Ronald T. Ackermann, MD, MPH; Aaron E. Carroll, MD, MS
Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the views of the Robert Wood Johnson Foundation, the U.S. Department of Veterans Affairs, the University of Washington, or Indiana University.
Acknowledgments: The authors thank the Robert Wood Johnson Foundation and the Department of Veterans Affairs for their generous support of this project. They are especially indebted to Diane P. Martin, PhD, and Richard A. Deyo, MD, MPH, for assisting with survey design and question content and Frederick P. Rivara, MD, MPH, and Thomas D. Koepsell, MD, MPH, for their helpful comments about statistical analyses and manuscript preparation.
Grant Support: By the Robert Wood Johnson Foundation and the U.S. Department of Veterans Affairs.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Aaron E. Carroll, MD, MS, Indiana University School of Medicine, 699 West Drive, Riley Research, Room 330, Indianapolis, IN 46202; e-mail, firstname.lastname@example.org.
Current Author Addresses Dr. Ackermann: Indiana University School of Medicine, 250 University Avenue, Suite 122, Indianapolis, IN 46202.
Dr. Carroll: Indiana University School of Medicine, 699 West Drive, Riley Research, Room 330, Indianapolis, IN 46202.
Author Contributions Conception and design: R.T. Ackermann, A.E. Carroll.
Analysis and interpretation of the data: R.T. Ackermann, A.E. Carroll.
Drafting of the article: R.T. Ackermann, A.E. Carroll.
Critical revision of the article for important intellectual content: R.T. Ackermann, A.E. Carroll.
Final approval of the article: R.T. Ackermann, A.E. Carroll.
Statistical expertise: R.T. Ackermann, A.E. Carroll.
Obtaining of funding: R.T. Ackermann, A.E. Carroll.
Administrative, technical, or logistic support: R.T. Ackermann, A.E. Carroll.
Collection and assembly of data: R.T. Ackermann, A.E. Carroll.
Nearly 40 million persons in the United States were without health insurance for all of 2000. National health insurance would remedy this situation, and many believe the success of reform efforts in this direction may depend on physician support.
To determine the general attitudes of U.S. physicians toward the financing of national health care.
National mailed survey.
3188 randomly sampled physicians from the American Medical Association Physician Masterfile.
Physicians were asked whether they support or oppose 1) governmental legislation to establish national health insurance and 2) 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 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.
A plurality of U.S. physicians supports governmental legislation to establish national health insurance. This support may be relevant to the success of future efforts to reform national health care.
Data about U.S. physicians' attitudes toward a national health insurance program are lacking.
This survey of U.S. physicians suggests that 49% support national health insurance and 26% support federal financing of all care under such a program. 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.
Support of a national health insurance program is substantial among U.S. physicians but varies by specialty. Support of federal financing is less enthusiastic. This information will help to inform proposals for health insurance reform.
Main survey questions.
Table 1. Characteristics of 1263 Respondents from the General Random Sample Compared with the American Medical Association Physician Masterfile
Table 2. Physician Attitudes about National Health Insurance Financing
Physician support for national health insurance (NHI) financing by practice specialty.
Predictors of physician support for governmental legislation to establish national health insurance (NHI).
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Catherine H Kassens
March 31, 2008
Misleading Study on National Health
I question the accuracy of the data obtained in your study of physician support for a national health insurance program. Getting good quality data would require getting a crossection of physicians who are in active practice. The study may also have been biased by a difference in practicioners who chose to respond. If the study is truly representative of the opinion of US physicians, they need to travel abroad and see similar systems firsthand. Having seen medical systems in action in countries where the government pays for medical care, I know that patients and physicians in the US will be very sorry if they get what they think they want.
Edward J. Volpintesta
April 13, 2008
National Health Plan: Now
That unprecedented numbers of physicians are in favor of a national health insurance program attests to their desperation. Unfair reimbursement and excessive administrative hassles =have finally taken their toll.
With government regulation a single clearing house will be provided for physicians grievances. The multitude of private insurers to which doctors are accountable forces them to spend too much time on too many fronts. This is exemplified by the frequent reports seen in the media of lawsuits by physician groups against private insurers defending themselves against unfair contracts, economic credentialing, and ranking of physicians into tiered networks. What's more, the powerful lobbying position of insurers almost guarantees them the upper hand in negotiations with doctors.
Clearly, the time has come for a national insurance program. Without government regulation, doctors and patients have no recourse to address their grievances. For those who look at national health plans elsewhere and focus on their deficiencies, it is important to remember that an American system will be unique and need not have the weaknesses that exist in other countries.
Edward J. Volpintest MD
Ackermann RT, Carroll AE. Support for National Health Insurance among U.S. Physicians: A National Survey. Ann Intern Med. 2003;139:795–801. doi: 10.7326/0003-4819-139-10-200311180-00006
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Published: Ann Intern Med. 2003;139(10):795-801.
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