PRINCETON, NJ -- A Â鶹´«Ã½AV analysis of historical data finds 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.
These results are based on aggregated interviews with more than 3,000 U.S. adults, conducted in the 2006-2008 Â鶹´«Ã½AV annual November Healthcare surveys. These include interviews with 1,753 Americans who have a private insurance plan and 1,049 who receive insurance through a government plan such as Medicare or Medicaid.
According to the data, more than 8 in 10 Americans rate the quality of care they receive as excellent or good, regardless of the type of plan they have. Although slightly more privately insured individuals (87%) than Medicare or Medicaid recipients (82%) rate their quality of care as excellent or good, the percentage giving their plan an excellent rating is the same for both groups (38%).
And roughly three in four Americans give a positive rating to their health coverage, whether it is privately or publicly funded, which includes a 31% excellent rating from those on Medicaid or Medicare plans and a 27% excellent rating from those on private plans.
In general, the overall results reinforce the notion that Americans are largely pleased with their own health insurance plans, be they publicly or privately funded. But the data do suggest that recipients of some government health plans, such as the well-established Medicaid and Medicare plans, are about as pleased with their healthcare as are those on private plans.
The pattern of largely similar ratings of coverage between Medicare/Medicaid recipients and privately insured Americans has persisted over time. Â鶹´«Ã½AV has consistently found roughly 7 in 10 Americans with either a public or a private plan rating their coverage in positive terms.
Likewise, 8 in 10 insured Americans typically rate the quality of their care as excellent or good, regardless of the type of insurance plan they have.
The basic pattern of similar ratings of coverage and quality between those who have private and those who have government insurance generally holds when income is controlled for. That is especially the case in terms of the quality ratings, which are nearly identical for government-insured and privately insured individuals at all income levels.
However, an analysis of the data by age suggests 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.
Bottom Line
Perhaps the most contentious proposal for healthcare reform is the inclusion of a "public option" insurance plan that Americans could choose to take. The fate of a public option is very much in doubt at this time, and the details of such a plan are far from settled. But these data suggest that Americans who currently receive government-subsidized healthcare -- those on Medicaid or Medicare -- rate their healthcare similarly to the ratings of those who are privately insured.
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.
Survey Methods
Results are based on telephone interviews with 2,802 national adults, aged 18 and older, who have health insurance coverage, conducted in November 2006, November 2007, and November 2008. For results based on the total sample of national adults, one can say with 95% confidence that the maximum margin of sampling error is ±2 percentage points.
For results based on the sample of 1,753 adults with private insurance, the maximum margin of error is ±3 percentage points.
For results based on the 1,049 adults with public insurance, the maximum margin of error is ±3 percentage points.
Interviews are conducted with respondents on land-line telephones (for respondents with a land-line telephone) and cellular phones (for respondents who are cell-phone only).
In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls.
