When it comes to the multifaceted healthcare system, most
Americans hold doctors and nurses in high esteem, but a majority of
them rate nursing homes and health insurance companies poorly.
Gallup asked Americans to assess the quality of various aspects of
healthcare in this country in November 2003, and posed similar
questions in Canada and Great Britain a month later*. Given the
differences between their healthcare systems and the U.S. system,
do healthcare ratings in these two countries follow a similar
pattern?
Overall, Americans rate the quality of U.S. healthcare higher
than do Britons and Canadians. Sixty percent of Americans rate the
quality of healthcare as excellent or good, compared with 54% of
Canadians and 49% of Britons. But Gallup this year also asked about
specific aspects of the healthcare system to investigate which
factors most influence perceptions of quality. How do healthcare
recipients in each country feel about the places they go for
healthcare treatment? The people who administer care? The companies
that provide medicine?
Nurses and Doctors
In each country, respondents rate the quality of the people who
provide healthcare most positively. Nurses and physicians receive
higher marks than any of the other five healthcare elements
included in the survey. More than 80% of Americans, Canadians, and
Britons rate the medical services that nurses provide as
"excellent" or "good," with no significant differences among the
three countries.
And at least 75% of respondents in each country rate the
services that physicians provide as excellent or good. The quality
of physician service is slightly more likely to be rated as
excellent or good in the United States (81%) than in Canada
(75%).
Hospitals and Accident/Emergency Rooms
Despite the bad press that emergency rooms tend to receive in
the United States, Americans rate them more positively than
negatively, and also more positively than do Canadians and Britons.
In the United States and Great Britain, majorities of respondents
give positive ratings to accident/emergency rooms (62% in the
United States and 54% in Great Britain rate these as excellent or
good), while accident rooms in Canada receive lower ratings
(40%).
Americans are also more pleased with the quality of their
hospitals than either Canadians or Britons are. Seventy percent of
Americans rate hospitals positively, compared with 57% of Canadians
and 61% of Britons.
Pharmaceutical or Drug Companies
Medicare prescription drug plans and the difference in
prescription drug costs in the United States and Canada have
received intense publicity in America. The high drug costs in the
United States have almost certainly affected ratings of
pharmaceutical companies, but the Gallup data show Americans are
still more likely to rate them in positive than in negative terms.
Fifty-three percent of Americans rate pharmaceutical companies as
excellent or good, compared with 67% in Canada and 62% in Great
Britain.
Private Healthcare/Health Insurance Companies and
Nursing Homes
Health insurance companies, referred to by the Canadians and
British as private healthcare, are the norm here in the United
States, but not in Canada and Great Britain. Only a third of
Americans give positive ratings to health insurance companies,
while private healthcare is rated positively by 57% of Canadians
and 51% of Britons.
Nursing homes receive low scores in all three countries, and in
fact are the lowest-rated healthcare institution in each country.
However, Canadians’ ratings (47% excellent or good) are
significantly more positive than Americans’ (29%) or
Britons’ (27%).
These differences highlight the relative weaknesses in private
vs. government-administered healthcare systems and pits two
healthcare priorities against one another -- quality versus
cost/access.
In the United States, quality is rated high, while cost and
access are major concerns. The U.S. population seems to support a
move toward greater government involvement in the healthcare system
(see "Greener on the Other Side? Universal vs. Private Healthcare"
in Related Items). In Canada and Great Britain, both private
healthcare and the current public system are positively
evaluated.
These responses suggest that healthcare consumers in all three
countries may be happiest with a mixed system of private and public
healthcare, combining elements of the current systems in the United
States, Canada, and Great Britain. However, substantial majorities
of Britons and Canadians are reluctant to give up their
government-run systems for private ones. Given the lower ratings of
overall quality of healthcare in those countries, those numbers
could change if it was clear the limited privatization might
produce substantial gains in quality.
Bottom Line
The overall quality of healthcare receives the most positive
ratings in the United States, and these high scores seem to be
driven by positive perceptions of doctors, nurses, hospitals, and
emergency rooms. But Americans’ concerns regarding health
insurance, pharmaceutical companies, and nursing homes -- both in
absolute terms and relative to the Canadian and British systems --
persist.
It seems that the U.S. health system could benefit from adapting
selected elements from the Canadian and British systems. The
question is: How can cost and access be better controlled, without
compromising the high quality of U.S. healthcare? This is the
question that those seeking to reform the healthcare system must
face in the months and years to come.
*Results in the United States are based on telephone
interviews with 1,007 national adults, aged 18 and older, conducted
Nov. 3-5, 2003. For results based on the total sample of national
adults, one can say with 95% confidence that the maximum margin of
sampling error is ±3 percentage points. The survey was
conducted by Gallup USA.
Results in Canada are based telephone interviews with 1,012
national adults, aged 18 and older, conducted Dec. 5-11, 2003. For
results based on the total sample of national adults, one can say
with 95% confidence that the maximum margin of sampling error is
±3 percentage points. The survey was conducted by Gallup
Canada.
Results in Great Britain are based telephone interviews with
1,000 national adults, aged 18 and older, conducted Dec. 2-21,
2003. For results based on the total sample of national adults, one
can say with 95% confidence that the maximum margin of sampling
error is ±5 percentage points. The survey was conducted by
Gallup UK.
