Support for National Health Insurance among U.S. Physicians: A National Survey

18 November 2003 | Volume 139 Issue 10 | Pages 795-801

Background: Nearly 40 million persons in the United States were without health insurance for all of 2000. National health insurance would remedy this situation, and many believe the success of reform efforts in this direction may depend on physician support.

Objective: To determine the general attitudes of U.S. physicians toward the financing of national health care.

Design: Cross-sectional study.

Setting: National mailed survey.

Participants: 3188 randomly sampled physicians from the American Medical Association Physician Masterfile.

Measurements: Physicians were asked whether they support or oppose 1) governmental legislation to establish national health insurance and 2) a national health insurance plan in which all health care is paid for by the federal government. Weighted multivariate logistic regression analyses were performed to identify factors that independently predicted support for each of these strategies.

Results: Sixty percent of eligible participants returned a survey. Forty-nine percent of physicians supported governmental legislation to establish national health insurance, and 40% opposed it. Only 26% of all physicians supported a national health insurance plan in which all health care is paid for by the federal government. In analyses adjusting for differences in personal and practice characteristics, physicians in a primary care specialty, physicians reporting that at least 20% of their patients had Medicaid, and physicians practicing in a nonprivate setting or in an inner-city location were statistically significantly more likely to support governmental legislation to establish national health insurance.

Conclusions: A plurality of U.S. physicians supports governmental legislation to establish national health insurance. This support may be relevant to the success of future efforts to reform national health care.

Editors' Notes Context Data about U.S. physicians' attitudes toward a national health insurance program are lacking. Contribution This survey of U.S. physicians suggests that 49% support national health insurance and 26% support federal financing of all care under such a program. With the exception of family practitioners, anesthesiologists, and surgical subspecialists, more than half of physicians in major specialties supported national health insurance. Support was highest among pediatricians, psychiatrists, and general internists. Implications Support of a national health insurance program is substantial among U.S. physicians but varies by specialty. Support of federal financing is less enthusiastic. This information will help to inform proposals for health insurance reform. –The Editors

 

Author and Article Information

From University of Washington and Veterans Affairs Puget Sound Health Care System, Seattle, Washington; and Indiana University School of Medicine, Indianapolis, Indiana.

Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the views of the Robert Wood Johnson Foundation, the U.S. Department of Veterans Affairs, the University of Washington, or Indiana University.

Acknowledgments: The authors thank the Robert Wood Johnson Foundation and the Department of Veterans Affairs for their generous support of this project. They are especially indebted to Diane P. Martin, PhD, and Richard A. Deyo, MD, MPH, for assisting with survey design and question content and Frederick P. Rivara, MD, MPH, and Thomas D. Koepsell, MD, MPH, for their helpful comments about statistical analyses and manuscript preparation.

Grant Support: By the Robert Wood Johnson Foundation and the U.S. Department of Veterans Affairs.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Aaron E. Carroll, MD, MS, Indiana University School of Medicine, 699 West Drive, Riley Research, Room 330, Indianapolis, IN 46202; e-mail, aaecarro{at}iupui.edu.

Current Author Addresses Dr. Ackermann: Indiana University School of Medicine, 250 University Avenue, Suite 122, Indianapolis, IN 46202.

Dr. Carroll: Indiana University School of Medicine, 699 West Drive, Riley Research, Room 330, Indianapolis, IN 46202.

Author Contributions Conception and design: R.T. Ackermann, A.E. Carroll.

Analysis and interpretation of the data: R.T. Ackermann, A.E. Carroll.

Drafting of the article: R.T. Ackermann, A.E. Carroll.

Critical revision of the article for important intellectual content: R.T. Ackermann, A.E. Carroll.

Final approval of the article: R.T. Ackermann, A.E. Carroll.

Statistical expertise: R.T. Ackermann, A.E. Carroll.

Obtaining of funding: R.T. Ackermann, A.E. Carroll.

Administrative, technical, or logistic support: R.T. Ackermann, A.E. Carroll.

Collection and assembly of data: R.T. Ackermann, A.E. Carroll.

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