Research

The first phase of Minnesota HealthBasics is research. The unique collaboration of leaders involved in this project each lent their expertise to help identify the critical issues put before Minnesotans and brought their thoughtfulness to interpreting the results. HealthBasics was under the direction of Rob Daves of Daves & Associated Research, an independent, nationally-recognized research firm. Daves conducted the research and provided expert analysis of the results.

We believe this collaboration has made the HealthBasics research the most comprehensive and unbiased investigation into the knowledge, values and priorities Minnesotans bring to the health care discussion.

Research Process

The first phase of HealthBasics – research – has been completed. The research began in May 2014 when HealthBasics reached out to diverse Minnesota leaders to invite their thoughts on what to ask Minnesotans.

The request we made of these Minnesota influencers was direct: “If you could ask Minnesotans one question that would help get to core beliefs and values about health care or misconceptions that stand in the way of finding consensus on key issues, what would it be?”

We received a variety of thoughtful and insightful suggestions. Along with the recommendations of the HealthBasics partners, these questions were crafted into focus group discussions and a statewide survey. The survey and the focus groups were conducted by Rob Daves of Daves & Associates Research.

Six focus groups were conducted in July 2014 – two each in the Twin Cities, Rochester and St. Cloud. Participants in the focus groups (generally 10 people in each group) included a balanced mix of men and women (in fact, in each community, one focus group was conducted exclusively among women and a second exclusively among men). The groups included people with diverse racial and ethnic backgrounds; economic and education statuses; age (all participants were voting-age adults); workers, unemployed and retirees; and, a mix of people with employer-provided health coverage, individual coverage, coverage through government programs, Medicare and those without insurance.

The results of these focus groups provided a core foundation for a statewide, comprehensive survey. The survey methodology follows:

Sample size: N=1,000 – 650 landline interviews, 350 cell phone interviews
Fieldwork dates: August 11-25, 2014
Geography: State of Minnesota
Population:  English speaking adults with cell or landline telephones
Precision: +/- 3.9 percentage points at a 95% confidence level
Weighting: Iterative sampling balancing for gender, age, education, race, telephone service and Hispanic ethnicity after correcting for unequal probabilities of selection
Sponsor:  HealthBasics sponsored the survey; the cost was underwritten by Medica
Contractor: Daves & Associates Research
Sampling frames: All landline and cell phones with Minnesota geographic tags
Sample design: Dual-frame random-digit-dial stratified area probability sampling
Respondent Selection: One person per household selected at random using the last birthday method for the landline sample; a qualified adult for the cell phone sample.

 

Key Research Findings

Want to know how Minnesotans think about the challenges, opportunities and priorities of the health system? The fastest way is to ask them about their politics. It turns out that ideology – not gender, education, employment or any other factor – is the key driver of the divisions on health care policy.

The HealthBasics research reveals that unless Minnesotans are able to bridge the ideological divide on health care, we won’t be able to solve the challenges of affordability and access. Among the major survey findings are the following:

My position on health reform? Just look at my politics

More than two-thirds of Minnesotans see the health system challenges and solutions through the perspective of their political ideologies. Conservatives place cost and quality above coverage, believe these goals are best reached through the marketplace and want the government largely to stay out of health care. Moderates and liberals are more inclined to put affordable universal coverage at the top of their priorities, and believe government is best able to deliver on these goals. Consistent with their views, they favor government action to control costs and compensation paid to executives.

We don’t play the blame game…too much

In spite of the ideological divide on health care, some hot-button issues haven’t reached the boiling point in Minnesota. For example, while a majority think there is too much waste, fraud and abuse in the health system, there isn’t much intensity on the issue. Likewise, health care spending for undocumented aliens or unemployed welfare recipients divides Minnesotans, but sentiment on both sides of those issues generates intense opinions among less than a third of the state’s adults. And while Minnesotans generally think that those who don’t take care of themselves should pay more for health insurance (and believe that those who exercise and don’t smoke should pay less), most of us aren’t willing to deny care in hospital emergency rooms or through public health programs to those who don’t buy health insurance.

We have a pretty good sense of where our health dollars are going…

Minnesotans generally have a good sense of where our health dollars are being spent. We know, for example, that hospitals (about one-third of health care spending) and physician services (about one-fifth) are the major expenses. We do overstate how much is spent on prescription drugs (the estimate is 18 percent versus real spending of less than 9 percent). (NOTE: The actual spending is based on data published by the Minnesota Department of Health in 2013).

…but don’t recognize the overall cost.

A bit less than one-fourth of us recognize that Minnesota spends more than the national average on health care. According to national data compiled by the Wall Street Journal in 2013 (based on 2009 spending, the latest year for which national data were available), Minnesotans spend $7,409 per capita, about 9 percent above the national average. For the money spent, Minnesotans have a health care system that is very highly regarded nationally. In fact, the Commonwealth Fund’s “Scorecard on State Health System Performance” called Minnesota’s health system the best in the nation in its 2014 report. This study is one of the most comprehensive evaluations of state health systems, using 42 indicators to measure access, quality and cost.

We recognize the cost drivers and agree on some solutions.

Minnesotans generally recognize that several trends are driving health costs higher, from an aging population to new drugs and technologies. We tend to place much more blame on hospitals charging too much than Americans in general (compared to a 2014 Kaiser Family Foundation survey). We offer a variety of solutions, and often there is broad consensus. For example, at least seven out of 10 Minnesotans believe limits should be set on prices charged by drug companies and health providers and on the compensation paid to executives in health organizations. We also believe that making available easy-to-understand information on how much hospitals and clinics charge for their services and the success rate of doctors would be effective in controlling health costs.

I’m not the problem. Solutions are for others.

A strong majority of Minnesotans say when it’s all said and done, we don’t want limits placed on our own interactions with the health system. We want whatever treatment is prescribed by a physician; we want to see specialists without referrals; and, we want our health insurance to pay the full cost of care. And never mind the contradictions. For example, while 52 percent agree that doctors often order too many tests and treatments that don’t really improve a patient’s health, only 41 percent agree (and 39 percent disagree) that insurance companies should work with medical professionals to evaluate the effectiveness of expensive treatments and services, then pay only for the ones that are most successful. In fact, 67 percent of us say that insurers should pay for every treatment or service a doctor prescribes.

How Minnesotans Align

The HealthBasics research reflects one of the core challenges in reaching consensus on health care policies and priorities. Two-thirds of Minnesotans are split right down the middle – one group wants a health system rooted in marketplace competition while the other side favors more government involvement.

What makes this division most challenging is that the respective positions on health policies and priorities are not defined by demographics (for example, gender and age) or personal economics (income and employment status, among other factors), but mainly by ideology. In fact, if Minnesotans can’t find a way to bridge their ideological differences, the challenges of health cost, access and quality will be increasingly difficult to resolve.

Minnesota’s four groups are these:

Free Marketers (34%)
  • This segment is ideologically conservative.
  • Affordability and quality are more important health system goals to this group than universal coverage.
  • They tend to support marketplace competition to achieve their goals:
    • They believe people who don’t take care of themselves should be held accountable and asked to pay more for health coverage.
    • They aren’t willing to use government to impose cost constraints on the marketplace; for example, they oppose limiting the salaries of health care executive or placing caps on the earnings of providers, insurers or pharmaceutical companies.
    • They tend to see external factors – inflation and high malpractice awards – as significant health cost drivers.
    • They don’t believe insurers should pay for any treatment or procedure ordered by a doctor; rather, they are willing to hold doctors accountable to quality measures.
  • They also see too much waste, fraud and abuse in the health system and they believe providers order more tests than are needed by the patient.
  • This group is middle-aged or older; most have at least some college education.
  • They are more likely than other groups to have one or two young children in the household.
  • This is the highest-income segment.
Insure All (33%)
  • Politically, this segment is moderate to liberal.
  • They favor universal coverage as the core health system goal, and think the government option would provide the fairest, most affordable way to deliver on this value. They also see quality health care as an important value.
  • They see government as the better solution to ensuring access and quality.
  • They accept government interventions in the marketplace to limit the compensation of health executives.
    • They are the least likely segment to see waste, fraud and abuse or over-prescribing by doctors as major cost-drivers. At the same time, they believe that health providers charge too much.
    • They would hold government accountable by subjecting lawmakers to health regulations and laws they pass.
  • This group is racially diverse; in particular, it includes more Hispanics than the other groups.
  • It is a low-income segment, with about half earning less than $50,000 annually and one in five earning less than $20,000.
  • This segment is the youngest, and less likely than other segments to be married or have kids.
Managed Competitors (15%)
  • This group is a mix of ideologies.
  • Members of this group favor universal coverage, but want it achieved through marketplace competition, not the government.
    • In spite of their marketplace orientation, this group is most likely to agree that providers, pharmaceutical companies and insurers charge too much.
    • They also agree that aging and technology are significant cost drivers.
    • They are split on other issues, including whether insurance should pay for any treatment or procedure ordered by a doctor.
  • This group is older; 43% of this group is 55 or older.   It is the least likely of any of the segments to have kids in the household.
  • It is the most racially diverse of the groups.
  • Members of this group also are the least likely to be employed (large number of older, retired people in this group).
Cost-Conscious (18%)
  • This group tends to be ideological moderates.
  • On many issues, they align with the Insure-All segment. But on one key value they differ. The Cost-Conscious group values affordabiity of health care more than quality or universal access.
  • This is the lowest-income of the four segments, with half making less than $50,000 per year. About half have full-time jobs; one-in-five works only part time.
  • They have more kids in the household than any other segment, with many having two school-aged kids.