive, Inc.
Field Date: November 14, 2006—December 8, 2006
Sample: Peer-nominated experts in health care policy, finance, and delivery; select members of the Modern Healthcare database
Sample Size: 289 (survey successfully e-mailed to 1,467 potential respondents; the response rate was 19.7 percent)
Interview Method: Online/E-mail
Read a Commission Data Brief that summarizes these findings, as well as two commentaries: "Change Will Be Incremental" by Rep. Pete Stark, (D–Calif.) and "Bipartisan Progress Is Possible" by Sen. Mike Enzi (R–Wyo.).
Introduction
This survey was conducted online by Harris Interactive on behalf of The Commonwealth Fund among 289 opinion leaders in health policy and innovators in health care delivery and finance. This was the ninth in a series of bimonthly surveys designed to highlight leaders' perspectives on the most effective and timely health policy issues facing the nation. It was the first conducted in partnership with the publication Modern Healthcare. This survey focused on priorities for the new Congress.
Summary
The U.S. health care system is in what many experts would call a crisis due, in large part, to the ever-increasing number of Americans living without health care coverage. Health insurance, health care costs, and the quality of care are pressing issues in policy circles—and in American homes. As in the HCOL survey conducted in January 2006, we asked leaders to share their views on the health care issues Congress should prioritize in the next five years. Once again, there is broad consensus among health care opinion leaders that expanding coverage to the uninsured is of great importance, with eight of 10 leaders describing this issue as absolutely essential or very important. The issue is the priority most often referred to as absolutely essential or very important among all four groups of leaders in the survey: academic/research institutions (90%), health care delivery (83%), government/labor/consumer advocacy (84%), and business/insurance/other health care industry (80 %).
The other issues most often referred to as absolutely essential or very important are: ensuring Medicare's long-run solvency (80%), expanding the State Children's Health Insurance Program (SCHIP) (76%), moderating the rise in health care costs (81%), and increasing the use of information technology (80%).
Health care opinion leaders see many achievable and desirable goals/targets for policy action within the next 10 years. Along the lines of expanding coverage for the uninsured, health care leaders would also like to reduce the proportion of the under-65 population that has no health insurance from 18 percent to 5 percent in the next decade, and think it can be done with the appropriate policy changes. They also favor decreasing the proportion of households spending more than 10 percent of their income on out-of-pocket health care costs and premiums from the current 17 percent to 10 percent in 10 years, while holding the total cost of health care as a proportion of gross domestic product (GDP) at the current figure of 16 percent.
The leaders also believe that the proportions of recommended care that children and adults receive can be dramatically increased (from the current 44% and 55%, respectively, to 80% and 75%) in the next 10 years, with similar increases in the proportions of recommended preventive care that both children and adults receive (from the current 43% and 49%, respectively, to 85% and 75%).
As a whole, almost three of five health care leaders think that mandating that all individuals buy coverage and providing subsidies and a pooled mechanism for the uninsured to purchase affordable insurance (57%) and providing federal matching funds for Medicaid/SCHIP coverage of adults below 150 percent of the federal poverty level and children below 300 percent of poverty (57%) would be extremely or very effective ways to expand coverage, with establishing a single-payer insurance system run by the federal government (54%) and covering everyone under Medicare (53%) receiving slightly less support. Other options that were judged extremely/very effective by at least half of health care opinion leaders included: requiring employers who don't provide coverage to contribute to a fund that would pay for such coverage, and allowing individuals and small businesses to buy into the Federal Employees Health Benefits Program or a similar federal group option. By contrast only 14 percent think promoting tax-free health savings accounts would be an extremely/very effective way to expand coverage, and only 13 percent think permitting association health plans to provide coverage without state licensing restrictions would be extremely/very effective at expanding coverage.
While health care opinion leaders clearly agree on the need to expand coverage of the uninsured, they differ somewhat on what kind of reforms would be most effective in doing so. Among leaders from academic/research institutions, the top two choices as extremely or very effective options were establishing a single-payer insurance system run by the federal government (66%) and covering everyone under Medicare (63%), although a majority of leaders in this group also indicated that several other options had promise.
By contrast, leaders from both the health care delivery and business/insurance/other health care industry sectors most often responded that mandating all individuals to buy coverage and providing subsidies and a pooled mechanism for the uninsured to purchase affordable insurance (62% and 57%, respectively) would be extremely or very effective, with providing federal matching funds for Medicaid/SCHIP coverage of adults below 150 percent and children below 300 percent of the poverty line (58% and 53%, respectively) also viewed as a promising option.
Meanwhile, the options viewed as most promising by leaders from the government/labor/consumer advocacy sector were requiring employers who don't provide coverage to contribute to a fund that would pay for coverage (62%), with establishing a single-payer insurance system run by the federal government (54%), covering everyone under Medicare (54%), and opening up Medicare to everyone not covered by an employer plan (54%) also viewed as potentially effective options.
In addition to the high number of uninsured, the relentless increase in health care costs is seen as presenting a major challenge to the nation's health care system. When asked to assess a list of potential approaches to control health care costs and improve the quality of care, three of four health care leaders report that reducing inappropriate care would be extremely or very effective. The biggest support for this approach came from members of the business/insurance/other health care industry (83%). Other approaches that health care leaders most often thought would be extremely or very effective are use of evidence-based guidelines to determine whether a test or procedure should be done (70%), increased and more effective use of information technology (66%), increased use of disease and care management strategies for the chronically ill (65%), and rewarding providers who are more efficient and provide higher-quality care (61%).
Methodology
This survey was conducted online by Harris Interactive on behalf of The Commonwealth Fund among 289 opinion leaders in health policy and innovators in health care delivery and finance within the United States between November 14, 2006, and December 8, 2006. No weighting was applied to these results.
The original sample for this survey was developed using a two-step process. Initially, The Commonwealth Fund and Harris Interactive jointly identified a number of experts across different sectors and professions who have 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. This sample included 1,246 people. In 2006, The Commonwealth Fund and Harris Interactive joined forces with Modern Healthcare to add new members to the panel. The Fund and Harris were able to gain access to Modern Healthcare's database of readers. The Fund, Harris, and Modern Healthcare identified the readers in the database considered health care opinion leaders and invited them to participate in the survey. The final list included 1,467 people.
Harris Interactive sent out individual e-mail invitations containing a password-protected link to the entire sample. Data collection took place between November 14, 2006, and December 8, 2006. A total of four reminder e-mails was sent to anyone who had not responded. A total of 289 respondents completed the survey.
With a pure probability sample of 289 adults, one could say with a 95 percent probability that the overall results have a sampling error of +/- 5.8 percentage points. However, that does not take other sources of error into account. This online survey is not based on a probability sample and therefore no theoretical sampling error can be calculated.
Health Care Opinion Leaders Survey Part I, Assessing Health Care Experts' Views on Policy Priorities
Health Care Opinion Leaders Survey Part II, Assessing Health Care Experts' Views on Health Insurance Issues
Health Care Opinion Leaders Survey Part III, Assessing Health Care Experts' Views on Health Care Costs
Health Care Opinion Leaders Survey Part IV, Assessing Health Care Experts' Views on Medicare and Its Future
Health Care Opinion Leaders Survey Part V, Assessing Health Care Experts' Views on Medicaid and Its Future
Health Care Opinion Leaders Survey Part VI, Assessing Health Care Experts' Views on Long-Term Care
Health Care Opinion Leaders Survey Part VII, Assessing Congress's Policy Priorities
Health Care Opinion Leaders Survey Part VIII, Evaluating Medicare Part D