Two-fifths of US adults report experiencing unsafe, wasteful or poorly coordinated health care

Three-quarters of adults advocate fundamental changes in health care system; Nearly half of middle-income families report serious problems paying for health care

New York, NY, August 17, 2006-- Patients, who experience the health care system on a first-hand basis, find much that could be improved. According to a new survey from The Commonwealth Fund Commission on a High Performance Health System, a surprisingly high proportion of Americans--42 percent--reported experiencing poorly coordinated, inefficient, or unsafe care at some time during the past two years, including unnecessary care or treatment recommended by a doctor, failure to provide important information or test results to other doctors or nurses, medical errors, or duplicate tests.

Overall, the survey found strong public support for efforts to improve care coordination, and a shared belief that expanded use of information technology and teams could improve the quality of care. An overwhelming majority--92%--said it is either very or somewhat important to have a medical home--one place or doctor responsible for providing and coordinating all of their medical care.

"Coordination and information are vital to improving our health care system. When care isn't coordinated there is a higher risk for unsafe care and duplicative or wasteful medical spending," said Commonwealth Fund President Karen Davis. "This survey shows that patients place high value on having a medical home that coordinates all of a patient's care and provides better access to information and care. Unfortunately, the reality is that too many patients have short-term relationships with their physicians and rarely have easy access to their own medical records."

The nationally representative survey of over 1,000 adults reveals widespread concerns about the affordability of health care, access to quality care, and the safety and efficiency of care. The survey was conducted in June by Harris Interactive for the Commonwealth Fund Commission on a High Performance Health System.

"Rather than thinking more care is better care, patients are quite perceptive about wasteful care," said Commonwealth Fund Senior Vice President Cathy Schoen, lead author of the report on the survey findings, Public Views on Shaping the Future of the U.S. Health Care System. One in four U.S. adults reported that their physician had recommended unnecessary care or treatment, and one in six reported their physician ordered tests that had already been done.

Paying for and Receiving Health Care Is Increasingly a Middle Class Problem
About half (48%) of adults in middle-income families ($35,000 to $50,000 annual income) reported serious problems paying for health care and health insurance. In fact, health care costs are now stretching budgets even for those with higher incomes. One-third of adults with family incomes between $50,000 and $75,000 a year, and one-fifth with incomes over $75,000 report serious medical bill problems.

"The increasing difficulties Americans are facing paying for health care and health insurance are cause for concern," said Dallas Salisbury, President and CEO of the Employee Benefit Research Institute, and a Commission member. "As economic stresses related to health care rise up the income ladder we are undermining the economic security of the workforce. In addition to less affordable medical care, families will no longer be able to save as much for retirement. Rising costs also put financial stress on employers based in the United States."

A Large Majority Says Major Changes Are Needed to System
Three quarters (76%) of all adults said the health care system needed either fundamental change or complete rebuilding. Just 20% said only minor changes are needed in the health care system. These views were shared across income groups and regions of the country. Majorities of both Republicans and Democrats saw a need for fundamental changes in or complete rebuilding of the health care system--although more Republicans than Democrats said there was only a need for minor changes (35% vs. 11%). Similarly, large majorities of both the uninsured and insured supported major changes in the current system.

Adults who had experienced serious problems with their care were more likely to say the system needs to be completely rebuilt compared to those reporting no serious problems. Forty-three percent of those who had experienced a medical error in the past two years said the system needs to be rebuilt, compared with 27 percent of those who did not experience a medical error.

Asked about the importance of health care policy actions for President and Congress, survey respondents said the four top priorities were: ensuring that all Americans have adequate and reliable health insurance, controlling the rising costs of medical care, lowering the cost of prescription drugs, and ensuring that Medicare remains financially sound long-term.

Americans Are Concerned About the Future
Schoen and her co-authors note that "health insecurity is moving up the income ladder." The survey found that half of adults with incomes up to $75,000 a year worry they won't get high quality health care when they need it. About half (48%) of all adults are very or somewhat worried about their ability to afford the health care they or their families might need in the future.

Other key findings from the survey include:

  • About two of five adults (39%) report that time spent on paperwork or disputes related to medical bills and health insurance is a serious problem.
  • Thirty-nine percent of adults said they experienced serious problems getting timely appointments to see doctors.
  • 94% said it is important that they have easy access to their medical records.
  • 95% felt it is important to have information about the quality of care provided by doctors and hospitals.
  • 87% of respondents think it is important for insurance companies to reward doctors and hospitals for providing efficient high-quality care.
  • Half (52%) ranked ensuring that all Americans have adequate, reliable health insurance as the top or second most important health care priority for the President and Congressional action.

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The survey follows a recent report from the Commonwealth Fund Commission on a High Performance Health System outlining a framework for dramatically enhancing health care in the United States by improving quality and safety, expanding the use of information technology, public reporting of quality and costs, payment system reforms, and ensuring affordable coverage for all. Commission Chairman James Mongan, M.D. commented that "the convergence of expert views and those of patients and consumers on what is wrong about health care in this country is striking. There is also an emerging consensus on steps that can be taken to improve our system, and those steps should be taken with considerable urgency."

The survey was conducted by Harris Interactive, Inc. in telephone interviews with 1,023 adults ages 18 and over between June 1 and June 5, 2006. Questions focused on: public views and health system values, support for moving toward more integrated care and electronic medical records, recent access, quality, efficiency, and affordability experiences and concerns, and priorities for federal action. Samples of this size have an overall margin of sampling error of +/- 3 percent.

The Commonwealth Fund is a private foundation supporting independent research on health and social issues.


Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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