Hero Joachim O, Blendon Robert J, Zaslavsky Alan M, Campbell Andrea L
Joachim O. Hero (
Robert J. Blendon is the Richard L. Menschel Professor of Health Policy and Political Analysis in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, in Boston, Massachusetts.
Health Aff (Millwood). 2016 Mar;35(3):502-9. doi: 10.1377/hlthaff.2015.0978.
For decades, public satisfaction with the health care system has been lower in the United States than in other high-income countries. To better understand the distinctive nature of US health system satisfaction, we compared the determinants of satisfaction with the health system in the United States to those in seventeen other high-income countries by applying regression decomposition methods to survey data collected in the period 2011-13. We found that concerns related to "accessing most-preferred care" (the extent to which people feel that they can access their top preferences at a time of need) were more important to satisfaction in the United States than in other high-income countries, while the reverse was true for satisfaction with recent interactions with the health system. Differences among US socioeconomic groups in survey responses regarding access to most-preferred care suggest that wide variation in insurance coverage and generosity may play a role in these differences. While reductions in the uninsured population and the movement toward minimum health plan standards could help address some concerns about access to preferred care, our results raise the possibility of public backlash as market forces push plans toward more restricted access and higher cost sharing.
几十年来，美国公众对医疗保健系统的满意度一直低于其他高收入国家。为了更好地理解美国医疗系统满意度的独特性质，我们通过对2011 - 13年期间收集的调查数据应用回归分解方法，将美国与其他17个高收入国家对医疗系统满意度的决定因素进行了比较。我们发现，与“获得最偏好的医疗服务”（人们在需要时能够获得其首选医疗服务的程度）相关的担忧对美国满意度的影响比对其他高收入国家更为重要，而对于近期与医疗系统互动的满意度则相反。美国社会经济群体在关于获得最偏好医疗服务的调查回复上的差异表明，保险覆盖范围和慷慨程度的广泛差异可能在这些差异中起作用。虽然未参保人口的减少以及朝着最低健康计划标准的推进可能有助于解决一些关于获得首选医疗服务的担忧，但我们的结果提出了随着市场力量推动计划走向更受限的获取和更高的费用分担，公众可能产生强烈反对的可能性。
