Health care providers are particularly harsh in their assessment of the quality of care
Stakeholders in general believe that the overall quality of health care in the United States has gotten worse over the last five years, according to a survey among more than 1,300 stakeholders conducted by APCO Insight. Health care providers are particularly harsh in their assessment of the quality of care with only one-in-four saying that overall quality has improved. Patients are also dubious though not as negative, while policy leaders are more positive.
The negative view about the quality of care among health care providers appears to be linked to their opinion that the quality of interactions between them and patients has deteriorated and the level of clinical autonomy for physicians and other providers has gotten worse.
The survey, which was conducted from October 12, 2016 to January 5, 2017, included responses from 1,349 stakeholders, comprised of 690 health care providers (physicians, nurses and pharmacists), 555 patient opinion leaders, 78 payers and 26 policy leaders.
Opinions About the Quality of Care
According to the survey findings, only one-in-three find that the quality of care in the United States has improved over the last five years. A little more than one-quarter of health care providers and payers believe the quality has improved, while patients are skeptical. A 55% majority of policy leaders find that quality of care has gotten better.
Health care providers are particularly negative in their assessment of the quality of interactions between them and their patients with only one-in-five saying that this has improved over the last five years. And, health care providers are even more negative with more than three-in-four stating things are worse related to their level of clinical autonomy or the freedom they have to pursue treatment plans without interference.
These findings indicate that the negative perception among health care providers about the quality of care is related to their experience of reduced freedom to practice medicine without interference.
The sentiment that things have gotten worse over the last five years is echoed among other audiences – patients, payers and policy leaders – while not as pointedly as among physicians and other health care providers.
Opinions about Trends in Health Care Delivery
The lines are drawn between the audiences when it comes to views on trends in health care delivery. Policy leaders are most optimistic, patients somewhat positive and health care providers more reserved or directly negative.
Only the establishment of quality standards to reduce clinical variability and the use of electronic medical records pass muster.
All other trends are controversial, especially the shift of doctors from being independent practitioners to salaried employees, the consolidation into large health systems and the evolution of bundled payments related to the episode of care. Again, health care providers have a much more negative view on these trends, while policy leaders are more positive.
The overall findings in the survey appear to reflect the general shift in American health care over the last several years, moving from a market-based health care model to a system with a higher level of government and policy maker control similar to European health care systems. Not surprisingly, policy leaders tend to embrace this shift, while health care providers and other stakeholders in the health care universe are more skeptical or directly negative.
The findings of a potential correlation between the declining trust in the quality of care and the accelerated government and policy control is cause for concern, in particular as health care providers feel that they are losing control and freedom to practice medicine. While legislation, policy initiatives, guidelines and incentives can play a positive role in advancing the quality of care, they can also come at the expense of the engagement and ingenuity of the medical profession, which at the end of the day is critical to the delivery of quality care to patients.