health security project: reforming...

Health Security Project: Reforming Medicare

Key findings from a survey among U.S. voters ages 55 to 79 Conducted September 2010

by HART RESEARCH

A S S O T E SC I A

Health Security Project: Reforming Medicare – September 2010 – V.J. Breglio, Inc/Hart Research for 2

Project Overview & Methodology

  Dialogue among academic and policy experts to identify a set of reforms to test (Spring 2010)

  Interactive discussion session conducted with older voters to explore reactions and “fine-tune” description of reforms (June 2010)

  Online survey among 600 voters ages 55 to 79 conducted September 17-19, 2010

•  Core measures of attitudes toward health care reform and Medicare

•  Reactions to six detailed Medicare reform proposals (three focused on reducing costs, three focused on better management)


Older Voters’ Views Of Health Care Reform

And Medicare


Top priorities for older voters include issues that have a direct impact on health care and Medicare.

Other than the economy, which of these should be the top three priorities for the new administration and Congress?

Jobs/employment

Illegal immigration

Government spending

Wars in Iraq/Afghanistan

Social Security

Federal budget deficit

Taxes

Homeland security

Education

Environment Social issues

5% 3%

Less than 10%


Older voters have a strongly positive view of Medicare (especially among those already receiving it).

How well does Medicare work for most seniors?

Very well

Fairly well

Just somewhat

well

Not at all well

77% WORKS WELL

How well does Medicare work for you personally?*

Very well

Fairly well

Just somewhat

well

Not at all well

89% WORKS WELL

*among seniors receiving Medicare


Older voters are deeply skeptical about the impacts of health care reform, especially on seniors

Will health care for most Americans be better or worse under the new health care law?

Will health care for most seniors be better or worse under the new

health care law?

Will be better

Will be no different

Much better

9% Will be worse

Much worse 23%

42% 45%

Will be better

Will be no different

Much 5%

Will be worse

Much worse 23%

31%

48%


Medicare’s solvency is a significant con-cern for older voters, and they feel health care reform has worsened the situation. How concerned are you about the

future solvency of Medicare?

Very concerned

Fairly concerned

Just somewhat concerned

Not at all concerned

82% HIGH CONCERN

Will the new health care bill make the Medicare solvency situation

better or worse?

Will have no effect

Don’t know enough to say Will make

Medicare solvency

worse

Will make it better


Initial Interest/Support For Medicare Reforms Among Older Voters: Top Priorities

Top three changes to Medicare about which I would be most interested in getting more information

Allow Medicare to negotiate Rx prices with

pharma companies Coordination between primary care doctors &

specialists to reduce costs, improve treatment

Medicare cover home care for chronically ill, keeping

them out of nursing homes Change to “bundling”

system to pay doctors Prevent Medicare from

running out of funds thru means testing: higher

income = higher premiums


Initial Interest/Support For Medicare Reforms Among Older Voters: Lesser Priorities

Top three changes to Medicare about which I would be most interested in getting more information

Financial incentives for MDs to go into primary care

Medicare commission pro-pose changes Congress

must consider as package Gov’t vouchers for seniors to buy their own insurance

Prevent running out of funds by raising age for

eligibility Cut gov’t spending on

Medicare to prevent run-ning out (also cut benefits)

Raise taxes to ensure continued funding


Reactions to Proposals For Better Managing Medicare:

 Bundled Payments: Changing Incentives for Doctors/Hospitals

 Medical Team Shops

 Increased Home Care Coverage


Bundled Payments/Changing Incentives For Doctors & Hospitals: Overall Reaction Summary: Pay doctors & hospitals for bundle of services rather than individual services for a particular condition. For example, a fixed amount would be paid for the bundle of care for a hip replacement – including surgery, hospital, doctor visits, therapy, medications

Average rating*

4.8

*ratings on zero-to-ten scale, 10 = strongly support

Support strongly

Support

Mixed

Oppose

(4-5*)

(6-8*)

(9-10*) (0-3*)


Best Aspects of Proposal Reduces overall cost of care

Comprehensive, all services combined in one price

Standardizes prices, eliminates overcharging

Eliminates unnecessary tests, procedures

Bonuses to doctors/hospitals to improve care, outcomes

None, nothing appealing about this proposal

Worst Aspects of Proposal Would reduce overall care patients receive

Needed tests/treatment might be deemed unnecessary, won’t be available

Doctors will only perform procedures that make them the most money

Health care should be individualized, case-by-case, don’t like rationing health care

22%

12%

10%

10%

6%

18%

21%

19%

15%

8%

Bundled Payments/Changing Incentives For Doctors & Hospitals: Best And Worst Aspects


Not sure

Ratio of Advantages to Disadvantages

-1.63

Bundled Payments/Changing Incentives For Doctors & Hospitals: Evaluation

(21% feel strongly)

Advantages are significant enough to justify changing

system Disadvantages are significant enough

its not worth changing system

Evenly divided between advantages and disadvantages


Medical Team Shops: Overall Reaction

Summary: Have medical teams in which patients are under the care of a team of physicians, nurses, and other medical practitioners who know a host of specialties and can work together to recommend and follow through with tests and procedures


Average rating*

6.1

Support strongly

Support

Mixed

Oppose

(4-5*) (6-8*)

(9-10*) (0-3*)


Best Aspects of Proposal Improved communication/ coordination among health care providers, work together Fewer redundancies/overlaps in tests/procedures Services easier/convenient for patients to obtain Improve overall care, personalized/focused Improve medical record- keeping/information sharing Reduce overall cost of care Good idea, like team approach

Worst Aspects of Proposal Doctors/specialists won’t agree to this, will resist merging practices Will increase overall cost, additional expenditures Will take too long to start, will take years Prefer choosing my own doctors, don’t want to be forced into a team Government intervention, criticisms of government None, nothing unappealing about this proposal

27%

15%

12%

11%

8%

6% 6%

19%

10%

8%

8%

7%

15%

Medical Team Shops: Best And Worst Aspects


Medical Team Shops: Evaluation

23%

Not sure

(17% feel strongly)


system

Disadvantages are significant enough




+1.83


Increased Home Care Coverage: Overall Reaction Summary: Have Medicare pay more for home-based care. This benefit would cover part-time at-home services if an individual is homebound and has been authorized by a physician for chronic-condition related services.


Average rating*

6.4

Support strongly

Support

Mixed

Oppose

(4-5*) (6-8*)

(9-10*)

(0-3*)


Best Aspects of Proposal Better for patients to be home, people more comfortable/ prefer to be at home Reduce overall cost of care Fewer hospitalizations, less hospital overcrowding/ bed shortages Improve overall care patient receives, care personalized/ focused Fewer institutionalizations/ patients in nursing homes

Worst Aspects of Proposal Would reduce quality of care patient receives, could be denied health care Further increase overall cost of care, too expensive Possibility of abuse/fraud, difficult to manage/provide oversight Concerned about home health aides, qualifications/honesty Patients might be forced to stay home when should be hospitalized

54%

22% 17%

12%

7%

23%

13%

7%

7%

6%

Increased Home Care Coverage: Best And Worst Aspects


43% (13% strongly)

Increased Home Care Coverage: Evaluation

17% 23%

Not sure

(13% feel strongly)


system

Disadvantages are significant enough




+2.53


Ranking Of Proposals For Better Managing Medicare

Which one of these proposals would you recommend as the top priority for managing Medicare?

Increased Home Care Coverage

Medical Team Shops

Bundled Payments/ Changing Incentives for Doctors/Hospitals


Reactions to Proposals For Controlling Medicare Costs:

 Redefine Medicare Eligibility – Raise Age to 67

 Redefine Medicare Eligibility – Means Testing

 Fund Medicare through Dedicated Tax Voucher System


Redefine Medicare Eligibility – Raise Age To 67: Overall Reaction Summary: Raise the age to qualify for Medicare services to age 67, as many Americans are in good health and living longer.


Average rating*

4.1

Support strongly

Support

Mixed

Oppose

(4-5*)

(6-8*)

(9-10*)

(0-3*)


Best Aspects of Proposal Will save federal govern-ment/Medicare money Raises age to receive entitlement, Social Security has already done this Americans are healthier, living/working longer Would reduce the overall cost of care Would help Medicare remain solvent/in existence None, nothing appealing about this proposal

Worst Aspects of Proposal Unfair, people planning to retire at 65 based on promise of Medicare Health care delayed for some, people won’t get preventative care they need Not everyone able to work beyond age 65, creates coverage gap Further increase overall cost of health care, prevention is cheaper than treatment Creates unnecessary financial hardships for seniors

18%

13%

10%

6%

5%

29%

32%

19%

11%

7%

6%

Redefine Medicare Eligibility – Raise Age To 67: Best And Worst Aspects


Redefine Medicare Eligibility – Raise Age To 67: Evaluation

21%

Not sure


-2.10

(29% feel strongly)






Redefine Medicare Eligibility – Means Testing: Overall Reaction Summary: Those determined to have least financial means qualify for gov’t paying full Medicare benefits: lower-income seniors and possibly those with medical/other high-risk conditions; higher incomes receive government support for only a portion of benefits


Average rating*

4.4

Support strongly

Support

Mixed

Oppose

(4-5*)

(6-8*)

(9-10*)

(0-3*)


Best Aspects of Proposal Those who can afford to pay more should do so, wealthy can afford it Would benefit poor/low- income seniors Will level playing field, provide good/affordable care to all based on income Will save federal govern-ment/Medicare money None, nothing appealing about this proposal

Worst Aspects of Proposal Unfair, everyone who paid into system should get full benefits Penalizes hard work/fiscal responsibility, hurts those who have planned and saved Bad idea, dislike the concept Would result in some losing coverage entirely, difficult for seniors to find insurance Unclear who decides/what is used to determine “means”

17%

11%

8%

7%

29%

22%

12%

7% 6%

6%

Redefine Medicare Eligibility – Means Testing: Best & Worst Aspects


42% (26% strongly)

Redefine Medicare Eligibility – Means Testing: Evaluation

24% 21%

Not sure


-1.75

(26% feel strongly)






Fund Medicare Through Dedicated Tax Voucher System: Overall Reaction Summary: Give seniors vouchers to buy health insurance, less income = higher amount of voucher; voucher also could vary with geographic location and age, so poorest, oldest people in expensive communities would receive largest vouchers


Average rating*

3.0

Support strongly Support

Mixed Oppose (4-5*)

(6-8*) (9-10*)

(0-3*)


Best Aspects of Proposal Would give us a choice, allow us to decide what policy/the amount of coverage to buy Would benefit poor seniors/ those most at risk Would reduce the overall cost of care Ensures that all seniors get health care None, nothing appealing about this proposal

Worst Aspects of Proposal Confusing/complicated, people might not know enough to buy right plan Bad idea, dislike voucher Leaves some without enough coverage, have to pay the difference Unfair, all who have paid into system should get same voucher Reduce quality of care, lead to rationing of health care Government intervention

9%

7%

5%

5%

36%

21%

12% 9%

9%

8%

7%

Fund Medicare Through Dedicated Tax Voucher System: Best & Worst Aspects


58% (42% strongly)

Fund Medicare Through Dedicated Tax Voucher System: Evaluation

10% 21%

Not sure


-5.80 (42% feel strongly)






Ranking Of Proposals For Controlling Medicare Costs

Which one of these proposals would you recommend as the top priority for controlling Medicare costs?

Redefine Eligibility: Means Testing

Redefine Eligibility: Raise Age to 67

Fund Through Dedicated Tax Voucher


Additional Segmentation Analysis


Cluster Analysis Centered On Medicare Management Reforms

Opposers 14%

Fence Sitters 36%

Potential Supporters

25%

Strong Supporters

25%

  Older (just 40% ages 55 to 64)

  Least diverse (95% whites)

  Most strongly Republican (51%)

  Mostly women (64%)

  Priority on Social Security (28%)

  Health care law = Medicare solvency worse (64%)

 Younger (53% ages 55 to 64)

  Largest minority cluster

 Most strongly Democratic (57%)

 Majority men (54%)  Health care law =

health care better (60%)

 Health care law = Medicare solvency better (23%)

 Majority women (56%)

 Older (just 40% ages 55 to 64)

 Better educated (40% college graduates/more)

 Evenly divided Republicans and Democrats

  Less educated (49% high school graduates/less)

 Evenly divided Republicans and Democrats


Relative Support For Medicare Management Reforms, By Cluster Net positive (Advantages>Disadvantages) Divided Net negative (Disadvantages>Advantages)

Bundled Payments/Changing Incentives for Doctors & Hospitals

Medical Team Shops

Increased Home Care Coverage

Strong Supporters Potential Supporters

Fence Sitters Opposers






Cluster Analysis Centered On Reforms To Reduce Medicare Costs

Opposers %

Fence Sitters %

Long Shot Persuadables

% Persuadables

%

  Older (just 44% ages 55 to 64)

  Least diverse (99% whites)

  Most strongly Republican (44%)

  Largest number of Independents

  Health care law = Medicare solvency worse (50%)

  Younger (56% ages 55 to 64)

  Most strongly Democratic (62%)


  Health care law = Medicare solvency better (25%)

  Largest minority cluster


  Majority men (52%)

  Group with high-est concern about Medicare solvency (89% very/fairly concerned)

  Evenly divided Republicans and Democrats

  Most likely to have a chronic health condition

  Health care law: plurality say health care will be worse


Relative Support For Reforms To Reduce Medicare Costs, By Cluster

Redefine Eligibility – Raise Age to 67

Fund Medicare Through Dedicated Tax Voucher

Redefine Eligibility – Means Testing Persuadables

Long Shot Persuad Fence Sitters

Opposers

Persuadables Long Shot Persuad


Persuadables Long Shot Persuad


Net positive (Advantages>Disadvantages) Divided Net negative (Disadvantages>Advantages)

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