HEALTHCARE REFORM: IMPACT ON RURAL PHYSICIANS AS EMPLOYERS AND PRACTITIONERS Sponsored By
Survey of New Hampshire Physicians on Healthcare Reform October 2007
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Transcript of Survey of New Hampshire Physicians on Healthcare Reform October 2007
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Survey of New Hampshire Physicians on Healthcare Reform
October 2007
• Survey questions developed by NHMS Task Force with input from UNH Survey Center
• 2594 surveys distributed – 842 e-mailed to physician employees of Dartmouth
Hitchcock Clinic by DHC administration– 1199 e-mailed by UNH Survey Center to non-DHC
physicians– 553 Mailed to physicians without email information\
• Follow-up to email recipients x 1• Total responses =514 (20% response rate)
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Demographics of Respondents
• Gender– 75% Males– 25% Females
• Age– 31% under 45– 57% 46 to 64– 12% 65 and older
• Employment Status– 34% self employed– 34% salaried– 24% DH employee– 9% other
• Specialty– 29% Primary care– 15% Surgery– 25% Specialist– 31% Other
• Practice Size– 13% Solo Practitioners– 22% 2 to 4 Physicians– 25% 5 to 10 Physicians– 20% 11 to 50 Physicians– 19% More Than 50 Physicians
• Party Identification– 53% Democrats– 17% Independent– 29% Republicans
• Member of NH Medical Society– 69% Members– 31% non-members
• Source of survey mailing– 19% survey from DHC– 81% survey from UNH SC
Note: Demographics of responders reasonably reflect NH Physician
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Perceptions of CurrentQuality, Cost and Access
In the U.S. Healthcare System
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By most measures the quality of healthcare in the U.S. is better than that of most other industrialized nations.
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The per capita cost of healthcare in the U.S. is about the same as that in other industrialized nations.
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In the ideal healthcare system, basic healthcare would be available to all individuals as part of the social contract,
a right similar to basic education, police and fire protection.
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Locus of Responsibility for Healthcare
in the Ideal System
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In the ideal healthcare system, basic healthcare would be available to all individuals as part of the social contract,
a right similar to basic education, police and fire protection.
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In the ideal healthcare system, employers would be responsible for providing health insurance for their employees.
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In the ideal healthcare system, individuals would be responsible for purchasing health insurance that meets their personal and family needs.
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Role of the Public Sector
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The U.S. healthcare system would benefit from planning of services and infrastructure to match demonstrated need.
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I would favor a simplified payor system in which public funds, collected through taxes, were used to pay directly for services
to meet the basic healthcare needs of all citizens.
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If public funding of basic healthcare were provided through a simplified payor system, individuals should have the option
to purchase additional insurance and health services.
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The government should pay for healthcare only when disability, misfortune or other obstacles make it
impossible for individuals to provide insurance for themselves.
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Role of the Private Sector
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Insurance companies provide important services that add value to the healthcare system.
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Competition and profit within the insurance industry drives innovation, quality and/or efficiency in healthcare and
must be preserved in the US healthcare system.
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The free-market is the best way to create a high quality, equitable, affordable and accessible healthcare system in the United States.
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Universal access to healthcare is best achieved by making private insurance more affordable through mechanisms such as tax credits, expanding eligibility
for public programs and/or other incremental changes.
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Cost Controls
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Denying or limiting access to needed and effective medical care (in non-futile situations) in order to preserve profitability is unethical.
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Denial of insurance to those with pre-existing conditions is an appropriate means of controlling costs.
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Control of healthcare costs ultimately must include some limits on availability of services on demand.
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Our society should decide through a democratic process what services should be provided as part of basic healthcare and what services denied.
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Medical Practice Issues
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Putting aside paperwork and administrative issues, I find the practice of medicine deeply satisfying.
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Paperwork and administrative issues interfere with my ability to serve patients well.
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The financial reimbursement that I receive for the services I provide to patients is fair when compared to other physicians.
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The financial reimbursement that I receive for the services I provide to patients is fair when compared to other professionals outside of healthcare.
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There should be greater equity in reimbursement of different medical/surgical specialties for equal time spent in providing care to patients.
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Procedures (surgery, high tech interventions/studies etc) require more skill, training and/or engender greater liability than evaluation and management of
patients; reimbursement should reflect this.
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I would be willing to accept a somewhat lower income as a physician in order for all people to access quality healthcare through a simplified planned healthcare system.
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Health outcomes are improved when patients receive coordinated care of chronic illness in a primary care medical home.
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Chronic illnesses are best managed primarily by specialists who see large volumes of the same condition and therefor have specialized skill and
expertise.
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Health Determinants
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The health of indiviudals can be enormously affected by their personal behaviors and choices.
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Psychosocial and socioeconomic factors are important contributors to health status in the U.S.
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Biogenetic heritage and physical health factors in the environment (infectious, traumatic etc) are the major determinants of health in the U.S.
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