Doctors, Patients Cite Concerns Over Care

Orange County doctors are less sure than their counterparts in several communities nationwide about their ability to give high-quality care to all patients, according to a new study made public today.

And one in four Orange County families surveyed says that access to medical care has worsened in the last three years, mirroring a perception found across the country.

The report from the independent Center for Studying Health System Change, based in Washington, examined the nation’s attitudes toward health care from the perspective of doctors and patients.

Researchers focused on Orange County and 11 other metropolitan areas. More than 23,000 families and 9,200 physicians nationwide were surveyed by telephone in 1996-97. The margin of error was plus or minus 1 percentage point or less nationally but higher for specific communities.

The report found that 24% of U.S. doctors surveyed did not agree with the statement: “It is possible to provide high-quality care to all of my patients.”

In Orange County, 31% did not agree with that statement, compared with 21% in Cleveland and Little Rock, Ark., and 18% in Lansing, Mich., and Syracuse, N.Y.

Possible reasons the researchers cited for the differences in attitudes were variations in patient populations, the degree of autonomy doctors enjoy and the availability of medical specialists.

The president of the Orange County Medical Assn. attributed concerns among county doctors in part to the growth of managed-care health systems.

“When you have to go through a number of hurdles to get the [medical] plans to agree to do some of the things that you as a physician want to do for your patient--and you find roadblocks--then the quality issue comes up,” said Dr. Stanley Lowenberg, an ear, nose and throat specialist in Orange.

Lowenberg said many of his peers report that the large majority of their patients are enrolled in managed-care programs, which set controls on patient treatment that some doctors find burdensome.

Among patients, the report found that nine out of 10 families surveyed nationwide were satisfied with their health care in the last year, but one-quarter found their access to medical service limited compared to three years ago.

Orange County families did not hold significantly different opinions.

Nationwide, people with lower incomes, people who were uninsured and Latino families were more likely to report restricted access to care.

Patients surveyed in Orange County appeared anxious on one point: 20% said they worried that “my doctor may not refer me to a specialist when needed,” while 16% of patients in large urban areas said the same.

Meanwhile, about one in five primary care physicians nationwide reported encountering some difficulty in obtaining help from a top-notch specialist when needed. The figure in Orange County was about one in four.

One health care analyst said the public should expect a lower level of service if it wants to cut costs. Sometimes, he said, patients want it both ways.

“People want full access . . . and yet they don’t want to pay,” said Paul Feldstein, a professor of health care management at UC Irvine. “People are making choices. If people were willing to pay more, they would have more access.”

But Felix A. Schwarz, executive director of the Health Care Council of Orange County, said the patients who suffer the most are those who can least afford to pay more.

“They’re generally the working poor and the indigent,” Schwarz said. Lamenting the county’s shortage of public health facilities, he added: “They get charity care, emergency care or no care.”

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Measuring Health Care Attitudes

Orange County was one of 12 areas selected for a recent survey of attitudes toward health care delivery. The survey posed questions to patients and physicians regarding specialist referrals, quality of care and access.

ACCESS TO SPECIALISTS

Patients agreeing that their doctor might not refer them to a specialist when needed:

City: Percent

Miami: 22%

Orange County: 20

Phoenix: 18

Little Rock, Ark.: 17

Greenville, S.C.: 16

Cleveland: 15

Newark, N.J.: 14

Indianapolis: 13

Seattle: 13

Boston: 12

Syracuse, N.Y.: 12

Lansing, Mich.: 11

Metropolitan areas*: 16

United States:: 16

Primary care physicians reporting some difficulty obtaining referrals to high-quality specialists when medically necessary:

City: Percent

Miami: 31%

Newark, N.J.: 31

Orange County: 26

Phoenix: 23

Lansing, Mich.: 19

Little Rock, Ark.: 17

Seattle: 15

Greenville, S.C.: 14

Cleveland: 14

Syracuse, N.Y.: 13

Boston: 12

Indianapolis: 6

Metropolitan areas*: 20

United States:: 18

ACCESSIBILITY

Percent who say access to health care is worsening:

City: Percent

Miami: 33%

Newark, N.J.: 27

Phoenix: 26

Little Rock, Ark.: 25

Orange County: 25

Cleveland: 24

Greenville, S.C.: 23

Indianapolis: 23

Boston: 21

Seattle: 21

Syracuse, N.Y.: 20

Lansing, Mich.: 19

Metropolitan areas*: 24

United States: 24

QUALITY OF CARE

Families not satisfied with the health care they received in the last 12 months:

City: Percent

Miami: 16%

Phoenix: 14

Orange County: 13

Cleveland: 12

Newark, N.J.: 12

Seattle: 12

Greenville, S.C.: 11

Indianapolis: 11

Little Rock, Ark.: 11

Boston: 10

Lansing, Mich.: 10

Syracuse, N.Y.: 8

Metropolitan areas*: 12

United States: 11

Physicians who say it is not possible to provide high-quality care to all patients:

City: Percent

Orange County: 31%

Miami: 30

Phoenix: 30

Newark, N.J.: 29

Seattle: 25

Indianapolis: 24

Boston: 23

Cleveland: 21

Little Rock, Ark.: 21

Greenville, S.C.: 19

Lansing, Mich.: 18

Syracuse, N.Y.: 18

Metropolitan areas*: 25

United States: 24

* Over 200,000 population

Note: This 1996-1997 survey includes responses from 43,771 people in 23,554 families residing in 12 randomly selected areas.

Source: Center for Studying Health System Change