Category: Single Payer Health Care; Physicians Opinions

Most Minnesota doctors like single-payer health care, academic study finds | Twin Cities Daily Planet | Minneapolis – St. Paul

Most Minnesota doctors like single-payer health care, academic study finds Twin Cities Daily Planet Minneapolis – St. Paul:

“In his years as a physician, he has seen a sharp change in how physicians look at health care. “Having lunch with other doctors used to mean listening to conservatives griping about the government. Now lunchroom talk is that single-payer would be a good idea,” said Adair.

A recent survey through the University of Minnesota and St. Olaf College found that 64 percent of Minnesota’s physicians support a single-payer system much like the Minnesota Health Plan. Another 25 percent said that health savings accounts were the way to go, and only 12 percent thought that the current system of managed care was adequate.

“I personally feel very angry and frustrated when I know my patients are not getting the care that they deserve,” said Dr. Elizabeth Frost, a supporter of the Minnesota Health Plan. “I hate saying to people, ‘you need this test or this study,’ all the while knowing they don’t have insurance and likely don’t have a lot of savings either.”

Of the reasons that a single-payer system is so attractive to the majority of physicians in Minnesota is that the current multi-payer, managed-care system often gets in the way of physicians’ ability to provide the care that they swore an oath to provide.”

The following point is also made:

“Because of [these] barriers people often under-use the system, “as opposed to the overuse that people erroneously cite as a significant problem in the current system,” said Settgast. “This under-use leads to unnecessary human suffering and also financial waste because the cost of caring for a patient with a stroke far exceeds the cost of effectively managing someone’s high blood pressure.”

Please click on “Moral Hazard” (along the right of this blog) to see more about that last point. But the bigger point is true in my expereince too: physicians are tired of this “system” we now have and are ready to take a chance on change. It would make an interesting poll for the AMA to undertake…

UPDATE: The findings section of the paper, from Minnesota Medicine.
Findings A majority of respondents (72%) were male with a median medical school graduation year of 1979. Nearly half (46%) practiced primary medicine, followed by medical specialty (35%), surgical specialty (12%), and general surgery (6%). More than three-quarters (79%) worked in a metropolitan setting, and nearly two-thirds (65%) practiced in a clinic.
Of the 390 respondents who answered the question about which financing system would offer the best health care to the greatest number of people for a fixed amount of money, 64% said they favor a single-payer financing system, 25% preferred HSAs, and only 12% preferred managed care (Figure 1). Figures 2, 3 and 4 offer a closer look at who prefers those financing structures by sex, geographic location, specialty, and type of practice.
A single-payer system was favored by women physicians over men (female, 76%; male, 59%; p=.003); more male physicians than female preferred HSAs (male, 30%; female, 16%; p=.004). The percentage of male respondents who favored the current managed care system slightly exceeded that of female physicians (12% versus 9%; p=.553).
Geographic setting was also significantly associated across the 3 choices. Urban physicians favored a single-payer system over their rural and suburban colleagues (71%, 60%, and 54%, respectively; p=.009). Rural physicians preferred HSAs over suburban and urban physicians (34%, 32%, 17%; p=.002). Managed care garnered less than 15% support overall, with 14% of suburban physicians, 12% of urban doctors, and 6% of rural respondents favoring it; p=.217). Thus, urban physicians had the most support for a single-payer system and the least for managed care. Rural physicians were relatively enthusiastic for HSAs but least supportive of managed care.
When looking at physicians’ responses across medical specialty, those practicing primary medicine most favored a single-payer system (74%); general surgeons least favored such a system (36%). Conversely, general surgeons most favored HSAs (55%), and primary medicine physicians least favored them (20%). Managed care found greatest support among physicians who practiced a medical or surgical specialty (17% each) and the least among those who practiced primary medicine (6%). Of those who favored managed care, the significant split was specialists over generalists (17% and 7%; p=.001).
Physicians also were asked who should be responsible for providing access to health care. Nearly all (86%) believed it is the responsibility of society through government to ensure access to good medical care for all, regardless of ability to pay. Only 41% held that the private insurance industry should continue to play a major role in medical care financing and delivery.
Using a regression model, we found that physicians who agreed that it is the government’s responsibility to ensure access to medical care were significantly more likely to favor a single-payer financing system (OR 13.51; CI 2.85, 64.15; p=.001). Those who believed the private insurance industry should continue to play a major role in financing medical care were significantly less likely to favor a government-run system (OR 3.45; CI 1.35, 8.33; p=.009

Political self-characterization of US women physicians

Social Science & Medicine : Political self-characterization of US women physicians:

“The political self-characterization of US physicians, especially including women physicians, has been poorly described. We used data from the 4,501 respondents to the Women Physicians’ Health Study (WPHS), a stratified random sample of US women M.D.s surveyed in 1993–1994, to assess US women physicians’ political characteristics. US women physicians were most likely to consider themselves politically moderate (36.6% of respondents). More considered themselves liberal (28.4%) or very liberal (8.8%) than considered themselves conservative (20.5%) or very conservative (5.8%). US women physicians predominantly bring moderate and liberal voices to political discourse. Organizations that wish to attract US women physician members should consider promoting less conservative policies.”

from Erika Frank at Emory (1999) (she’s now at UBC, Vancouver, where she did the study of med students, below).

And another one…

Political Self-characterization of U.S. Medical Students

Political Self-characterization of U.S. Medical Students:

“RESULTS
Among these medical students, 5% self-characterized as politically very conservative, 21% conservative, 33% moderate, 31% liberal, and 9% as very liberal.” Being male, white, Protestant, intending to specialize in Surgery or anesthesiology/pathology/radiology, or currently or previously being married significantly (P≤.001) increased the likelihood that a student self-identified as very conservative or conservative. Disagreement or strong disagreement with the statements, “I’m glad I chose to become a physician” and “Access to care is a fundamental human right,” were also both associated with being very conservative or conservative. Being more liberal was reported by blacks and Hispanics; those intending to become ob-gyns, psychiatrists, and pediatric subspecialists; and atheists, Jews, and adherents of eastern religions.

CONCLUSIONS
U.S. medical students are considerably more likely to be liberal than conservative and are more likely to be liberal than are other young U.S. adults. Future U.S. physicians may be more receptive to liberal messages than conservative ones, and their political orientation may profoundly affect their health system attitudes.”

from Erica Frank, Jennifer Carrera, and Shafik Dharamsi

A little more on this topic. There is hope!

Physicians views on Single Payer

This is not new data, but I am just trying to get as much information into this blog as I can. So here we go, first from Archives of Internal Medicine in 2004, by Himmelstein and Woolhandler of PNHP:

Single-Payer National Health Insurance: Physicians’ Views

Danny McCormick, MD, MPH; David U. Himmelstein, MD; Steffie Woolhandler, MD, MPH; David H. Bor, MD

Arch Intern Med. 2004;164:300-304.

Results Of 1787 physicians, 904 (50.6%) responded to our survey. When asked which structure would provide the best care for the most people for a fixed amount of money, 63.5% of physicians chose a single–payer system; 10.7%, managed care; and 25.8%, a fee-for-service system. Only 51.9% believed that most physician colleagues would support a single–payer system. Most respondents would give up income to reduce paperwork, agree that it is government’s responsibility to ensure the provision of medical care, believe that insurance firms should not play a major role in health care delivery, and would prefer to work under a salary system.

Conclusions Most physicians in Massachusetts, a state with a high managed care penetration, believe that single–payer financing of health care with universal coverage would provide the best care for the most people, compared with a managed care or fee-for-service system. Physicians’ advocacy of single–payer national health insurance could catalyze a renewed push for its adoption.

A response from Dr. Palmisano of the AMA

The Danger of Single-Payer Health Insurance
Donald J. Palmisano
Arch Intern Med. 2004;164(20):2281-2282.
EXTRACT FULL TEXT

Dr. Palmisano cites Dr. Ian Bogle in his “Outgoing speech as Chairman of the British Medical Association Council.” Available at: http://www.bma.org.uk/ap.nsf/Content/ARM03chcouncil.

and a survey published a year earlier to make his case: “Support for national health insurance among US physicians: a national survey.” Ann Intern Med. 2003;139:795-801.

Regarding the former, England has a National Health Service, not a single payer system, though I always urge us to learn from the faults of other systems. We are not doomed to repeat the mistakes of others (unless we’re stupid).

Regarding the second study, which Dr. P argues “found that only 26% supported a single-payer system,” here is the results section of the abstract:

Results: Sixty percent of eligible participants returned a survey. Forty-nine percent of physicians supported governmental legislation to establish national health insurance, and 40% opposed it. Only 26% of all physicians supported a national health insurance plan in which all health care is paid for by the federal government. In analyses adjusting for differences in personal and practice characteristics, physicians in a primary care specialty, physicians reporting that at least 20% of their patients had Medicaid, and physicians practicing in a nonprivate setting or in an inner-city location were statistically significantly more likely to support governmental legislation to establish national health insurance.

The editors’ notes from the journal:

With the exception of family practitioners, anesthesiologists, and surgical subspecialists, more than half of physicians in major specialties supported national health insurance. Support was highest among pediatricians, psychiatrists, and general internists.

With all due respect to the authors, these questions were as clear as mud. I am very engaged and strongly favor single payer, but I don’t know how I would have answered these questions. I’d suggest: “Would you favor expanding Medicare to all citizens?” for instance.