Opinions of New Hampshire Physicians Contrast with Presidential Candidate Plans for Healthcare Reform

New Hampshire Medical Society
For the betterment of public health since 1791

For Immediate Release
December 18, 2007

Dr. Seddon Savage, President, NH Medical Society 603-646-9215,
Dr. Gary Sobelson, 228-0071,
Dr. Beth Smith, 229-5200,
Palmer Jones, Executive Vice President, NHMS, 224-1909,

A recent survey of New Hampshire physicians regarding the United States healthcare system suggests that many are ready for change. While physicians have divergent opinions about some of the directions that change should take, there is consensus on many issues that may be surprising. The 514 physicians who responded to the survey, which was sponsored by the NH Medical Society and conducted by the University of New Hampshire Survey Center, appear to be demographically representative of New Hampshire physicians. 29% percent of the respondents were primary care physicians and 71% specialists, surgeons or in other types of practice.

Physician opinions, as reflected in the survey, are not entirely resonant with key features of many of the proposals for healthcare reform offered by current Presidential candidates. While the candidate's plans differ from one another, most would preserve a central role for private insurance companies, maintain a regulated market-based system, make employers or individuals responsible for purchase of health insurance and restrict publicly funded healthcare to specific groups, all features that the survey suggests NH doctors do not widely support.

The survey found that 81% of responding physicians agree healthcare should be "available to all citizens as part of the social contract, a right similar to basic education, police and fire protection," with 94% of primary care physicians endorsing this view. Two thirds of New Hampshire physicians, including 81% of primary care clinicians, indicated they "would favor a simplified payor system in which public funds, collected through taxes, were used to pay directly for services to meet the basic healthcare needs of all citizens." Only one third of physicians indicated support for an employer-based system or agreed that "the free market system is the best way to create a high quality, equitable, affordable and accessible healthcare system." The physicians were split on individual responsibility for purchasing healthcare.

73% of the physicians indicated they do not believe "insurance companies provide important services that add value to the health care system" and 80% disagreed that "competition and profit within the insurance industry drive innovation, quality or efficiency." 86% indicated that administrative and paperwork burdens interfere with their ability to serve patients well and 77% (93% of primary care physicians) indicated that there should be greater equity in reimbursement of different specialties for time spent in providing care to patients. Despite these challenges however, 88% percent of New Hampshire physicians agree that, "putting aside paperwork and administrative challenges," they "experience deep satisfaction in the practice of medicine."

The doctors disagreed with some common cost containment practices: 92% agreed that the current practice of "denying or limiting access to needed care in non-futile situations in order to preserve profits is unethical" and 96% disagreed with statement that "denying insurance to those with pre-existing conditions is an appropriate means of controlling costs." Most agreed, however, that control of healthcare costs must include some limits on availability of services (88%) and that the US healthcare system would benefit from planning of services to match need (93%). Nearly all (97%) agreed "health outcomes are improved when patients receive coordinated care of chronic illness in a primary care medical home."

Whatever the structure and funding of the healthcare system, however, the survey finds that physicians believe "the health of individuals can be enormously affected by their personal behaviors and choices"(98.6%) and that "psychosocial and socioeconomic factors are important contributors to health status in the United States" (97.7%). The results of the survey are expected to shape advocacy efforts by the New Hampshire medical community related to public health and the healthcare system.