Americans as Health Care Consumers

The Role of Quality Information

1996 survey of Americans showed that quality of care is their biggest concern.

Highlights of a National Survey

Americans As Health Care Consumers: The Role of Quality Information is a nationally representative telephone survey of 2,006 adults designed by the Kaiser Family Foundation, the Agency for Health Care Policy and Research (AHCPR), and Princeton Survey Research Associates (PSRA). It was conducted by PSRA between July 26 and September 5, 1996. The margin of error is plus or minus three percentage points.

The full text of the survey results—the Questionnaire and Toplines—can be downloaded; select for Downloading Information.

In choosing a health plan, Americans say quality of care is their biggest concern (42%), over low cost (18%), a wide choice of doctors (17%), and a range of benefits (14%). But, what most people say ultimately sways their decision are personal recommendations from their doctors (59%) and family members and friends (57%), according to a new national survey by the Kaiser Family Foundation and the Agency for Health Care Policy and Research (AHCPR) on what information affects Americans' health care choices, particularly the role of quality.

Seven out of ten (69%) people regard their family and friends as "good" sources of information about health plans because they share common concerns. Employers, on the other hand, are seen less favorably. Nearly six out of ten (58%) say employers are not a good resource because they cannot be trusted to provide reliable information about the quality of different health plans "because employers' main concern is saving money on health benefits."

When it comes to making health care decisions, a personal recommendation weighs so heavily with Americans that three-quarters (76%) would opt to see a surgeon they know rather than one they don't even if he or she had much higher ratings, and 72% would go to a hospital they are familiar with over one rated much higher in quality by the experts. A majority—52%—also say that if they had to choose between two plans, they would select the one strongly recommended by their friends and family over one rated much higher by independent organizations that evaluate plans.

If they had to find a new doctor, Americans are also more likely to turn to someone they know for a recommendation: 51% would ask friends and family, and 57% would get a referral from their current physician. Furthermore, when choosing a doctor, Americans are more concerned with how well a doctor communicates with patients and shows a caring attitude (84%), and whether a doctor is board certified (71%), than whether the doctor has been highly rated by an independent organization (25%) or local news outlet (15%).

Americans' lukewarm reception to quality information produced by independent organizations could reflect their lack of familiarity with such information: only two out of five (39%) Americans say they have seen quality comparisons within the last year. While most of those who have seen these comparisons say they think it would be useful for someone trying to make a decision about health plans (87%), doctors (86%), and hospitals (83%), far fewer have actually ever used the information in their own decisionmaking (34% in choosing health plans; 35%, doctors; and 30%, hospitals). In fact, even those who have seen quality comparisons are more likely to choose the provider they are more familiar with when presented with a choice between a health plan, doctor, or hospital they know or one rated much higher by the experts. In addition, they, like other Americans, also say they rely most heavily on the recommendations of friends and family and their personal physician over that of the experts.

Almost half (45%) of respondents with employer-based coverage say they are offered only one health plan through their work, leaving them with no selection of plans to compare and, understandably, less interested in comparative information. In fact, those with a choice of two or more plans who had seen quality comparisons were more likely to use the information they saw in selecting a health plan (46%).

Still large majorities of Americans say specific information about quality of care, such as how well a plan cares for members who have health problems (90%), ease of getting needed care (88%), and success at early disease detection (87%), are "very important" to know when choosing a health plan. Furthermore, given that 47% of Americans—and 57% of those who have seen quality comparisons—believe that there are "big differences" in the quality of care among health plans, there may be future demands for more comparative information.

What Americans say tells them the most about the quality of health plans is the ease of access to specialists (68%) and the range of benefits offered (66%). Other health care quality indicators that are likely to be meaningful for Americans are those emphasizing patient experiences and attitudes:

  • The percentage of doctors who have had a complaint filed against them by patients (64% say this tells them a lot about quality).
  • The percentage of plan members who get regular preventive health care screenings (62%).
  • The percentage of members who change plans because they are dissatisfied (61%).
  • How patients rate their plan's doctors (58%).
  • How patients rate the overall quality of their health care plan (57%).

Patient satisfaction surveys are one of the sources of information on quality of health plans that Americans find most influential after their regular doctor, and friends and family (45%).

Most Americans—88%—believe there is a role for the government in the quality of health care arena. A majority (52%) think the government should both monitor health providers to ensure a minimum standard of quality and make sure information about quality is available to the public. Another 24 percent think the government should only make sure information is available so people can make judgments about quality themselves, and 12 percent say the government's only role should be to monitor for a minimum standard of quality of care.


The Henry J. Kaiser Family Foundation, based in Menlo Park, California, is a non-profit, independent national health care philanthropy and is not associated with Kaiser Permanente or Kaiser Industries.

The Agency for Health Care Policy and Research (AHCPR) is the Federal focal point for health services research to improve the quality of health care, reduce costs, and broaden access to essential services.


Downloading Information

Shift-click from this Web page: Your browser may support downloading the survey results file from this Web page. To download the file from this Web page, click on the following links with the right mouse button and select "Save Link As" (Netscape) or "Save Target As" (Internet Explorer). The file is available in both Microsoft® Word® and as a PDF File.

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Page last reviewed December 2000
Internet Citation: Americans as Health Care Consumers: The Role of Quality Information. December 2000. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/kff/index.html