Americans as Health Care Consumers

Update on the Role of Quality Information

New survey of Americans shows that medical errors is among the public's leading measures of health care quality.

Highlights of a National Survey

Americans as Health Care Consumers: An Update on the Role of Quality Information is a nationally representative telephone survey of 2,014 adults designed by the Kaiser Family Foundation (KFF) and the Agency for Healthcare Research and Quality (AHRQ). It was conducted for KFF by Princeton Survey Research Associates between July 31 and October 9, 2000. The margin of error is plus or minus two percentage points.

The full text of the survey—toplines (the survey), a summary of the results, and a chartbook of the results—can be downloaded. Select for Downloading Information.

A new survey of Americans by the Kaiser Family Foundation (KFF) and the Agency for Health Care Research and Quality (AHRQ) shows that medical errors is now among the public's leading measures of health care quality. The results of the national survey of over 2,000 adults indicate that people are more concerned about mistakes happening when they are in the hands of the health care system than when they are flying on an airplane. Large majorities say that information about medical errors (71 percent) and malpractice suits (70 percent) would be the biggest help to them in determining the quality of providers.

The survey also found that the public is more likely to rely on recommendations of friends, family and health professionals they know than on standardized quality indicators. However, the gap between relying on family, friends, and personal physicians versus data has begun to narrow since 1996, when the survey was first conducted (select to access the highlights of the 1996 survey).

The survey also shows that, although most Americans get their health coverage through the work place, 6 in 10 do not believe employers are a trusted source of information on quality of providers, and few have consulted the internet for such information.

Americans are more likely now than in 1996 to say there are big differences in the quality of local health plans, hospitals, and specialists. For example, more than half of Americans (55 percent) say there are big differences in the quality of care among local health plans, an increase from 47 percent in 1996.

Provider experience is also important to Americans in informing them about the quality of a doctor or hospital: 66 percent say how much experience a hospital has in performing a particular test or procedure, and 65 percent say the number of times a doctor has conducted a specific medical procedure are important measures of quality. Patient experiences in getting care are also important to consumers. Whether the plan has programs to help people with chronic illnesses (67 percent), how easy it is for plan members to see specialists (66 percent), how quickly patients can see a doctor when they need an appointment (64 percent), and the percentage of plan members who get preventive care for conditions like high blood pressure (63 percent), were frequently cited as indicators of quality of a health plan.

Familiarity Weighs Heavily in Selecting Providers

Around 6 in 10 Americans say they would rely "a lot" on friends and family members or their regular doctors to make choices. Less than half say they would rely on indicators such as patient surveys, consumer groups, and newspapers and magazines. The majority say that if they wanted to find information comparing the quality of different providers, they would be very likely to ask for recommendations from friends, family members or co-workers (70 percent), or from a doctor, nurse, or other health professional they know (65 percent).

Personal recommendations and familiarity are so important that they often outweigh more formal indications of quality. More people say that they would choose a surgeon they had seen before but who was not well rated (50 percent) than a surgeon they had not seen before who was rated higher (38 percent). Likewise, people are more likely to choose a hospital that is familiar (62 percent) over one that is rated higher (32 percent).

Availability and Usefulness of Quality Information

Only about one in ten Americans have used information that compares quality among health plans, hospitals or doctors to help them make their health care decisions. This is not surprising given that few people have seen any information of this kind. About one-quarter have seen comparative information about health plans, only 15 percent about hospitals, and one in ten about doctors.

Among those who have seen information comparing the quality of providers, many indicated that they did not need to make a decision at the time they saw the information on quality, or that the information was not relevant to their personal health concern.

Role of the Internet

Despite the increased role of the Internet in information gathering of all kinds, the survey shows that few people are currently going online to find information about the quality of providers, and few trust health websites to provide accurate information. Currently, just 7 percent of the public has seen information about quality online, which is equivalent to 27 percent of those who had actually seen any comparative quality information at all.

However, when asked where they would be likely to turn in the future for such information, 28 percent say they would go online. Although more than 7 in 10 say they trust doctors and pharmacists to provide accurate information about prescription drugs, only 9 percent say they have "a lot" and 31 percent say "some" trust in health websites for such information.

Role of Government

Seventy-three percent say that the government should require health care providers to report all serious medical errors and to make sure this information is publicly available, versus 21 percent who say that this type of reporting should be voluntary in order to ensure the privacy of patients and medical staff. Furthermore, more than six in ten believe there is a role for government in promoting, monitoring and providing information about the quality of doctors, hospitals and health plans:

  • 28 percent say that the Government should just work with providers to improve quality.
  • 21 percent say that the Government should go further and penalize providers that fail to meet standards.
  • 12 percent think that the Government should just make sure information is available.

Methodology

The Kaiser Family Foundation and Agency for Healthcare Research and Quality sponsored the National Survey on Americans as Health Care Consumers: An Update on the Role of Quality Information. The telephone survey was conducted between July 31 and October 9, 2000, among a randomly selected nationally representative sample of 2,014 adults 18 years or older. Representatives from both organizations worked together to develop the survey questionnaire and to analyze the results.

Fieldwork was conducted by Princeton Survey Research Associates for the Kaiser Family Foundation. The margin of sampling error is ±2 percentage points. For results based on subsets of respondents the margin of error is higher. Note that in addition to sampling error there are other possible sources of measurement error.

Trends from the 1996 survey, Americans as Health Care Consumers: The Role of Quality Information are available online. That survey was conducted from July 26 to September 5, 1996 with 2,006 adults. Fieldwork for this survey was also conducted by Princeton Survey Research Associates. The margin of error for that survey is ±3 percentage points.

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

The Agency for Healthcare Research and Quality is the lead Federal agency charged with supporting research designed to improve the quality of health care, reduce its cost, address patient safety and medical errors, and broaden access to essential services. 

Downloading Information

The toplines (survey questionnaire) and summary of results are available as both Microsoft® Word® 97 and Adobe® PDF Files. The chartbook is available as a Microsoft® PowerPoint® file; disabled persons can access the data by using the Notes Page View feature in PowerPoint®. To download the files, right click on the links and then select "Save Target As" (Internet Explorer) or "Save Link As" (Netscape). After saving a file, find the file by using Windows® Explorer (Windows® 98/95/NT/2000) or File Manager (Windows® 3.x) and then open it by double clicking on it.

Software Requirements

  • Microsoft® Word® files can be viewed with a free Word® Viewer (Plugin Software Help).
  • PowerPoint® files can be viewed with Microsoft® PowerPoint® or with a free PowerPoint® Viewer (Plugin Software Help).
Current as of December 2000
Internet Citation: Americans as Health Care Consumers: Update on 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/kffupdate/index.html