What is healthcare quality? Most patients judge healthcare quality not on the way in which care is delivered or on the clinical outcomes obtained, but on clinicians’ bedside manners, according to a new survey.

Among the findings of a survey of 1,002 adults by the Associated Press-NORC Center for Public Affairs Research, released this week, was that most (59 percent) defined high-quality physician care based on physician-patient relationships and the personality of their physicians, rather than on the delivery of care or a patient’s own health outcomes (29 percent). The most frequently cited characteristic of a high-quality physician is one who is attentive or shows interest in his patients (18 percent), survey respondents said.

Such findings appeared to run counter to the increasing efforts by public and private healthcare payers to measure and reward clinical care based on the quality of care provided and—increasingly—clinical outcomes. Only a small share of provider measurement tools—such as components of Medicare’s Hospital Consumer Assessment of Healthcare Providers and Systemssurvey—track and reward patient perceptions of quality interactions.

The survey also found that, in general, consumers are supportive of quality improvement efforts, including public reporting requirements for physicians to improve healthcare quality. For instance, overwhelming majorities said requiring physicians to report the effectiveness of their treatments and patient satisfaction with their care would improve the quality of care provided.

Access Problems

However, less than a quarter of respondents reported access to provider quality information. Most lacked confidence they could find provider quality information they can trust on their own, including direct comparisons of physicians. Word-of-mouth and personal recommendations from physicians garnered far more trust than provider quality data coming from the government or third parties.

Information on providers’ charges was even harder to find than quality information, the survey found. Only one-third said it was easy to find information they trust related on the costs of provider care. Even fewer said it was easy to find data that compares a provider’s costs and quality.

When asked to rate providers’ quality based on their personal experiences with different care settings, survey respondents had a dimmer view of hospitals than other care settings. The 81 percent of respondents who rated hospitals as providing “very or somewhat good” care trailed the high-rated care at local physician’s offices (88 percent) or retail clinics (82). The lowest shares of high-quality ratings were given to walk-in clinics (76 percent) and emergency departments (69 percent).

The public’s perceptions also challenged a central pillar in healthcare payment reform efforts: that higher quality care can be delivered at a lower cost. About half of Americans believe that higher quality healthcare generally costs more, while 37 percent said there is no real relationship between quality and cost.

Even as the number of uninsured has declined under coverage expansions instituted this month by the Affordable Care Act, the remaining uninsured reported more challenges finding information about provider quality and cost. However, the uninsured were more inclined than people with insurance to believe public reporting of cost and quality would improve the overall quality of care physicians provide.

Publication Date: Tuesday, July 22, 2014