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Voter Attitudes on Health System Change Reforms

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									Voter Attitudes on Health System
Change Reforms

Findings From A Survey of 800 Likely
Voters Nationwide


                             herndon A l l i a n c e
                               Healing America’s Healthcare

                              202.776.9066 | www.lakeresearch.com | March 6, 2009
           Strategic Summary
 Voters overwhelmingly support health system reforms. Voters understand
  the connection between coverage and health system change, and want a
  more affordable health system and coverage for all.

 Voters think about system reform in personal terms and consider how
  changes will affect their personal relationship with their doctors.

 Rising costs, lack of coverage, prevention of disease, and prevention of
  medical errors are areas where voters are most dissatisfied and want to
  see change.

 Voters most support:
   • allowing providers who are not doctors to provide more routine care;
   • providing incentives for people to actively manage their health;
   • and reforming how we pay for care so that doctors are rewarded for
      better quality rather than quantity.

 Voters worry that changes will interfere with their doctors. They strongly
  support reforms that help their doctors do a better job.

 Messages on comparative effectiveness that reinforce giving doctors
  clinical and cost effectiveness information test very strongly.
                                                                               2
 The broad consensus in support of health system reforms remains robust
  – even after hearing opposition arguments.
          Key lessons on system change build on
          previous waves of research for The
          Herndon Alliance.
•   Health care is a core value to voters, who talk about it in moral terms
    when thinking about coverage, cost, and quality.

•   Health care is personal to voters. With any reform package, voters
    worry about what they might lose or gain and are concerned about
    how it will affect their own situation.

•   Voters view health care reform in terms of their personal
    relationship with their own doctors.

•   Security, peace of mind, choice, and control are very important.
    Voters, especially women, want affordable health care they can
    count on.

•   Rising costs are consistently a top concern for voters.

•   Despite some tax sensitivity in this economic climate, voters
    continue to support providing quality, affordable health care for all     3
    even if it means raising taxes or a major role for the federal
    government.
                       Key Findings: Context
•   By a margin of over 2-to-1, voters support changes to the health care
    system that improve the quality of care we receive and help control rising
    costs.

•   Voters express a strong desire for change in our health care system, with
    over two-thirds saying we need a complete overhaul or major reform.

•   The greatest dissatisfaction among voters is with the rising costs of health
    care, and they strongly support reforms that will help control costs.

•   People are happy with their doctors and trust their doctors’ training and
    ability to give good care.

•   They want reforms that help doctors do their jobs and support doctors do
    what is right for their patients. Having doctors as messengers is
    important.
                                                                                   4
               Key Findings: Specific Reforms
•   Voters solidly support payment reform and want to reward doctors for
    providing quality care.

•   People feel strongly about prevention and they support providing
    incentives for people to actively manage their health before they get sick.
     – They are less supportive of penalties for people who don’t actively
        manage their health.

•   Receiving care from health professionals other than doctors is a change
    that voters welcome. They strongly support encouraging patients,
    through lower costs or more flexible appointments, to see providers other
    than doctors and to free up doctors to spend time with those who need it
    most.

•   Instituting comparative effectiveness reforms to supplement doctors’
    clinical knowledge has solid support, but voters need to be reassured that
    scientific and cost effectiveness data do not replace or interfere with their   5
    own doctor’s judgment.
             Key Messaging Points
•   Voters need to be reassured that change will help control costs and
    improve the quality of the care they receive.

•   Messages in favor of reform test very strongly, especially messages
    that reinforce the doctor-patient relationship.
     – Voters think about change in personal terms and how it will affect
        their relationship with their own doctor. Messages need to resonate
        with voters on a personal level.

•   Messages that focus on providing doctors with scientific and cost
    effectiveness evidence, modernizing the health care system with health
    information technology, and helping doctors and patients make
    informed choices are seen by voters as both supporting doctors and
    improving care for patients.

•   Opposition messages raise some doubts for voters about reforms, and
    voters need to be reassured that changes will help control costs and
    improve the quality of the care they receive by supporting, not
    supplanting, doctors.
                                                                              6
•   Still, even after hearing opposition messages, voters strongly favor
    health system reforms by a 2-to-1 margin.
         Appendix
Poll Results and Key Messages




                                7
                 Voters express a strong desire for change in our health
                 care system, with over two-thirds saying we need a
                 complete overhaul or major reform.


Does our health care system need complete overhaul, major reform, minor reform or no reform at all?




                            69%




                                                                                                      8
                       Voters’ greatest dissatisfaction is with the rising cost of
                       health care and the lack of coverage for everyone. While
                       they trust their doctors’ training and the quality of care,
                       over one-third are dissatisfied with prevention of medical
                       errors.
Now I am going to read you some different aspects of the health care system in the U.S. For each one, tell me how
SATISFIED you are with that aspect of our health care system – VERY satisfied, SOMEWHAT satisfied, SOMEWHAT
unsatisfied, or VERY unsatisfied.



                                           81%                                          29%


                                                 62%                                           33%



                                                           38%                                         52%


                                                                                                                72%


                                                                    16%                                             78%




                                                                                                                          9
      In an engaged debate, voters support overhauling how we
      pay for and deliver health care by over 2-to-1.

                    Initial Reform Ballot


90%
80%
70%         60%

60%
50%
40%                          28%
30%
                                                11%
20%
10%
0%
        Favor Health    Oppose Reforms   Both/Neither/Don't
       System Reforms                     Know/Refused        10
            Statements for and against health
            system reforms:

•   FOR                                      •   AGAINST
     We need to overhaul how we pay               America has high quality health
    for and deliver health care so that          care because we allow doctors and
    doctors can focus on providing high          patients the freedom to choose the
    quality care for you and your family         treatments and medicines that are
    and so that patients have the best           right for them, not faceless
    information necessary to manage              government bureaucrats. This so-
    their own health and focus more on           called reform is about putting the
    prevention. The health care system           government in charge of our
    should provide the right information         personal health care decisions,
    and incentives for doctors not just to       tying the hands of your own doctor
    provide more health care, but the            and creating a one-size fits all
    most effective high quality health           health care system run by a huge,
    care based on scientific evidence.           costly new bureaucracy that we
    This will make the health care               can’t afford in these tough economic
    system more responsive to patient            times.
    needs, more convenient, and give                                                    11
    us peace of mind.
           Over 6 in 10 women and older men support reform by a
           margin of over 2-to-1. Younger men are more hesitant
           about health system changes.

                             Initial Reform Ballot

90%

80%
                                    70%
70%                 66%
                                                 62%
60%                                                          Favor Health System
                                                             Reforms
50%      47%
      43%                                                    Oppose Reforms
40%
                                                             Both/Neither/Don't
30%                                                  27%     Know/Refused
                       21%             20%
20%
                             13%          11%          11%
               9%
10%

0%
      Men <50       Women <50        Men 50+    Women 50+
                                                                                   12
              Support for reform is strong across all the important
              political groups, with the strongest support among
              Democrats and Independents, and with over half of
              Republican voters on board.
                              Initial Reform Ballot                 Republican Support by Gender

                                                             90%

                                                             70%
90%                                                                                     54%
                                                                      49%
                                                             50%                              44%
                                                                            38%
80%                                                          30%
                                                                                  13%
70%   67%                                                    10%                                    2%

                        59%                                  -10%   Republican Women    Republican Men
60%
                                            52%
50%
                                                  42%
40%

30%                           27%
            21%                                                       Favor Health System
                                                                      Reforms
20%                                 15%
                  12%                                                 Oppose Reforms
10%                                                     7%
                                                                      Both/Neither/Don't
0%                                                                    Know/Refused

      Democrats         Independents        Republicans
                                                                                                         13
The broad consensus in support of health system reforms
remains robust – even after hearing opposition arguments.


             Final Reform Ballot




                                                       14
                             Voters solidly support payment reform that would reward
                             doctors for providing quality care.
Our health care system rewards doctors for providing more tests and procedures rather than better care,
but more is not always better. We should reform how we pay for care so that doctors are rewarded for
better quality, as measured by patients’ health outcomes instead of by how much the doctors do. This
would allow patients and doctors to focus more on the health of their patients and the most appropriate
treatment. *
                                                 +62
                             77%                points




                             48%


                                                         15%
                                                                                 8%
                                                         8%
                  Support Payment Reform      Oppose Payment Reform           Undecided
                                                                                                     15

                                           Darker color indicates intensity
* Asked of half of sample.
                             Voters feel strongly about prevention and they support
                             providing incentives for people to actively manage their
                             health before they get sick.
In order to control skyrocketing health care costs and promote a healthier society, we should provide
incentives for people to actively manage their health before they get sick or engage in behaviors that may
adversely affect their health. For example, people who eat healthy, get regular exercise, and avoid
smoking would get discounts on the costs of their health coverage.*

                                             +54
                                            points




                                                                                                       16

                                        Darker color indicates intensity
* Asked of half of sample.
                             They are much less supportive of penalties for people who
                             don’t actively manage their health.

In order to control skyrocketing health care costs and promote a healthier society, we should have
penalties for people who don’t actively manage their health or engage in behaviors that may adversely
affect their health. For example, people who are overweight, don’t exercise, and smoke would pay more
for their health coverage. *


                                                                           The greatest drop-off between strong
                                                                           support for penalties vs. incentives is
                                      -2 points
                                                                           among:
                                                                           • pre-retirement voters (-41 point margin)
                                                                           • white non-college women (-39)
                                                                           • older women (-37)
                                                                           • Democrats (-36), especially weak
                                                                             Democrats (-42).




                                                                                                                        17

                                        Darker color indicates intensity
* Asked of half of sample.
                             By an overwhelming margin, voters support allowing
                             health professionals other than doctors to provide more
                             care to free up doctors and help control costs.
We should allow providers who are not medical doctors – such as nurses, nursing assistants, physician
assistants, and others – to provide more routine treatments and procedures as long as they are properly
trained and supervised. We need to encourage patients, through lower costs or more flexible
appointments, to see these providers instead of doctors. Doing so will free up doctors to spend time with
those who need it most and it will help control costs for routine care.
                                            +57
                                           points




                                                                                                      18

                                       Darker color indicates intensity
* Asked of half of sample.
                             Instituting comparative effectiveness reforms to
                             supplement doctors’ clinical knowledge has solid support.
                             Voters need to be reassured that scientific and cost
                             effectiveness data do not replace their doctor’s judgment.
We should create an independent national organization that supports health care providers by giving
them information about the most effective treatments. This information would be based on the best
available evidence from scientific research and would help ensure that doctors are relying on independent
evidence as well as their own personal judgment when making decisions about a patient’s care.


                                             +56
                                            points




                                                                                                     19

                                       Darker color indicates intensity
* Asked of half of sample.
                             Messages in favor of reform test very strongly, especially
                             messages that reinforce giving doctors information to
                             provide good care. Comparative effectiveness has
                             overwhelming support with or without explicitly
                             mentioning costs.
Now I am going to read you a series of statements people have made in support of health system changes
like those we have been discussing. Please tell me whether each is a very convincing, somewhat
convincing, not very convincing or not at all convincing reason to support these changes to the health
care system.

                                                    % Convincing (intensity in dark)

                  Comparative
              Effectiveness w/out              46%                                          84%
                     costs*

                        Comparative
                        Effectiveness         40%                                        81%
                           w/costs*


                    Evidence-based
                                            36%                                        78%
                       Medicine*
                                                                                                   20


* Asked of half of sample.
               Text of Most Effective Messages
[Comparative Effectiveness w/out Costs] We need to make sure doctors have
access to the latest research that compares the effectiveness of different types of
treatments, such as comparing which drugs work best. That will help doctors and
patients choose the best treatment for their patients’ situation and make more
informed choices rather than risk receiving less effective treatments.

[Comparative Effectiveness w/Costs] We need to make sure doctors have
access to the latest research that compares the clinical and cost effectiveness of
different types of treatments, such as comparing which drugs work best. That will
help doctors and patients choose the best treatment for their patients’ situation
and make more informed choices rather than waste money on less effective
treatments.

[Evidence-Based Medicine] Advances in health care occur so fast we need to
provide doctors with constantly updated information based on the most current
scientific evidence available. The best information should be available to your
doctor and only effective health services should be covered. This would help your
doctor do what’s right for you and give you the best quality care.                    21
          The Comparative Effectiveness message tests better with
          seniors and Republicans when it explicitly cites cost
          effectiveness. It does better with Democrats, women and
          independents when cost is not mentioned.



                                  % Very Convincing


  Democrats                                                               52%
                                                          39%

Independents                                                     46%
                                                        37%

     Women                                                          48%
                                                              42%

 Republicans                                              39%
                                                                45%

Senior voters                                                 42%
                                                                44%

                0%     10%        20%         30%       40%         50%         60%   70%
          Comparative Effectiveness w/Costs   Comparative Effectiveness w/out Costs
                                                                                            22
                             Second tier messages about reducing over-use of the
                             health care system, helping doctors avoid malpractice suits,
                             and modernizing the health care system are still strong, but
                             lack intensity.
Now I am going to read you a series of statements people have made in support of health system changes
like those we have been discussing. Please tell me whether each is a very convincing, somewhat
convincing, not very convincing or not at all convincing reason to support these changes to the health
care system.

                                                  % Convincing (intensity in dark)


                  Over-use Doesn't
                        Help
                                            33%                                         80%



              Evidence-Based
                                            33%                                       77%
             Medicine w/Liability*



              Modernize w/Doctor
                                            33%                                    73%
                    Time*
                                                                                                   23


* Asked of half of sample.
               Text of Second Tier Messages
[Over-use Doesn’t Help] We have amazing advanced technology in health care,
but just because it’s there doesn’t mean we have to use it every time. Over-use of
the health care system contributes to the high cost of tests and treatments for
everyone, and often does nothing to improve our health and can actually harm it.
We need to support doctors with the best information about prevention, and the
treatments that actually work the best for patients.

[Evidence-Based Medicine w/Liability] Advances in health care occur so fast we
need to provide doctors with constantly updated information based on the most
current scientific evidence available. The best information should be available to
your doctor and only effective health services should be covered. This would
reduce doctors’ risk of malpractice lawsuits and help your doctor do what’s right for
you by protecting doctors and enabling them to give the best quality care.

[Modernize w/Doctor Time] It is time to modernize our health care system in order
to control costs and keep our high quality health care. If we continue with our
outdated system of using paper records, rewarding doctors for providing tests and
treatments without regards to quality, and not supporting healthy living, doctors will 24
keep spending more time on paperwork and less time on their patients.
                    While opposition messages raise some doubts for voters,
                    they are much weaker than supporting messages.
                    Interfering with the doctor is the strongest concept in
                    opposition messages.
Now I am going to read you a series of statements people have made in opposition to some of these
health system changes. Please tell me whether each raises serious doubts, some doubts, minor doubts,
or no real doubts in your own mind about reforms to the health care system. If you are not sure how you
feel about a particular item, please say so.
                                                                         In a head-to-head
                                                                         contest, even after
                                                                         hearing opposition
                                                                         arguments, support for
                                                                         health system reform
                                                                         remains strong, with a
                                                                         +29 point margin
                                                                         favoring reform (56%
                                                                         support, 27% oppose).




                                                                                                     25
               Text of Opposition Messages

[Rationing] Doctors offices are already struggling with too much paperwork and a
shortage of staff. Adding rules and regulations to what kinds of treatments doctors
should provide and having financial incentives for so-called cost efficiency will lead
to rationing of care, so millions of Americans will be denied access to their choice
of health treatment.


[Interfere w/Doctor] Forcing doctors to accept government mandated guidelines
about treatments means putting government bureaucrats in charge of our health
care, not your doctor. And pushing care down to lower level providers like nurses
means we’ll get lower quality care from people with less training. This isn’t reform,
it’s a government takeover that will hurt patient care.




                                                                                         26
                    Methodology


•   Lake Research Partners designed and administered this survey that
    was conducted by telephone using professional interviewers between
    February 2-8, 2009.

•   The survey reached a total of 800 likely voters nationwide.

•   Telephone numbers for the sample were generated by random digit dial
    (RDD) methodology. The margin of error for this survey is +/- 3.5%.




                                                                           27
Voter Attitudes on Health System
Change Reforms

Findings From A Survey of 800 Likely
Voters Nationwide


                             herndon A l l i a n c e
                               Healing America’s Healthcare

                              202.776.9066 | www.lakeresearch.com | March 6, 2009

								
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