Significant Proportion of Americans Experience Problems With Care Coordination, Survey Finds

More than four in 10 Americans have experienced at least minor problems with coordinating care among different physicians, and one in six has had "major problems" coordinating health care services. That's according to a new survey issued by the Kaiser Family Foundation, the Harvard School of Public Health and National Public Radio.

"Americans see a lot of doctors, and many report having problems coordinating all the care they receive," says a summary (20-page PDF; About PDFs) of the results of the survey (23-page PDF; About PDFs), which was based on a nationally representative sample of 1,238 randomly selected respondents ages 18 and older. "Nine in 10 report seeing at least one doctor or health professional over the past two years, and seven in 10 have seen at least two."

Nearly three in 10 Americans reported having seen four or more health care professionals during the past two years, according to the survey. "Not surprisingly, coordination-of-care problems were more frequent among those who had seen multiple health professionals in recent years," the survey summary says.

Sixty-seven percent of people who reported seeing four or more physicians during the past two years experienced at least one of six issues:

Half of the survey respondents experienced at least one of the six coordination-of-care issues, and a quarter experienced two or more, according to the survey report.

Among respondents who reported experiencing at least three coordination-of-care issues, 63 percent said overtreatment was a major problem; that figure compares with 48 percent of respondents with fewer than three coordination-of care issues who reported overtreatment as a problem. Patients with coordination-of-care issues also said they were more likely to receive tests and treatments they probably didn't need. Forty-eight percent of these respondents said they may have experienced overtreatment compared with 12 percent of respondents without coordination-of-care issues who thought they had been overtreated.

Overall, nearly half of survey respondents said they believe the American health care system has a major problem with patients getting medical tests and treatments they don't need. Only 16 percent said they themselves have received unnecessary care, however.

On the other side of the spectrum, 67 percent of respondents said the American health care system has a major problem with too many patients not getting the medical tests and treatments they need. One in 10 reported having a physician deny them a medical test or treatment they wanted in the past two years because the physician did not consider it medically necessary.

The survey also addressed patient and physician interactions regarding treatment effectiveness and cost. It found that 72 percent of Americans said they believe there is not always clear scientific evidence about which treatment is likely to work best for any one patient.

"This belief in the uncertainty inherent in medical treatment suggests that the public might welcome the concept of more comparative effectiveness research," the study says. "But it also suggests that they will be particularly sensitive to whether it is their doctor or some other body who is navigating these uncertain decisions on their behalf."

Sixty percent of Americans said their physician often discusses his or her reasons for recommending a treatment, and about two in 10 said they rarely or never have this kind of talk with their physician. The remainder reported having this conversation sometimes.

The survey suggests that Americans' faith in their physicians extends even to the question of money. Sixty-five percent of respondents said their physician's charges are reasonable, and nearly 63 percent said they believe their physician is working to keep the cost of their health care down.

The survey also indicates a "distinct sense of discomfort on the part of the public with having insurers or the government involved in making decisions about which tests and treatments should be covered by insurance." More than 50 percent of the public would prefer to have a panel of experts from an independent scientific organization weigh in on coverage decisions. But that support drops to only 41 percent when the words "appointed by the federal government" are added to the description.

One in four Americans with insurance reported that their insurance company has denied coverage for a treatment or medication recommend by their physician. In those situations, 40 percent said their physician gave them a different treatment, and 20 percent paid for the treatment out-of-pocket. Another 20 percent went without treatment, and 9 percent eventually convinced the insurance company to pay for the treatment.

Not surprisingly, half of the respondents said the amount they pay for their family's health care, which includes insurance, has increased during the past year. Twenty-one percent reported the amount went up a lot, and 17 percent described the increase as a "big problem" for them. Thirty-two percent of those surveyed said they have skipped dental care during the past year, and 21 percent haven't filled a prescription. Twenty percent have skipped a recommended medical test or treatment.

One in four Americans, meanwhile, have gone to work sick because they were worried about the financial consequences of taking time off, according to the survey.