Changes Over Time in Attitudes Towards Health Care Policy Options

Objective - To obtain information from a cohort of physicians about their attitudes toward current health policy options and initiatives and compare their current attitudes with their attitudes in 1993. Design - Mailed surveys in 1993 and 1999. Participants - Family medicine residency-trained physicians who achieved certification between 1989 and 1991 and resided in Ontario in 1993. Main Outcome Measures - Extent of approval of health policy options and initiatives and extent of agreement with statements about the health care system. Results - Over 84% of physicians responding in 1993 responded in 1999, although the overall response rate in 1999 was lower (53%). Although the group expressed approval (80%) for the use of evidence-based medicine, less than forty percent approved of other policy options and initiatives. They were particularly disapproving of changes in physician resource policies and in the acute care sector and of possible primary care reforms. Significantly greater disapproval was seen in 1999 for most policy initiatives first inquired about in 1993. However, in 1999 significantly fewer agreed than in 1993 that some government policies (eg. regarding physician income caps) result in negative outcomes. Conclusion - Many of the policy initiatives that have occurred since 1993 to restructure the health care system and limit the growth of the physician supply were initially viewed favourably by these physicians and are now viewed unfavourably, probably because of their impact on these physicians and their patients. The level of disapproval of proposed initiatives to reform primary care suggest reform should be approached cautiously and in consultation with the profession.