Only 11% of Americans think "the health care system works pretty well and only minor changes are necessary." 35% of Americans think the health care system should be "completely rebuilt," up from 24% a year ago, and 52% think "fundamental changes" are needed. In September of 1994, at the height of the health care reform debate, 35% called for a complete overhaul of the system (Harris Poll, 12/96).
Nearly one-third of hospital patients felt they were released from the hospital "before they were ready," according to a survey of nearly 24,000 hospital patients for the American Hospital Association. Patients also had problems getting answers to their questions (25%), not having enough say in their treatment (36%), finding someone to share concerns with (34%), and not being alerted about danger signals to watch for after discharge (30%) (AHA release, 1/27).
According to a national study of 160,000 households, satisfaction with quality of care and outcomes has decreased in the past two years, with the greatest declines and lowest ratings among HMO enrollees. The percentage of HMO enrollees "completely" or "very" satisfied with quality of care decreased from 69.3% in 1994 to 55.6% in 1996; satisfaction with medical outcomes dropped from 64.5% in 1994 to 52.5% in 1996. Nearly one-fourth (22.9%) of HMO enrollees have problems in getting referrals to specialists, compared with 6.1% in fee-for-service. 19.8% of HMO enrollees experience delays in treatment waiting for insurance approval (compared with 9.0% in fee-for-service), and 15.7% have difficulty in obtaining necessary care (compared with 7.6% in fee-for-service). HMOs received better ratings on the amount of paperwork for patients and out-of-pocket costs (Modern Healthcare, October 7, 1996).
Sixty-one percent of Americans are "very" concerned about being unable to afford necessary health care when a family member gets sick, up from 48% in 1994 (Pew Research Center, 10/25). 42% of Americans with health insurance fear they are likely to lose their health insurance within three years (AHA poll, 10/8).
Nurses Give Hospital Care Poor Marks
In a survey of 7,560 nurses 60.2% reported a reduction in the number of registered nurses providing direct patient care, while 65.5% percent reported an increase in the number of patients assigned to each RN. Two out of three nurses reported substitution of unlicensed personnel for RNs. Reductions were reported most frequently in the Northeast, while substitution was reported most frequently in the Pacific region. 76.7% reported greater patient acuity; 66% declines in length of stay; 55% less continuity of care; and 55.1% increased levels of unexpected readmissions of recently discharged patients. A majority (53%) of nurses rated the care given by their health care organization as average or below average; 36% said they would not recommend their institution to a family member (J. Shindul-Rothschild, American Journal of Nursing, 11/96, pps. 24-39).
Physicians' antipathy towards managed care is growing. According to a recent survey of 1,010 physicians, 71% believe managed care has negatively affected quality of care, up from 56% in 1994. 81% think that the doctor-patient relationship has been negatively affected, up from 74% in 1992. A negative impact was also cited on clinical independence (92%), time spent justifying medical decisions (84%), paperwork (79%), professional liability (49%), access to care (48%), and early diagnosis (45%), all increases from 1994 (AMA/Black Corp. Poll, 1996).
(From the website of Physicians for a National Health Plan)