A REALITY CHECK:
THE PUBLIC’S CHANGING VIEWS OF OUR HEALTH CARE SYSTEM
BY
JOEL E. MILLER, DIRECTOR, POLICY
NATIONAL COALITION ON HEALTH CARE

Introduction
      In January 1997, a national poll of American households commissioned by the National Coalition on Health Care, the nation’s largest health care alliance, indicated a lack of confidence among the majority of Americans in the quality, cost and accessibility of medical care and the health care system overall. The survey, “How Americans Perceive the Health Care System,” highlighted the most pressing health care concerns that faced American families a year ago and revealed deep concern about the current state of our health care system. The survey illustrated that the majority of Americans had lost confidence in the health care system’s ability to care for people.

      The Coalition survey looked at perceptions of health care in three specific categories: 1) cost, 2) coverage, and 3) quality.

The findings revealed:

A lack of confidence in the quality of health care and concern about rising costs and access,

Belief that the system is putting profits ahead of people and quality,

Fear that quality medical care is becoming unaffordable to the average American, and

Desire for better information in order to evaluate quality and make decisions about treatment.

      A large proportion of middle-class respondents were strongly troubled by what they saw as serious flaws in the system related to costs, access and quality.

      Public opinion surveys conducted over the 12 months since the Coalition’s survey was released indicate that the electorate is even more disgruntled with the health care system than they were a year ago. Anxieties are running high especially among middle-class Americans about health care.

      The methodology employed for this report entailed identifying and analyzing those surveys that were comprehensive in nature in ascertaining the public’s attitudes and perceptions on the health care system and on three key measures of satisfaction: cost, coverage and quality. This analysis did not include reviewing surveys where a single question on health care was asked as part of a larger public opinion survey.

Concerns About the Affordability of Health Insurance and Medical Care
      In the 1997 Coalition survey, people perceived costs rising, coverage decreasing and quality going down at the same time. This equation added up to anger, fear and cynicism. Nearly six in every ten people “strongly” agreed that “quality health care is almost unaffordable for the average person” and an additional 22% “somewhat” agreed with that statement. To the statement “health insurance premiums have gone up and coverage has gone down,” 44% “strongly” agreed and 27% “somewhat” agreed.

      The cynicism of people was evident in their responses. They felt they were paying more and getting less while health plans were profiting. That view was reflected in the agreement with the statement that the “high cost of medical care is due in part to greed of the insurance companies.” Only 10% agreed strongly that “health insurance companies put the needs of customers ahead of profits” while 43% “strongly” disagreed with this favorable view of their insurers. Nearly two-thirds of people agreed that “medical care costs have gone up but quality of care has gone down.”

      The 1997 survey also showed that the population was concerned about the impact of high health care costs. Four out of every ten people said they “worry that they will not be able to afford quality medical care for a serious illness” and felt that “the costs of health insurance have put a serious dent in our budget.” An equal proportion of people said that “my medical plan makes good health care affordable.” Over one quarter of respondents felt that they could not afford medical insurance.

      The Commonwealth Fund’s recent survey, “Working Families at Risk: Coverage, Access, Costs, and Worries” found that paying medical bills was a significant concern for many people – and not only for the uninsured, but also for middle-class working families, those with chronic or serious health problems, and those with low incomes – and prevented them from seeking needed medical care (12). According to The Commonwealth Fund study, for some people, paying these bills had a significant impact on their lives, including:

• Fear of high medical bills often led the uninsured to postpone getting needed medical care. More than half the uninsured (55%) had postponed getting care in the past year due to costs.
• Two-thirds of the uninsured with health problems said they had postponed obtaining care due to costs.
• Nearly half (46%) of recently uninsured working-age adults reported having either a problem paying their medical bills or getting needed care, or both, in the past year.
• The uninsured with health problems (age 18-64) are even more likely to report these types of problems. Three-quarters had either a problem paying their medical bills or getting needed care, or both, in the past year.
• Medical bills were so substantial that half the uninsured who said they had problems paying them – or almost one in five of all the uninsured – reported that they had to change their lives significantly (problems in paying for food and housing) to pay them. Nearly 40 percent of all survey respondents reported they worried “a great deal” or “quite a lot” about paying for basic living expenses such as food and housing due to medical bills.

      A Minneapolis Star Tribune series on health care that included polling data showed that 18 percent of the sick respondents said they could not get needed medical care in the past year (13). The most common reasons: they could not afford it or did not have insurance.

      The Commonwealth Fund survey also showed that working-age adults, many of whom were at financial risk because of gaps in insurance coverage, worried both about their ability to get health care and whether they would be able to pay for it (14). Half of all adults who had been recently uninsured or were in low-wage working families worried “a great deal” or “a lot” about their health care future.

Concerns About Coverage and Access to Medical Care
      The 1997 Coalition survey showed that many Americans were concerned about feeling unprotected and vulnerable to losing their insurance. About one-quarter of the respondents strongly agreed that they worried about losing their coverage. A similar proportion agreed that their coverage “keeps changing and getting less.” While over one-third of people felt that their coverage was satisfactory, they were troubled by what they saw as an erosion in quality and inequities in care, access and coverage for the population at large (15).

      The public’s perception on cost and coverage are inextricably linked. In the Kaiser/Commonwealth 1997 National Survey of Health Insurance the issue of affordable health insurance was raised in a dramatic fashion (16). The key findings from that study show that:

Going without health coverage is not a matter of choice for most of the uninsured. About half (51 %) of all uninsured adults reported that they do not have insurance because they could not afford it. Another quarter (25%) said they did not have health insurance because they lost their job or their employer does not offer the benefit. Only 4 percent are uninsured because they have poor health or were denied health benefits.

Families with incomes below the median U.S. family income of $35,000 are most affected by the lack of insurance. Three in five adults (59%) in families who earned less than $20,000 annually were uninsured or had a recent gap (sometime in the past two years) in health coverage. One-third (31%) who earned between $20,000 and $35,000 annually also were currently or recently uninsured.

Survey respondents who had temporary gaps in health coverage and were uninsured at some point in the past two years face problems similar to those of the currently uninsured.

• Overall, 30 percent of working-age adults and 40 percent of adults in low-wage working families said they worried “a great deal” or “a lot” that they would be denied a necessary medical procedure, compared with 17 percent of the elderly.
• One-third of all adults ages 18 to 64 in low-wage working families reported difficulty in paying their medical bills; 18 percent had dealt with a collection agency because of these bills, and 14 percent had made changes in their lives in order to pay the bills.

One in five insured individuals (21%) did not fill a prescription in the past year, and two in five (40%) postponed care in the past year due to costs. By comparison, about one in four of the uninsured (24%) did not fill a prescription; about half (55%) had delayed care.

      The Minnesota Star-Tribune survey found that 22 percent of people with serious or chronic illnesses said they have no health insurance (17). This finding and the others above show that the people who are the most vulnerable and in the most need of accessing the health care system are those least likely to do so. They need health insurance and timely medical care, but they cannot afford health insurance or the out-of-pocket expenses associated with medical treatment.

Concerns About Quality of Care and the Interface with the Health Care System
      The surveys during the last year show that the public has a significant degree of concern about the state of health care quality in America. These concerns are grounded in personal experience and show an electorate that is very troubled about the overall delivery system, the growing problem of medical errors and the lack of information on quality of care at the point of contact.

Overall Quality in the System
      In the 1997 Coalition Survey, thirteen statements dealt directly with perceptions of the quality of health care. The responses to many of these statements revealed very high levels of dissatisfaction with and concern about health care quality (18). The vast majority of Americans agreed with the statement “there is something seriously wrong with our health care system,” 87% agreed that “the quality of medical care for the average person needs to be improved,” and only 15% had “complete confidence” in hospital care. Less than half of people said they had “confidence in the health care system to take care of me.”

      Eight in ten Americans believed that the quality of medical care was being compromised in the interest of profit. They felt that “quality medical care has become unaffordable for the average American,” that “hospitals have cut corners to save money,” that “quality care is often compromised by health insurance companies to save money,”), and that “quality of medical care has gone down while costs have increased.” These views were held by individuals in both fee-for-service and managed care plans.

      Since the Coalition study was released, public opinion research shows increasing and widespread concern with quality of care in the health care system.

      In the American Hospital Association (AHA)/Picker Institute report on “Eye on Patients,” the public expressed serious concerns about the present and future of health care, notwithstanding reported high rates of “individual satisfaction.” These concerns are grounded in their personal experience (19).

      The AHA survey showed that “customer service” programs and quality improvement efforts have improved some aspects of patients’ interactions with health care providers, but they have not addressed the public’s core issue of concern. Patients’ experiences resulted in important problems with the way the “system” works (or fails to work) and the way decisions are made about their care (20).

      Recent polls also point up how “patient satisfaction surveys ” can be misleading. Observers of the health care scene have long noted a curious phenomenon: standard patient satisfaction surveys almost always yield high rates of “satisfaction.” For example, most of the patients surveyed by AHA rated their care overall as “very good” (33 percent) or “excellent” (40 percent); relatively few gave marks in the “fair” (5 percent) or “poor” (2 percent) ranges. But when, patients talk or write about their experiences, they tell a different story. The people who participated in the AHA focus groups prior to the survey, regardless of their education, income, geographic location, or ethnicity, were deeply troubled about the changes they saw taking place throughout the health care system, namely, they indicated:

Perception of reduced access to care and higher out-of-pocket costs.

Growing doubts about the quality of the care they were receiving and about the competence of their caregivers.

Increasing trend toward care that is cold and impersonal.

Feelings that “things” were not being done in their best interest.

According to the AHA/Picker Institute survey, respondents said the health care “system” does not feel – or work – like a “system.” (21)

Few people participating in the AHA survey perceived that there is a planned system of health care that operates in their behalf. Instead they saw a confusing, expensive, unreliable and often impersonal disassembly of medical professionals and institutions.

If a system were in operation at all, it was seen as one designed to block access, reduce quality, and limit spending for care at the expense of patients. This impression came not from sensational media accounts or the scare campaigns of special interest lobbying groups, but largely from personal experience. Patients told stories of their struggles to get past the many “gatekeepers” in the system or to get insurance or managed care approval for the care they and their doctors thought they needed. They talked about how assertive they must be to get answers and the frustrations of trying to coordinate care among many different specialists. And many worried about what will happen if and when they are too sick to manage such things on their own behalf.

They described a feeling of being abandoned when they were released from the hospital – like “jumping off into nowhere.”

The questions that elicited the highest problem rates in every hospital were those that queried patients about how well they were prepared to go home. Thirty percent of the hospital patients surveyed, for example, were not told about “danger signals” to watch for after they went home, 31 percent were not told about the side effects of medications they were to take, and 37 percent were not told when they could expect to resume normal activities.

Another series of surveys conducted by the Minneapolis Star-Tribune show that:

While 32 percent of the sick – those who were seriously ill or disabled last year – said they have a great deal of confidence that they will receive care they need from the health care system in Minnesota, only 40 percent of the healthy indicated the same level of confidence.

Over two thirds of the chronically ill/sick interviewed said they have only some or hardly any confidence in the health care system to provide them care they need (22).

The Hidden Epidemic – Medical Errors
      The most disturbing trend that was highlighted in the 1997 Coalition Survey, and that has been confirmed in other opinion research, is the public’s perceptions of the magnitude and effects of medical errors.

      The survey showed that disturbing stories about the quality of care had taken their toll on the confidence people have in the system. Three quarters of people agreed with the statement “I’ve heard some disturbing stories about medical care and mistakes that hurt or even killed people.” Four in ten Americans reported they had a bad experience with medical treatment or care (23).

      In September 1997, the National Patient Safety Foundation of the American Medical Association (AMA) commissioned Louis Harris & Associates to study the public’s perceptions and beliefs on health care patient safety issues. The report, “Public Opinion of Patient Safety Issues: Research Findings”, echoes the 1997 Coalition study results in the views about serious system-wide quality problems in the United States manifested through respondents’ awareness of, or direct experience with, medical errors (24).

      Respondents in the AMA poll were asked, “Have you, a close friend, or a relative ever been involved in a situation where a medical mistake was made?” More than two out of five adults (42%) said they have been involved, either personally or through a friend or relative, in a situation where a medical error was made.

Other key findings were:

Two out of five (40%) reported that the most recent medical error was a misdiagnosis. Approximately one quarter reported that the medical error was either an error with medication (28%) or an error during a medical procedure (22%).

Nearly one-half (48%) of all errors occurred in a hospital. Almost one quarter (22%) occurred in a doctor’s office.

Carelessness or negligence on the part of health care professionals (29%) was the factor most commonly cited as causing the medical error.

In more than one-third (38%) of all situations where a medical error occurred, respondents reported that nothing was done to correct the error.

One out of three adults (32%) indicated that the medical error had a permanent, negative effect on the patient’s health.

      Respondents were asked, “Have you ever heard about a situation where a medical mistake was made?” More than four out of five adults (84%) said that they had heard about a situation where a medical error was made.

      The public’s perceptions of the extent and magnitude of medical errors are well grounded. Researchers from the Harvard School of Public Health have estimated that there could be as many as three million Americans injured by treatment errors in hospitals each year, and that 180,000 patients die as a result of those errors with a cost of almost 150 billion dollars a year to the system (25).

Evaluating Quality of Care by Consumers and Consumer Protections
      The 1997 Coalition study showed that consumers want to be better informed: 83% said they “would like to be better informed about how to evaluate quality of medical care from doctors and hospitals,” and 72% “would like more information so [they] would feel more confident about decisions about medical care.” (26)

      The AHA survey also highlighted widespread concerns about the way treatment decisions are made and the care patients receive. These findings are striking because they show that consumers/patients are troubled by quality issues that go beyond choice of health plans or access to specialists (27). Full participation in treatment decisions is critical to today’s consumer and should be a key indicator of quality.

      Picker survey questions relating to involvement in decision making – Did you have enough say about your treatment? Were you involved in decisions about your care as much as you wanted? – correlated strongly with patients’ overall judgments about their care.

More than one in five clinic or office patients (21 %) said they were not as involved in decisions about their care as they wanted to be; and at least one in every three hospital patients (36 %) reported not having enough say about their treatment.

Moreover, participants in every AHA focus group expressed the belief that it is insurance companies, rather than health care professionals, who control critical decisions about their medical care.

      The need for information looms large in patients’ eyes and colors their overall perceptions of care. As one patient living with chronic illness remarked, “Information is my food.” Among the Picker survey questions that correlated most strongly with patients’ overall ratings of care were those that related to communication and information:

When you had important questions to ask a doctor (or nurse), did you get answers you could understand? Was it easy for you to find someone on the hospital staff to talk about your concerns? Did you get as much information about your condition and treatment as you wanted from your provider?

      Approximately one-third of all patients surveyed reported problems getting answers to important questions (30-32%) or talking to providers about the concerns they had (34%).

      The Kaiser Family Foundation/Harvard University “National Survey of Americans Views on Consumer Protections in Managed Care” released in January 1998 revealed that close to half of Americans — 48 percent – report that they personally, or someone they know, have experienced at least one of the problems addressed in the President’s Quality Commission’s “Consumer Bill of Rights” and in the legislative proposals before the Congress, including needing more information about health plans (29%). (28)

      Americans overwhelmingly supported federal guidelines for managed care, in a survey released by Wirthlin Worldwide (29). The survey found that 92 percent of the respondents support “federal laws ensuring patients adequate access to a full range of health professionals.” Ninety-three percent of respondents said they approve a “federal requirement that managed care companies provide patients with clear written information about covered services.” Seventy-three percent of respondents said they agree that HMOs “can too easily delay or deny treatment for patients.”

      A survey commissioned by California Gov. Pete Wilson’s Task Force on Managed Care Reform (30) found that “42 percent of those with medical insurance had a problem with their health plans in the last year (mid-1996 to mid-1997).” That represented a projected 6.7 million Californians.

      According to the California report, approximately 1.6 million people experienced recent problems with “denial or delays in getting medical treatment, inappropriate care or difficulty getting referrals to physician specialists.” Of the number of Californians reporting some difficulty with their health plans, 21 percent (1.4 million) said the problem “led to the worsening of their medical condition.”

      An important question that policymakers and health plan executives must start asking is: will patient protection bills buttress the public’s confidence in the health care system? If you are a patient and you don’t trust the health care system to provide the right care in the right way at the right time, will legislating consumer rights prevent consumers from losing confidence in the delivery system? If consumers want assurances and accountability that they will receive evidence-based care and protections from medical errors, then policymakers will need to take off their blinders and address this concern.

      Further, recent surveys show that quality of care is rated the top concern when choosing a health plan. But most consumers still rely on personal recommendations over the advice of experts when making decisions, and few trust employers to provide reliable information about health care quality. Most people regard their family and friends as “good” sources of information about health plans because they share common concerns.

      One survey found that consumers believe that employers cannot be trusted to provide reliable information about the quality of different health plans “because employers’ main concern is saving money on health benefits (31).” That same study showed that when it comes to making health care decisions, a personal recommendation weighs so heavily with Americans that three quarters would choose to see a surgeon they know rather than one they don’t, even if the unknown one is more highly regarded. Nearly 75 percent would go to a hospital they are familiar with over one rated much higher in quality by the experts. In addition, a majority said that if they had to choose between two plans, they would select the one strongly recommended by their friends and family over the one rated much higher by the independent organizations that evaluate plans.

Views on For-Profit Health Care
      Another area that is beginning to gain the public’s attention is not-for-profit versus for-profit health care. A series of surveys conducted and released in 1997 by the Kaiser Family Foundation showed a significant shift in the public’s opinion about for-profit health care. In general, a survey conducted in October 1997 compared to a March 1997 poll, showed that fewer Americans in the later survey believed for-profit hospitals and health plans offer better quality, are more responsive, or are more efficient than their nonprofit counterparts (33). Both surveys found that Americans believe two to one that the trend to for-profit health care is “bad” for the country.

      When asked about health plans in March, the majority of Americans thought that for-profit providers offered higher quality care and were more responsive and efficient than non-profits. Just six months later, public opinion largely leveled between for-profit and nonprofits on two measures: quality and responsiveness. Opinions about difference in efficiency also declined, but a higher percentage of Americans continue to perceive for-profit health care organizations as more efficient than non-profits.

      Noticeable shifts in opinion were identified about the issue in both health plans and hospitals, but the changes in opinion were particularly significant regarding hospitals:

Americans who said for-profit hospitals were more responsive dropped from 53 percent to 41 percent.

Those who said for-profit hospitals provided better quality dropped from 55 percent to 42 percent.

The opinion that for-profit hospitals were more efficient dropped from 57 percent to 48 percent.

      The public’s perceptions about for-profit health care are part of a growing concern about the changing health care system that is fueling substantial interest in Congress and in state legislatures in consumer protection and government regulation.

Conclusion
      In the 1997 Coalition survey, concerns raised by those polled were system-wide, relating to the quality of care delivered, the cost of health care, and accessibility of care for the average American. Those surveyed revealed a notable lack of confidence in the health care system at large. These anxieties crossed gender, age, political, economic and regional boundaries. Additionally, there was a widely held view that the future of health care did not look good. There was little confidence that the quality of health care delivery could be improved or that health care would be available to the average American.

      One year after that poll was conducted, a growing number of Americans, especially middle income working families, are losing confidence in the health care system and its ability to address the concerns raised in the Coalition survey. The public’s concerns with the health care system existed prior to the proliferation of managed care as public opinion polls showed between 1992 and 1994. Recent polls show that the public is growing increasingly concerned with the health care system along three key indicators: cost, coverage and quality. Further, these concerns cut across all types of delivery and financing mechanisms.

      And these concerns about cost, access and quality are grounded in their own personal experience. When you look at the data, you find many consumers asserting that the system is confusing, convoluted, uncaring, difficult to navigate to get what they perceive as necessary care and that they are not getting their money’s worth.

      There are serious concerns about the present and future of health care, notwithstanding reported high rates of “satisfaction” with individuals’ own health plans. The dichotomy is that among consumers who use (or try to access) the health care system, especially seriously ill patients, patient satisfaction dramatically declines. Survey data show not only a concern about “choice” as an indicator of quality but also the way the system works, or fails to work, and the way decisions are made about their care.

      Many respondents in the surveys reviewed are showing impatience with the lack of progress in controlling costs and improving quality and access. Many of those who felt they were protected adequately by their insurance expressed concern and dismay at the plight of many people who they believed were unprotected and poorly cared for. Many had friends, neighbors and close relatives who had lost their health insurance and were struggling to pay for or receive good health care. Their anxieties are underscored by the belief that even though they are currently protected, they could soon join the ranks of those without access to quality medical care.

      These survey findings indicate a growing concern of middle-class Americans with the state of our health care system and reflect the findings of other Coalition studies that begin to show the magnitude of system-wide problems of high costs, decreasing coverage and deteriorating quality.

      Public opinion surveys conducted over the last year and the Coalition’s studies on cost, coverage and quality illustrate the growing complexity and interrelated nature of the issues facing our health care system. Americans’ are feeling anxious about their ability to obtain necessary, affordable quality health care. The question remains: are policymakers feeling the public’s heightened concern or just the surface symptoms? And what are they prepared to do should it be the former?

ENDNOTES

0. National Coalition on Health Care. How Americans Perceive the Health Care System. Washington, DC, January 1997.
1. Kenneth E. Thorpe. Changes in the Growth in Health Care Spending: Implications for Consumers. Washington, DC, The National Coalition on Health Care, April 1997; Kenneth E. Thorpe. The Rising Number of Uninsured Workers: An Approaching Crisis in Health Care Financing. Washington, DC, The National Coalition on Health Care, October 1997; Mark A. Schuster, Elizabeth A. McGlynn and Robert H. Brook. Why the Quality of U.S. Health Care Must be Improved. Washington, DC, The National Coalition on Health Care, October 1997.
2. The Henry J. Kaiser Family Foundation and The Commonwealth Fund. Working Families at Risk: Coverage, Access, Costs and Worries. Kaiser/Commonwealth 1997 National Survey of Health Insurance, New York, NY, December 1997:3.
3. The Henry J. Kaiser Family Foundation. National Survey of Americans’ Views on Managed Care. Menlo Park, CA, November 1997:10.
4. Minneapolis Star Tribune. The Wellness Gap: Managing Managed Care. December 7, 1997:1.
5. The Henry J. Kaiser Family Foundation. National Survey of Americans’ Views on Consumer Protections in Managed Care. Menlo Park, CA, January 1998:1.
6. See Note 3.
7. Managed Health Care Improvement Task Force. Public Perceptions and Experiences with Managed Care. Sacramento, CA, November 1997:3.
8. American Medical Association. Public Opinion of Patient Safety Issues: Research Findings. Chicago, Il, September 1997:5.
9. American Hospital Association. Eye on Patients. Chicago, Il, June 1997:2.
10. Kaiser Family Foundation. Survey on Americans’ Perceptions About For-Profit and Not-for-Profit Health Care. Menlo Park, CA, March 1997:2; Kaiser/Harvard Health News Index, October 1997.
11. Working Families at Risk: Coverage, Access, Costs and Worries, 17.
12. The Wellness Gap: Managing Managed Care, 2.
13. See Note 12.
14. How Americans Perceive the Health Care System, 8-9.
15. Working Families at Risk: Coverage, Access, Costs and Worries, 35.
16. See note 13.
17. How Americans Perceive the Health Care System, 6.
18. See note 10.
19. Eye on Patients, 3
20. See Note 20
21. The Wellness Gap: Managing Managed Care, 19.
22. How Americans Perceive the Health Care System, 6.
23. Public Opinion of Patient Safety Issues, 3-7.
24. Lucian L. Leape. M.D. “Error in Medicine.” Journal of the American Medical Association, December 21, 1994:1851; Testimony by Lucian L. Leape M.D., before the Advisory Commission on Consumer Protection and Quality in the Health Care Industry, November 17, 1997.
25. See Note 23.
26. Eye on Patients, 2.
27. National Survey of Americans’ Views on Consumer Protections in Managed Care, 3.
28. Wirthlin Worldwide Release, October, 20, 1997.
29. See note 8.
30. Agency for Health Care Policy and Research. Americans as Health Care Consumers: The Role of Quality Information. Washington, DC, October 1996:5.
31. Americans as Health Care Consumers, 4.
32. See Note 11.

TABLE 1 – PUBLIC OPINION POLLS ON HEALTH CARE

Sponsoring Organization	Title of Survey	Date Released	Number Polled
AFL/CIO	Americans’ Views on Key National Issues	January 1998	1002
Agency for Health Care Policy and Research (AHCPR)	Americans as Health Care Consumers	October 1996	2006
Alliance for Affordable Health Care	Survey	May 1997	510
American Hospital Association	Eye on Patients	Summer 1997	1000
American Medical Association	Public Opinion of Patient Safety Issues	Sept. 1997	1513
American Psychological Association	Health Care Issues Survey	April 1997	1000
American Viewpoint	National Survey	January 1998	1000
California Governors’ Managed Health Care Improvement Task Force	Public Perceptions and Experiences with Managed Care	November 1997	1373
Center for Studying Health System Change	Community Tracking Study – Access	Fall 1997	43,771
Center for Studying Health System Change	Community Tracking Study – Tradeoffs	Fall 1997	43,771
Cincinnati Enquirer	The Ohio Poll	June 1997	861
Commonwealth Fund	Working Families at Risk: Coverage, Access, Costs and Worries	December 1997	4001
Hartford Courant	More Health Care Regulation Favored	October 1997	500
Kaiser/Harvard/PSRA	Post-Election Survey of Voters’ 1997 Health Care Agenda	January 1997	1000
Kaiser/Harvard	Survey on Americans’ Perceptions About For-Profit and Not-for-Profit Health Care	March & October 1997	1000
Kaiser/ Harvard	Health News Index	October 1997	1000
Kaiser/Harvard	National Survey of Americans’ Views on Managed Care	November 1997	1204
Kaiser/Harvard	National Survey of Americans’ Views on Consumer Protections in Managed Care	January 1998	1204
Kaiser	A Compilation of Findings on Knowledge and Attitudes About Managed Care	1997	N/A
Minneapolis Star-Tribune	The Wellness Gap: Managing Managed Care	December 1997	1273
National Coalition on Health Care	How Americans Perceive the Health Care System	January 1997	1001
United Food and Commercial Workers	Health Care Survey	November 1997	1000
Wirthlin Worldwide	Survey	October 1997	1000

Full copies of “A Reality Check: The Public’s Changing Views of our Health Care System” are available by contacting the National Coalition on Health Care at (202) 637-6850.

Press Release: Public Concern About Health Care on the Rise

Key Findings: Key Findings on the Public’s Changing Views of our Health Care System

Executive Summary: Executive Summary, The Public’s Changing Views of our Health Care System