Rating California’s Health Concerns

Nearly half of Californians say more money should be devoted to the health of their community, and a third want more spent on prevention of disease and disability, according to a new survey of residents’ attitudes about health care.

The concern about the community is especially notable because almost one in three state residents doesn’t have a personal physician, said Karen Bodenhorn, lead author of a report based on the survey. Californians clearly understand “that more than just doctors and nurses keep them well,” she said.

Compared with a similar survey conducted in 1996, Bodenhorn said, Californians increasingly recognize that clean air and water, safe neighborhoods in which they can exercise, good school-based programs and changes in their own habits contribute to a community’s overall health.

*

Bodenhorn, president and chief executive of the nonprofit California Center for Health Improvement, released findings from the survey, commissioned by CCHI, last week in San Diego. The survey was conducted by the nonpartisan, nonprofit Field Institute research organization.

She hopes the survey’s findings will signal that Californians want improvements in quality of life, compelling policymakers, legislators and health plans to act.

For example, she said, 49% of those surveyed believe government and other private and public organizations spend too little money on improving the overall health of their community. When asked what they’d change, 33% would devote more dollars to prevention, while 10% want more spent on the sick and injured.

When it came to their own health care, survey respondents with health insurance reported a high degree of satisfaction with their provider: 80% were satisfied that the provider was concerned about keeping them healthy and 76% were satisfied with preventive services.

*

“Satisfaction with preventive services is probably higher than it should be,” Bodenhorn said, citing 1997 data from the California Managed Health Care Improvement Task Force Survey. That survey showed that 68% of smokers reported that their health provider or plan gave them no help in quitting. Other statewide data have shown that 79% of women over 50 received a mammogram in 1998 and 83% got one in 1999, but every woman in that age group should be screened annually, she said.

“We have a job to do in educating the public about some of the specific services they should come to count on as coming from their health care providers and health plans,” she said. Doctors are particularly poor at counseling patients about such preventive strategies as following a healthy diet and exercising regularly.

With survey data indicating that only 32% of Californians have a personal doctor, the majority of residents don’t have the relationship with a doctor or other health care provider that leads to regular care, which is especially important for children and those with chronic illnesses.

“To keep people well, you have to have not only a doctor, but systems in place” that remind them to come in for immunizations and encourage them to take advantage of programs to quit smoking, Bodenhorn said.

Among other findings:

* In California, one of the most diverse states in the nation, many residents prefer to be treated by someone who either shares their background or understands it.

Of the two-thirds of survey respondents who reported having a personal physician, Latinos were twice as likely--and Asians three times as likely--as whites to say race or ethnicity were factors in choosing their doctor.

Such feelings, said Bodenhorn, indicate a need to recruit more doctors from those groups.

* Forty percent of adults use alternative treatments or providers, such as chiropractors, massage therapists and acupuncturists. And 54% expect to use such treatments in the next five years, especially women, Latinos, Asians and the uninsured.

The survey findings were based on a random sample of 1,612 California adults conducted in August in English and Spanish by the Field Institute. In addition, the surveyors included additional interviews among randomly selected African Americans and Asians. Results from the overall sample have a margin of error of plus or minus 2.6 percentage points; the margins of error are larger in the subgroups.

The survey was funded by the California Wellness Foundation, a nonprofit health care philanthropy.