While most hospital chief executive officers foresee improved access to healthcare under President Clinton's reform plan, many believe the gains will be offset by declines in quality and increased rationing of services.
Those are among the findings of a nationwide survey of 200 hospital CEOs conducted for MODERN HEALTHCARE by National Research Corp., a Lincoln, Neb.-based healthcare research firm. The telephone poll, which was conducted in October, represents all sizes of hospitals.
How much, and how good? Some 61% of the executives surveyed expected increased access to healthcare services under the president's plan, while 20% predicted no change, and 18% said access will actually decrease.
On the question of quality, 45% of the CEOs said they expected an erosion under the proposal, while 43% said they didn't think quality would be affected. Only 9% believed quality would improve. Quality declines were expected to a higher degree among the CEOs at smaller hospitals, those having fewer than 200 beds. Among the quality issues that have been raised in the reform debate are questions of provider choice and how restraints on spending will affect the use of high-cost treatments.
CEOs also expressed doubts about the plan's ability to contain costs. Some 43% said they expected costs to rise under the proposal, while 21% predicted improvements in health costs. Some 35% expected no change.
On the topic of healthcare rationing, 87% of the executives predicted an increase in rationing of services as a result of Clinton plan, which includes setting a ceiling on the nation's healthcare tab-known as global budgeting. Only 4% said there will be less rationing, and 9% saw no change.
Single-payer system? More than one-fourth-27%-of the chief executives surveyed thought it was very likely the regional health purchasing alliances that are a key mechanism in the Clinton plan eventually would evolve into a single-payer healthcare system. Another 50% thought it was somewhat likely, while 23% thought it was unlikely. The alliances have been a favorite target of those opposing the president's plan, including some Democratic members of Congress (Feb. 28, p. 2).
Matters of choice. The CEOs surveyed see consumers continuing their move into managed care when choosing health coverage. Some 42% believe consumers will join HMOs, 47% believe PPOs will be the favored choice, and 10% believe consumers will pick fee-for-service options.
And as consumers make their health-plan decisions, patient satisfaction information is likely to be more influential than clinical outcomes data, the CEOs said. Some 97% believe consumers will make use of satisfaction data-50% saying consumers are very likely to do so. While 81% of the CEOs said consumers will use clinical outcomes statistics in their decisionmaking, they weren't quite as certain in that category. Only 19% believed consumers will be very likely to consider outcomes data, while 62% said they would be somewhat likely, and 19% not likely at all.
Among other findings:
While most CEOs-58%-didn't foresee layoffs as a result of reform, 38% expected staff cutbacks at their facilities in the next two years. The average reduction in full-time-equivalent positions was about 10%. Clinical staffing was likely to escape the ax, with most cuts coming in clerical positions and middle and upper management.
65% of the executives said it was very likely they would continue in their current jobs for the next two years. Another 26% said it was somewhat likely they'd stay, while 9% said that, as a result of healthcare reform, it wasn't at all likely they would remain in their current jobs.
Even though reform is affecting their job security and causing rapid-fire changes in their responsibilities, 43% of the CEOs would encourage their children to become hospital administrators.