Consumers' growing disenchantment with hospitals and health systems could prove catastrophic to traditional relationships between providers and the public, says a confidential new report by the American Hospital Association.
Patients are bristling at the corporatization of healthcare and continue to believe that profit-not care-is driving consolidation in the industry, the report says (See cover story, p. 30).
Those less-than-fuzzy feelings are just some of the findings to emerge from the AHA's latest round of consumer research, called Reality Check II.
The AHA sponsored 40 focus groups with more than 300 people in eight states. The sessions were conducted by Lee Zacharias, an independent research consultant, and moderated by Public Opinion Strategies, a Washington-based firm. The sessions were held between May 1997 and January 1998.
"One of the most troubling and consistent themes that emerged . . . was participants' belief that no one in healthcare is on their side," the report said.
The AHA released the report only to its members earlier this month, but MODERN HEALTHCARE obtained a copy last week. The AHA last year made public a previous report (Jan. 13, 1997, p. 3). The earlier document found that erosion of the public's trust in the nation's healthcare system was a threat to the political leverage of hospitals.
The AHA already has another round of focus groups under way. This time, they are exploring the issues of trust and confidence in community organizations. It's not clear when that research will be completed.
This latest research found that despite a strong economy, people remain anxious about the security of their health coverage. While people agree that changes in the healthcare system must happen to control costs, sacrificing physician choice isn't the way to do it.
For the first time, the report also showed a shift in the public's perception of nurses and their role in patient care.
A number of group participants talked about being sent first to a nurse, rather than a doctor, when seeking primary care.
With politicians in Washington duking it out over federal managed-care legislation, the report says people react negatively to a bigger government presence in healthcare. However, they do feel unprotected from the bureaucracy and lack of accountability in the system, so "government as a protector has strong appeal," the report says.
Focus group participants continue to believe that insurers and managed-care companies control healthcare.
A dislike of insurance companies is fueling adversarial feelings between patients and their insurers, HMOs, hospitals and even doctors.
"Keep in mind that antagonism toward insurance companies and concern about coverage are now coloring the overall perception of healthcare," the report concludes.
The focus groups also voiced suspicion of provider-sponsored organizations, a managed-care option created by the Medicare+Choice program as part of the Balanced Budget Act of 1997.
"Clearly the successful PSO will have to demonstrate and communicate behaviors that will distinguish it from other kinds of managed care that already have disturbed the public," the report says.
