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United States Healthcare System and Providers

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1. What is the public's view of the U.S. health care system?

2. How was that perception shaped by the insurers?

3. How was that perception shaped by provider groups?

4. How was that perception shaped by the purchasers of healthcare.

5. Has managed care influenced or changed the ways in which healthcare providers make medical decisions? Why or why not?

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Solution Summary

This solution examines the public's perception of the United States healthcare system and how this perception was influenced from various sources e.g., insurers, provider groups and purchasers of healthcare.

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1. What is the public's view of the U.S. health care system?

The public's view is reported in various ways. Public polls are one way, but public opinion polls are often a product of the type of question asked and may not be a good representative of the population at large. Thus, research and other media coverage are also necessary for a more representative perception of public opinion.

Taken together, despite Americans' willingness to say they are "satisfied" with their health care plans, they harbor a lot of worries about the future—about treatment that could be denied them, about costs that could ruin them, and about loss of coverage—that make health care a tremendously potent political issue. Teixeira (2005) reports that HMOs are therefore whistling in the dark when they try to convince politicians that people don't care. On the contrary, not only is the public likely to look unfavorably on those who stand in the way of a patients' bill of rights, they are likely to demand more change even if such a bill actually passes. In that case, HMO lobbyists will be scrambling for new arguments—though if past experience is any guide, they will rely on the misrepresentation and misuse of polling data to make their case. (Copyright © 2005 by The American Prospect, Inc. Preferred Citation: Ruy Teixeira, "Happy with Health Care?", The American Prospect Online, Nov 30, 0002. (For full article see http://www.prospect.org/web/printfriendly-view.ww?id=4459)

Mainly as a result of managed care in 1990s, the healthcare system is perceived to be on the decline (i.e., increased cost, poor quality care, increased number of uninsured, mistrust amount the providers and insurers, unethical behavior by both insurers, and providers, etc.) by the public with overall lack of public trust in the health care system. Trust goes down when leaders are not seen as addressing the major issues in society, Blendon (2002) said. Since the 1970s, the two biggest things that worry Americans are the rising health care costs and uninsured people. In debates about national health insurance and efforts for cost containment, medical leadership was not only not supporting them, they were opposing them. Drug companies are widely perceived as greedy and insensitive (http://www.hsph.harvard.edu/trustinhealthcare/publicity.htm).
The US health care system has reached a tipping point, where public trust has eroded to record low levels, said David Shore, associate dean and executive director of the Center for Continuing Professional Education (CCPE) at HSPH, at a national symposium organized by CCPE in Boston from November 13 to 15, 2002. The eroding trust has created problems throughout the health sector, he said. "The Public's Health: A Matter of Trust" is a multi-dimensional initiative to restore Americans' flagging confidence in their health care and public health systems. The recent symposium covered causes, consequences, and cures for the trust deficiency and drew more than 80 doctors, medical directors, health care executives, consultants, academics, and other health care and public health leaders. (http://www.hsph.harvard.edu/trustinhealthcare/publicity.htm)

Public confidence in leaders running most public and private institutions, including those in health care, has fallen. The average shown above (gray line) includes the military, health care, U.S. Supreme Court, colleges and universities, organized religion (except for 1996), major companies, federal executive branch, the press, Congress, and organized labor (not 1991 or 1996). (Courtesy of Robert Blendon, from Harris 1966-2002.)

From http://www.hsph.harvard.edu/trustinhealthcare/publicity.htm see attachment

2. How did the insurers shape that perception?

a. High insurance premiums and out of reach for many American who remain uninsured
b. Differences in prescription patterns related to insurance coverage have also been documented, said Shore (November, 2002). Medicaid patients are more likely to be prescribed generic drugs than patients who have commercial health insurance. (http://www.hsph.harvard.edu/trustinhealthcare/publicity.htm).
c. Unethical behavior by the insurers. Robert Blendon, a public opinion expert at the Harvard School of Public Health, suggested that all executives-healthcare included-should develop better leadership and public relations savvy. He recalled that many institutions have incurred a world of trouble when they were perceived as violating fundamental values. For example, the savings and loan scandal of the late 1980s frightened consumers, who thought their money was safe in financial institutions. Stories emerged about government regulators and politicians aiding crooks or turning a blind eye toward malfeasance. Even though only a small number of savings and ...

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