Americans Do Not Believe Health Care Quality Is Improving

November 18, 2004 Contact: Alfred Chiplin, Esq.
(202) 293-5760

On Wednesday, November 17, 2004, the Kaiser Family Foundation, the Agency for Health care Research and Quality (AHRQ) of the Department of Health and Human Services, and the Harvard School of Public Health, released the results of its “National Survey on Consumers’ Experiences with Patient Safety and Quality Information.” The complete survey results are currently available through the Kaiser Foundation website ( and the Harvard School of Public Health website ( and should soon be available on the AHRQ website (

The survey found that Americans do not believe that the quality of health care in America is improving; that nearly 48% of Americans are concerned about the safety of the medical care they receive; that people with chronic conditions are considerably more likely than others to express concerns about health care quality and report personal experiences with medical errors; and that of persons reporting medical errors with serious consequences, one in seven report filing malpractice lawsuits.

The newly released survey comprises a randomly selected nationally representative sample of 2,012 adults 18 years old and older.  Participants were surveyed by telephone, in English and Spanish, by Princeton Survey Research Associates, from July 7 to September 5, 2004.  It echoes the findings of a November 1999 report of the Institute of Medicine (IoM), “To Err Is Human: Building a Safer Health System.”

The IoM report found that 44,000 to 98,000 people die in hospitals each year from preventable medical errors.  These findings were a major impetus for a more concerted effort by health care institutions to focus on improving quality of care in the U.S. and on providing information to the general public about quality of care improvement efforts.

As a policy solution, the new survey shows that nine in ten Americans (92%) support requiring the reporting of serious medical errors, some 63% want information about serious medical errors released publicly, and 88% feel that physicians should be required to tell a patient if a preventable medical error resulted in serious harm to that patient.  As to causes of medical errors, Americans find that health care provider workload, inadequate staffing and poor communication among health care providers are major factors.  In addition, the survey indicates a general feeling that physicians do not spend enough time with patients, there is a shortage of nurses in hospitals, and better of training of health professionals is needed.

According to the new survey data, Americans want more quality of care information.  About 35% report having seen information comparing the quality of health plans, hospitals, or doctors in the past year.  Only one in five Americans (19%) say they have used comparative quality information in choosing health plans, hospitals, and doctors.  The survey said that consumers generally say that data about medical errors, numbers of malpractice cases, and professional experience of health care providers, would most likely be useful in assessing quality of care.  Similarly, information about how many times a hospital has performed a particular test or surgery, and survival rates after surgery, are viewed as important in ascertaining quality.

The findings of the new survey are in sharp contrast with the quality of care information collection and dissemination activities of a variety of hospitals and their associations, as well as the work of the several accrediting bodies such as the Joint Commission on Accreditation of health care Organizations (JCAHO) and the National Committee for Quality Assurance (NCQA).  For the most part, providers are using a variety of tools to provide more information about their quality of care improvement activities, including “report cards”, websites, and news releases.  Nonetheless, this information is not filtering through to health care consumers, leaving an alarming gap between beneficiary perceptions and experiences of quality and the efforts of health care provider institutions.

The new survey also notes that Americans are becoming more proactive in reducing their risk of medical errors by doing such things as checking medications received from pharmacists to make sure they have the right prescription; calling to check medical tests results; talking to surgeons about the details of anticipated surgeries; bringing a friend or relative along to ask questions when talking to doctors; and consulting with their doctors about the hospital that they use.

The Center for Medicare Advocacy, Inc. has long advocated greater attention to providing health care consumers with reliable and verifiable information about the quality of care received in health care institutions. Making this information available in a variety of formats and venues, including the internet, is equally important.  Similarly, good comparative information about facilities, including patient mix, provider experience, error rates, staffing ratios, formal and/or informal sanctions for poor performance, and corrective efforts after sanctions, is essential to a dynamic and useful quality of care information system.  For more information on quality of care as an advocacy tool, visit the “Quality of Care” section of the Center’s website  Advocates can also visit the AHQR website (, the JCAHO website (, or the NCQA website ( for a variety of tools for assessing quality, both for providers and beneficiaries.

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