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Half of US doctors want national health insurance programme

New York Scott Gottlieb

A substantial proportion of US doctors supports government legislation to establish a national health insurance programme.

Researchers led by Dr Ronald Ackerman of the Indiana University School of Medicine, Indianapolis, Indiana, sampled 3250 doctors from the American Medical Association’s physician masterfile, which is recognised as the most complete and accurate list of licensed physicians in the United States (Annals of Internal Medicine 2003;139:795-801).

All participants were sent the survey and asked to respond to 12 questions, including whether they support or oppose the idea of governmental legislation to establish national health insurance and a national health insurance plan in which all health care is paid for by the federal government. Weighted multivariate logistic regression analyses were performed to identify factors that independently predicted support for each of these strategies.

Sixty per cent of eligible participants returned the questionnaire. Forty nine per cent of physicians supported governmental legislation to establish national health insurance, and 40% opposed it. Twenty six per cent of all physicians supported a national health insurance plan in which all health care is paid for by the federal government.

In analyses that adjusted for differences in personal and practice characteristics, certain groups were significantly more likely to support governmental legislation to establish national health insurance than others. These groups were physicians in a primary care specialty, physicians reporting that at least 20% of their patients had Medicaid (the joint programme run between the states and the US federal government to provide health insurance to poor Americans), and physicians practising in a non-private setting or in an inner city location.

With the exception of anaesthetists, family practitioners, and surgical subspecialists, more than half of respondents in major practice specialties supported the principle of establishing national health insurance through governmental legislation.

Previous physician surveys have found attitudes toward national health insurance to be mixed and changing over time (JAMA 1994;272:1546-50). The last major national survey of physicians’ attitudes towards healthcare reform was conducted in the context of the 1994 reform proposal by former president Bill Clinton.

"There is arguably some face validity to the finding that physicians with lower patient care continuity and greater exposure to underinsured patient populations are less likely to oppose the principle of governmental action to expand health care financing," the authors write.

"However, we were surprised to find that fewer than 50% of family practitioners supported governmental legislation to establish national health insurance. One possible explanation is that some relevant personal or practice characteristics of family practitioners differ from those of other primary health care providers."

A recent Harris Interactive poll found that 81% of physicians felt that at least some "fundamental change" was needed to make the current system more workable. This was an increase compared with the 57% who wanted "fundamental change" when the Clinton healthcare reform proposal was defeated in 1994.
 
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Rapid Responses:

Read all Rapid Responses

Is this a test?

Jim Whiting
bmj.com, 27 Nov 2003 [Full text]

More of a selective poll vs. survey

William D Martin
bmj.com, 1 Apr 2008 [Full text]