Center for Studying Health System Change

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HSC Surveys


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Design and Methods


Household Survey


Physician Survey


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Followback Survey


Employer Survey


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HSC periodically conducts national surveys of households and physicians. For the first four rounds of each survey, the survey samples were concentrated in 60 communities that were randomly selected to provide a representative profile of change across the U.S. Among these communities, are 48 "large" metropolitan areas (with populations greater than 200,000), from which 12 communities were randomly selected to be studied in depth. Those 12 communities have larger survey samples and also comprise the communities used for the site visits. The most recent physician (2008) and household (2007 and 2010) surveys are nationally representative but do not support community-level analyses.

The survey data collected over the first four rounds can be used to draw conclusions for the nation and for individual communities. Having data from multiple surveys for a common set of sites permits analysts to relate the individual-level measures obtained from one survey to market-level health system characteristics obtained from the other surveys. The 2007 and 2010 Household Surveys and 2008 Physician Surveys support analyses at the national level only. Note that there are no links between any of the survey respondents in the household, physician and employer surveys (e.g., respondents to the Household Survey are not patients of physicians in the Physician Survey).

Household Survey
Approximately 17,000 people took part in the 2010 survey. The survey focuses on assessing whether consumers’ access to health care is improving or declining over time. The survey also explores patients’ satisfaction with the care they receive and with their insurance coverage. Information about health status, sociodemographic characteristics and employment is also collected. Mathematica Policy Research conducts the Household Survey for HSC. The first five household surveys were conducted in 1996-97, 1998-99, 2000-01, 2003 and 2007.

Physician Survey
Practicing physicians across the country provide perspectives on how health care delivery is changing. Physicians respond to a series of questions about source of practice revenue, problems they face in practicing medicine, quality of care, access to services, information technology, sources of practice revenue and compensation, as well as questions about their practice arrangements and care practices. More than 12,000 practicing physicians across the country provided perspectives on how health care delivery is changing in the first three rounds of the survey (1996-97, 1998-99, 2000-01), while more than 6,600 physicians were interviewed in round four (2004-05) and more than 4,700 physicians were interviewed in the 2008 survey. Unlike previous rounds of the survey that were administered over the telephone, the 2008 survey used a mail questionnaire. It was conducted by Westat, while the Gallup Organization conducted previous rounds of the survey. The 2008 survey included questions in new topic areas, such as coordination of care, malpractice, and physician ownership of equipment and hospitals.


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The Center for Studying Health System Change Ceased operation on Dec. 31, 2013.