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Public opinion clues to health care in the '90s.


Public opinion often has a marked influence on the long-term course of government and private-sector health policy.

Taking that as a starting point, a Harvard University professor's analysis of more than two decades of poll results indicates the 1990s will see slow going for such alternatives to traditional medical care as health maintenance organizations; support for expansion of medical care as long as the United States economy stays sound; and opposition to less government spending on health care for the elderly.

The analysis of 75 opinion polis conducted between 1966 and 1987 was made by Robert J. Blendon, Sc.D., of the department of health policy and management at the Harvard University School of Public Health. He published his report in the June 24, 1988, issue of the Journal of the American Medical Association. Here are some of the findings:

*Most Americans are happy with their personal health care. While a large majority of Americans in 1986 felt the health care system required fundamental change, an equally large majority among those who had recently seen a physician or been hospitalized were completely satisfied with the quality of the medical care they received.

Blendon said most Americans (66 per cent) are not inclined to participate in the newer forms of medical practice, such as preferred provider organizations and HMOs. This resistance may decline over time, but gradually.

* Americans want more health spending, not less. In 1986, 54 per cent of Americans believed the U.S. spends too little for health services, versus 9 per cent who believed too much is spent. However, while Americans seek more and better medical care in the future-including high-tech medicine and insurance for catastrophic illness-they want it at much lower fees.

* Support for higher health spending depends on economic conditions. Severe economic downturns change public attitudes about the need to make hard personal choices on spending priorities, including health care. The deep recession of 1980-82 led to strong pressures among all segments of American society to slow the nation's rate of health care spending.

A 1985 survey found that 66 per cent of major employers had changed their insurance plans following the 1982 recession to shift a significant part of their health care costs to employees.

*The public does not see the Federal deficit as a reason to cut health spending. Seventy-one per cent of Americans would rather see a sharp cut in the nation's defense outlays than reductions in Federal health expenditures. If necessary, 66 per cent would support a small Federal sales tax and have the money earmarked for health care.

* The public differs from the experts on health cuts in an economic crisis. Health care experts often focus on three targets for a slowdown in future health spending: 1) setting limits on care of the elderly, 2) slowing the use of or withholding expensive medical technologies, and 3) reducing the future supply of physicians.

Opinion surveys suggest most Americans would follow a different course. In a 1987 poll, 78 per cent of the public favored increased Government spending on health programs for the elderly, and only 2 per cent said public outlays should be cut. No more than 21 per cent support rationing of high-cost medical procedures.

On the other hand, there's considerable interest in freezing hospital charges and physicians' fees; regionalizing the high-cost technologies; reducing inefficiency, including unnecessary tests and hospital stays; and limiting care of the poor in an economic crisis.

* Growing commercialization of health care may diminish public trust. The proportion of Americans expressing "a great deal of confidence" in the leaders of medicine dropped from 73 per cent to 33 per cent between the mid-1960s and the mid-1980s, according to data from Louis Harris & Associates, New York.

Blendon assessed the current aggressive marketing of health care, If people continue to believe medicine is becoming more commercial, there may be further erosion of public confidence.

And this could invite the backlash of increased government regulation of health care.
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Copyright 1988 Gale, Cengage Learning. All rights reserved.

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Author:Fitzgibbon, Robert J.
Publication:Medical Laboratory Observer
Article Type:editorial
Date:Aug 1, 1988
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