Support for National Health Insurance among U.S. Doctors

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The summary below is from the full report titled "Support for National Health Insurance among U.S. Physicians: A National Survey." It is in the 18 November 2003 issue of Annals of Internal Medicine (volume 139, pages 795-801). The authors are R.T. Ackermann and A.E. Carroll.

What is the problem and what is known about it so far?

Lack of health insurance is a big problem for many Americans. In 2000, nearly 40 million Americans had no health insurance. Many other countries ensure their citizens' health care through public national insurance programs, such as the program in Canada. Public insurance programs in the United States provide only limited coverage for limited groups, such as Medicaid for the poor and Medicare for the elderly. The high cost of private health insurance prevents many people from obtaining health insurance for themselves and for their families. Over the years, policymakers and politicians have proposed a variety of public insurance programs that would cover all Americans. Some believe that one of the reasons the United States has not adopted any of these proposals is because doctors do not support national health insurance.

Why did the researchers do this particular study?

To learn about U.S. doctors' attitudes toward national health insurance.

Who was studied?

1650 U.S. doctors who responded to a mailed survey.

How was the study done?

Using a database recognized as the most complete list of licensed doctors in the United States, the researchers randomly selected 2500 doctors for a mailed survey. Because they were particularly interested in the attitudes of surgeons and younger doctors, they also selected an additional 375 doctors from the group that identified their specialty as surgery and an additional 375 who graduated from medical school after 1990. They mailed the doctors a short survey that included the following questions: 1) In principle, do you support or oppose governmental legislation to establish national health insurance? 2) Do you support or oppose a national health insurance plan where all health care is paid for by the federal government? The researchers examined the overall support among surveyed doctors and looked for specific factors that were associated with support of national health insurance.

What did the researchers find?

Of the 3188 doctors surveyed, 1650 responded. About half of the doctors (49%) supported governmental legislation to establish national health insurance, and 40% opposed it. A little over one quarter of doctors (26%) supported a program in which the federal government would pay for all health care. Doctors were most likely to support national health insurance if they practiced in inner cities or nonprivate settings and if at least 20% of their patients were on Medicaid. The types of doctors with the highest support for national health insurance were internal medicine doctors, pediatricians, and psychiatrists. Support was lowest among family medicine doctors, anesthesiologists, and specialty surgeons.

What were the limitations of the study?

It is uncertain whether the attitudes of the doctors who responded to the survey accurately represent the attitudes of all doctors in the United States. The survey examined whether doctors support the principle of national health insurance but did not gather information on doctors' opinions about the details of such a program.

What are the implications of the study?

A substantial proportion of U.S. doctors support national health insurance. This support may be important to the success of proposals for improving health insurance.