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Kristin Murphy, Deseret News
Dr. Ryan Murphy talks with Jonan Williams and Steven Williams about medication for a blood clot after Steven's neurosurgery at University Hospital in Salt Lake City on Wednesday, Nov. 29, 2017.

SALT LAKE CITY — Physicians' rate of dissatisfaction with what they charge for health care is higher than patients' unhappiness with what they pay, according to the findings of a national survey released Wednesday by University of Utah Health.

Only 13 percent of 5,031 American patients surveyed said they were at least somewhat dissatisfied with the price they paid for health care in the past year, but 32 percent of 687 physicians who answered questions were somewhat or very dissatisfied with the costs their clients paid for the care they delivered over the same time frame.

"Doctors in the survey put an intense amount of responsibility on their own shoulders across the board, in terms of cost," said Dr. Bob Pendleton, chief quality officer for University of Utah Health. "Though that's laudable, it's also problematic because one of our problems in health care delivery is a system that relies on the heroics of the single provider, rather than an entire system that is coordinated and meeting a patient's need."

Doctors were also asked who is most accountable for a patient's health improving, with 75 percent saying they were. Forty-five percent of patients also put the onus on physicians. Possible responses included patients themselves, the overall health care system, employers and insurance companies.

But surveyed physicians also gave themselves high marks when asked whether they were happy with the quality of care they provided in the past year, with 94 percent of them being at least somewhat satisfied with it and just 2 percent being at least somewhat dissatisfied. In contrast, 80 percent of patients were satisfied with the care they received.

Asked about the price of health care in the United States generally, 89 percent of physicians and 83 percent of patients agreed that costs are too high. Slightly less than half of both groups believe the quality of health care in the country is the best in the world.

Defining value

The U. launched the study in response to the growing confusion over the concept of "value" in health care, which Pendleton said has been reduced to a buzzword with no clear connotation in the industry.

"We've talked a lot about value at the University of Utah and we have a pretty clear definition for us," he said. "It's the best outcomes and the best service at an affordable cost, but we also recognize that nationally, value has probably become the most overused word in health care, with really not (a) clear consensus on the meaning."

The poll was carried out by the Salt Lake firm Leavitt Partners and solicited responses online from May to July. The surveying used methodology "to ensure that the results represented U.S. demographics in terms of income levels, age, etc., and that the sampling met those standards," Pendleton said.

Although University of Utah Health calculates value by measuring quality outcomes plus level of service per dollar spent, "patients tend to conflate quality and service measures," according to University of Utah Health spokeswoman Kathy Wilets.

"In other words, there are not clear definitions of quality and service, but rather patients are measuring quality in terms of service," Wilets explained in a release.

Pendleton said that means that when patients hear the word "quality," their mind turns to the convenience and access of finding and receiving care — "things that make actually getting to see the doctor easy to do" — rather than immediately thinking of health outcomes.

"Patients are behaving more like consumers, which means they want things to be transparent. They want to be able to go online and search and gather as much information as they can (and) make their appointments online," he said.

Respondents were asked to select, among a large series of value statements, five sentences that aligned with what is most important to them. Nearly half of the patients' responses focused on convenient service, as opposed to cost or quality, according to Wilets. Though the top overall response was "my out-of-pocket cost is affordable," some others were "the wait time at the office is reasonable" and "I'm able to schedule a timely appointment."

"We aren't really at a point where taking off an entire day just to go to a doctor's appointment is acceptable. I thought that came through very, very loudly in the survey," Pendleton said.

Discussing costs together

Among the transparency that patients expect, Pendleton said, is the ability to communicate with their physician about out-of-pocket costs. Sixty percent agreed with the statement that "I would like my health care provider to talk with me about the cost of my care."

Nearly an identical proportion of doctors felt the same way, with 59 percent agreeing with the statement that "I believe it is my responsibility to discuss the cost of care with patients." Unfortunately for both groups, Pendleton said, "we currently don't equip patients or doctors with the tools to be able to have that conversation effectively."

"That's problematic," he said. "You wind up picking one (provider or service) and just sort of hoping it's an acceptable cost."

Pendleton said there are no easy solutions, pointing to the relatively small scope of medical services for which providers' pricing estimate tools can be useful and the difficulty of making any price approximation in light of insurers' widely divergent approach for each benefit.

"We know exactly what it costs us to deliver that care, but that internal cost has to go through a filter which is (patients') insurance plans, to know what the cost impact is actually for the patient," he said. "Currently, there really is no good way for an individual doctor who takes care of patients on maybe 14 different health plans to actually know what an intervention will translate to (for) that particular patient's out-of-pocket costs."

Utah differences

Patients from Utah gave significantly different answers in response to several of the survey's queries. For example, 78 percent said they would be willing to pay either slightly or a lot more if it ensured their health improves, compared to 62 percent nationally.

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Utahns are also more likely to want to speak to their providers directly about costs than the national average, with 72 percent saying they would like that compared to 60 percent. Additionally, 52 percent of Utahns consider themselves primarily responsible for improving their health, compared to 45 percent of all respondents.

Just 1 percent of respondents from the Beehive State believe the country's overall health care system is most responsible for keeping them in good health, compared to 9 percent across the country.