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Interest is resurging in the problems relating to the quality of patient care. This paper provides a comparative perspective on this issue from a five-country physician survey conducted in Australia, Canada, New Zealand, the United Kingdom, and the United States in 2000. Physicians in all five countries reported a recent decline in quality of care and concerns with how hospitals address medical errors. Physicians in four countries expressed serious concerns about shortages of medical specialists and inadequate facilities. U.S. physicians reported problems caused by patients' inability to pay for prescription drugs and medical care. Asked about efforts to improve quality of care in the future, physicians indicated support for electronic medical records, electronic prescribing, and initiatives to reduce medical errors.

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Informal and unpaid care is an integral feature of the U.S. health care system for the nation's sick, disabled, frail, and terminally ill. Much of what we know about caregiving is based on interviews with caregivers and, in some cases, care recipients. Prior studies have either not been based on a nationally representative sample or have collected very little information about non-caregivers. This study, using the Commonwealth Fund 1998 Survey of Women's Health, uses a nationally representative sample of caregivers and non-caregivers to examine the health impact of providing informal and unpaid care, focusing primarily on women. Our findings indicate that caregivers experience double jeopardy. They are significantly more likely to be in poor health and to have experienced problems getting needed care. These findings suggest that it is time to explore alternative or complements to informal caregiving. They underscore the need to find more equitable ways to share caregiving costs and risk, and provide support to assist those who currently provide care.

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This article presents the views of Americans on what the government's future role should be in regulating or overseeing the growing sales of dietary supplements for health purposes. Based on results of multiple national opinion surveys, including the views of both users and nonusers of supplements, we found that a substantial percentage of Americans surveyed reported that they regularly take dietary supplements as a part of their routine health regimen. However, they reported that they do not discuss the use of dietary supplements with their physicians because they believe that the physicians know little or nothing about these products and may be biased against them. Many users felt so strongly about the potential health benefits of some of these products that they reported that they would continue to take them even if they were shown to be ineffective in scientifically conducted clinical studies. However, there also was broad public support for increased government regulation of these products. We found that a majority of Americans surveyed supported the following: to require that the Food and Drug Administration review the safety of new dietary supplements prior to their sale; to provide increased authority to remove from sale those products shown to be unsafe; and to increase government regulation to ensure that advertising claims about the health benefits of dietary supplements are true.

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CONTEXT: Changes in the healthcare marketplace have begun to test the nature and adequacy of health insurance. The complex nature of insurance is driving us away from the notion that there are 2 distinct groups - the insured and the uninsured - toward an idea that insurance is best represented along a continuum, from the very well insured to the chronically uninsured, with a wide range of quality of coverage in between. OBJECTIVE: The objective of this study was to examine the experiences of insured adults as they try to get needed healthcare and balance the payment for these services against other basic needs. DESIGN: Using data from the Commonwealth Fund 1999 Survey of Workers' Health Insurance, the study analyzes the cost and access problems of insured adults by a number of different variables including income, plan satisfaction, health status, and insurance stability. RESULTS: Bivariate results indicate that insured adults with low incomes and those reporting fair or poor health are more likely to experience problems getting and paying for healthcare. These groups are also more likely to have problems paying for basic living expenses. CONCLUSIONS: The most essential notion of insurance is that it will provide protection against financial risk and assurance that we can get healthcare services when we are sick. Yet, we find substantial proportions of low- and modest-income, insured adults who struggle to afford insurance premiums; we also find that their insurance plans do not provide them with either access to care when needed or financial protection from the cost of that care.

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Recent opinion surveys show a high level of public support for the current employer-based health insurance system. Many Americans are not aware that this system is endangered or that the number of uninsured persons is growing. The public appears to favor a two-track system for the working uninsured--strengthening the existing employer-based system and developing a parallel system for those without employer coverage.

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