Satisfaction with Publicly Provided Health Care (9/3)

I recently saw two articles pop up, independently of each other, that address the question of consumers' satisfaction with health care provided as part of public/government programs.

Gallup aggregated data it had collected from 2006-2008 on consumers' satisfaction with their health care, dividing respondents into whether they had private or government (Medicare, Medicaid) health insurance coverage. Results revealed "only a slight difference in how Americans with Medicaid or Medicare versus those with private insurance plans rate the quality of care they receive, and no difference in how the two groups rate their coverage." In terms of quality of care, 87% of those with private coverage rated their care excellent or good, whereas 82% of those on one of the government programs did so.

Gallup noted an age difference, however, "...suggest[ing] that the private-government gap may be so small because senior citizens -- the vast majority of whom are covered by Medicare -- give very positive ratings to their healthcare coverage and quality. Among non-seniors, private plans tend to get better ratings than the traditional government plans on both coverage and quality." Gallup concludes the following from its findings:

It is not clear what the results discussed here might mean for satisfaction with a public healthcare option if it came to pass. The fact that Americans' ratings of their healthcare differ little, whether they have a private or a government plan, suggests that a properly constructed government health plan may not necessarily lead to perceptions of reduced quality or poor coverage from its beneficiaries. However, the fact that a public-private gap in quality ratings appears to exist for non-seniors (who presumably would be most likely to use a new public option) suggests that views about government-sponsored healthcare may differ by demographic group, possibly depending on one's likelihood of being affected.

The second survey pertains to a local program, Healthy San Francisco, which I frankly had not heard of (my thanks to a Daily Kos diarist for publicizing it). According to a February article from the San Francisco Chronicle, the program continues to succeed at covering city residents who had been uninsured. An article by New America Media provides these details of the program:

Healthy San Francisco is not health insurance but direct care provided on a sliding scale to the uninsured at city and private health clinics. The program began in July 2007 providing care to the city’s uninsured, who number over 60,000. It has now covered about 75 percent of them at a cost of roughly $120 million a year, including city money, state grants, employer contributions and participants’ fees. The average monthly cost per person is $280.

The Kaiser Family Foundation recently released a survey of HSF participants, the most salient finding being the high satisfaction with the program: 94% overall satisfaction (63% very satisfied, 31% somewhat satisfied).

Table 3 on health care utilization is also interesting, with the report concluding, "...while it is difficult to make direct comparisons, using the most recent available data, Healthy San Francisco participants report significantly greater numbers of doctor visits than the general population, both in San Francisco and nationally, perhaps a reflection of their greater health needs."

The apparent success of HSF arguably could be used to bolster support for a government-administered public option at the federal level, as is being currently considered by Congress. On the other hand, HSF could perhaps offer ammunition to lawmakers who support more localized mechanisms for expanding health care, such as statewide or regional co-ops (here and here).