Patients see health system as broken, but their own coverage and care as good

Gallup polling shows that most respondents' perception of quality of care and coverage has held steady since 2001. But there is a consistent discrepancy between respondents' rating of their own care and their rating of coverage and the quality of the broader health care system.

A majority of patients see U.S. health care coverage in general as "fair" or "poor" in quality, but most continue to say their coverage is "good" or "excellent" (link).

Since Gallup began asking in 2001, about eight in 10 respondents have rated their health care as "good" or "excellent." During that time, about seven in 10 have described their coverage that way.

At the same time, when Gallup asked in November about the cost of care, 30% said they had put off treatment for themselves or a family member because of cost concerns -- 20% said they had done so for a serious medical condition.

Meanwhile, of the 1,012 adults polled Nov. 3-6, 65% said U.S. health care coverage is either "poor" or "fair." Their dissatisfaction with the broader health care system showed up in other responses as well: 78% said they were "dissatisfied with the total cost of care in this country" (link).

Asked to describe the "state of health care in this country," 16% said it was "in a state of crisis" -- down from a peak of 21% in 2009 and 17% in 2010.

Asked to identify the biggest problem in health care, the most common answers were "access," with 24%, and "cost," with 20%.

The gap between the estimation of the broader health system and how people rate their personal experiences of health care reflects a phenomenon pollsters see when they ask about other topics, said Frank Newport, Gallup's editor-in-chief.

People are far more positive about their own schools, members of Congress and their neighborhood's safety than they are about the general state of education, Congress or crime, he said.

Newport said there are two reasons for that tendency. First, people without direct knowledge of what schools or hospitals across the country look like tend to base their answer on what they've seen in the news or heard from politicians. Because both sources tend to focus on problems, the person will perceive the national situation more negatively than the one in their local school or doctor's office.

The second reason is known as dissonance: People don't want to believe they are sending their children to a bad school or receive low-quality health care, so they overestimate the quality of those things close to them, he said.

Gallup also noted that there could be political reasons for the fluctuation in feelings about the health system. Republicans' and independents' satisfaction rate with the health system's care shot up as President Obama pushed the Patient Protection and Affordable Care Act, then fell after its enactment. Meanwhile, Democrats' satisfaction with the health system increased after health system reform was enacted. Gallup said 47% of Americans polled favored repealing the health reform law, with 42% in favor of keeping it. Republicans overwhelmingly want it repealed, Democrats overwhelming want it to stay, and independents are about evenly split in their opinion (link).

Despite those factors, Thomas Isaac, MD, MPH, an instructor of medicine at Harvard Medical School and a primary care physician at Beth Israel Deaconess Medical Center in Boston, said the numbers Gallup found are meaningful.

Dr. Isaac co-wrote a study for the journal Health Services Research in August 2010 that found patients' impressions of the care they received in the hospital bore a direct relationship to scores on more quantitative measures (link).

There's still more research to be done in that area, but "patients' perceptions of care are important in their own right," he said.

The public is fairly healthy, so they may have a more positive view of their care than sicker patients, Dr. Isaac said. "The majority of people, who see their doctor once a year for a checkup, say, 'Yeah, my access is great,' " Dr. Isaac said. "I realize this is a general poll, but I wish they could have surveyed a sicker group."

Assuming health system reform isn't overturned by the U.S. Supreme Court, which has added lawsuits against it to its docket, the poll results after the major elements of reform kick in post-2014 will be revealing in terms of whether the new rules and regulations affect patients' perceptions, Dr. Isaac said.

Separate Gallup Poll results published in September showed health care access and coverage still at recession levels. As of September 2011, 78.3% of respondents said they had a personal doctor, and 82.3% said they had health insurance, compared with 82.5% who said they had a personal doctor and 85.9% who said they were insured in 2008.

People insured under Medicare and Medicaid tended to rate the cost of care more favorably in Gallup's poll -- 76% of those publicly insured respondents said they were satisfied with the total cost of care, compared with 59% with another kind of plan and 24% who were uninsured.