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Recommendations from family and friends carry the most weight in choosing a physician, hospital, or health plan

A new survey of Americans by the Kaiser Family Foundation and the Agency for Healthcare Research and Quality shows that recent attention to medical errors may have entered the public's consciousness, since this factor is now among the public's leading measures of health care quality. The results of the national survey of over 2,000 adults indicate that people are more concerned about mistakes happening when they are in the hands of the health care system than when they are flying on an airplane. About 70 percent of those surveyed say that information about medical errors and malpractice suits would be the most helpful in determining the quality of providers.

The survey also found that the public is more likely to rely on recommendations of friends, family, and health professionals they know than on standardized quality indicators. However, the gap between relying on family, friends, and personal physicians versus data has begun to narrow since 1996 when the survey was first conducted. The survey also shows that, although most Americans get their health coverage through the workplace, 6 in 10 do not believe employers are a trusted source of information on quality of providers, and few have consulted the Internet for such information.

Americans are more likely now than in 1996 to say there are big differences in the quality of local health plans, hospitals, and specialists. For example, more than half of Americans (55 percent) say there are big differences in the quality of care among local health plans, an increase from 47 percent in 1996.

Provider experience is also important to Americans in informing them about the quality of a doctor or hospital. Sixty-six percent say how much experience a hospital has in performing a particular test or procedure is an important measure of quality; 65 percent say an important measure is the number of times a doctor has conducted a specific medical procedure. Patient experiences in getting care are also important to consumers. Whether the plan has programs to help people with chronic illnesses (67 percent), how easy it is for plan members to see specialists (66 percent), how quickly patients can see a doctor when they need an appointment (64 percent), and the percentage of plan members who get preventive care for conditions like high blood pressure (63 percent) were frequently cited as indicators of health plan quality.

Around 6 in 10 Americans say they would rely "a lot" on friends and family members or their regular doctors to make choices. Less than half say they would rely on indicators such as patient surveys, consumer groups, and newspapers and magazines. The majority say that if they wanted to find information comparing the quality of different providers, they would be very likely to ask for recommendations from friends, family members, or co-workers (70 percent) or from a doctor, nurse, or other health professional they know (65 percent).

Personal recommendations and familiarity are so important that they often outweigh more formal indications of quality. More people say that they would choose a surgeon they had seen before but who was not well rated (50 percent) than a surgeon they had not seen before who was rated higher (38 percent). Likewise, people are more likely to choose a hospital that is familiar (62 percent) over one that is rated higher (32 percent).

Only about 1 in 10 Americans have used information that compares quality among health plans, hospitals, or doctors to help them make their health care decisions. This is not surprising given that few people have seen any information of this kind. About one-quarter have seen comparative information about health plans, only 15 percent about hospitals, and 10 percent about doctors. Among those who have seen information comparing the quality of providers, many indicated that they did not need to make a decision at the time they saw the information on quality or that the information was not relevant to their personal health concern.

Despite the increased role of the Internet in information gathering of all kinds, the survey shows that few people are currently going online to find information about the quality of providers, and few trust health Web sites to provide accurate information. Currently, just 7 percent of the public has seen information about quality online, which is equivalent to 27 percent of those who had actually seen any comparative quality information at all. However, when asked where they would be likely to turn in the future for such information, 28 percent say they would go online. While more than 7 in 10 say they trust doctors and pharmacists to provide accurate information about prescription drugs, only 9 percent say they have "a lot" and 31 percent say "some" trust in health Web sites for such information.

Seventy-three percent say that the government should require health care providers to report all serious medical errors and to make sure this information is publicly available versus 21 percent who say that this type of reporting should be voluntary in order to ensure the privacy of patients and medical staff. Furthermore, more than 6 in 10 believe there is a role for government in promoting, monitoring, and providing information about the quality of doctors, hospitals, and health plans. Twenty-eight percent say that the government should just work with providers to improve quality, 21 percent say that the government should go further and penalize providers who fail to meet standards, and 12 percent think that the government should just make sure information is available.

The results of the Kaiser Family Foundation/Agency for Healthcare Research and Quality's National Survey on Americans as Health Care Consumers: An Update on the Role of Quality Information are based on a telephone survey conducted between July 31 and October 9, 2000, among a randomly selected nationally representative sample of 2,014 adults 18 years of age or older. Representatives from both organizations worked together to develop the survey questionnaire and to analyze the results. Fieldwork was conducted by Princeton Survey Research Associates for the Kaiser Family Foundation. The margin of sampling error is +/-2 percentage points. For results based on subsets of respondents, the margin of error is higher. Note that in addition to sampling error there are other possible sources of measurement error.

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