2000 Connecticut Policymaker Survey

Abstract

Connecticut policymakers were surveyed to assess their needs for health policy information and their perceptions of upcoming challenges facing Connecticut's health. Policymakers receive information from a wide variety of sources; most often from within state government - state agencies and legislative staff. Other common sources were health care provider organizations and health advocacy organizations/coalitions. The most trusted sources of information were legislative staff, national health policy organizations, state agencies and academic sources. Media and the press were a significant source of information, but not highly trusted. The areas of greatest need for information concerned health care for the uninsured, behavioral health, long term care and health care financing. Both legislators and staff policymakers overwhelmingly prefer to receive information in short, one or two page fact sheets.

Background

Policymakers need accurate, timely information on complex health care policy information to make the best policy decisions for all Connecticut residents. To assess the need for health policy information among Connecticut's policymakers, the CT Health Policy Project surveyed state legislators and legislative and administrative staff engaged in health care. The survey asked for their current sources of information, their confidence in those sources, areas of information need, how they prefer to receive information and predictions of upcoming health care challenges facing Connecticut.

Methodology

A two-page survey was sent to all Connecticut legislators during the 2000 legislative session. The survey was mailed to legislative office addresses, with post cards to home addresses. Follow-up calls and two sets of follow-up survey mailings were made to non-responders. Fifty-one legislative and executive branch staffers working on health care issues were sent a similar survey in June 2000 with follow up calls to non-responders. Survey tools were tested with legislators and staff and modified. Sixty-four legislators and 35 staffers responded, for a total of 99 respondents. The overall response rate was 44% (36% for legislators and 69% for staff). Fourteen legislative and 9 staff responses were anonymous. Of legislators, 37 Democrats and 13 Republicans responded, including 10 Senators and 40 Representatives. Agencies represented among staff responses were the Departments of Social Services, Public Health, Mental Health and Addiction Services, Mental Retardation, and Children & Families, the Office of Health Care Access, the State Comptroller's Office, the Office of the Child Advocate, the Office of Protection and Advocacy for Persons with Disabilities, the Commission on the Aging, the Commission on Children, the Permanent Commission on the Status of Women, the Latino and Puerto Rican Commission, and both partisan and nonpartisan legislative staff. The survey tools are attached.

Results

Respondents noted significant needs for information. In comments, several respondents noted that they had too much information; they needed analysis and summaries. The need for information and ease of getting questions answered was very similar between legislators and staff.

There was agreement among the respondents concerning sources of information. The most common sources were from within state government - both legislative and state agency staff. For legislators, nonpartisan staff is the most common source. Other frequent sources were health advocacy organizations/coalitions, and health care provider/professional organizations. A moderate amount of information was received from the media/press and insurance industry organizations. Little information came from academic sources, unions, legal sources, community groups, consultants or business organizations. Journals and publications, national health policy organizations and the federal government were significant sources for staff but not for legislators. Legislators reported getting a great deal of information from constituents and personal contacts.

Information sources, all respondents
Scale 1 (least frequent) to 10 (most frequent)

Respondents also largely agreed on their confidence in these sources. Most trusted sources were legislative staff, national health policy organizations, state agencies, academic sources, federal government sources. By a wide margin, legislators' most trusted source was nonpartisan legislative staff. Overall there was little trust in information from the media, the insurance industry and business organizations. In many cases the lack of confidence in the media was very strong, with comments in the margins. Lack of confidence in the media was common to both legislators and staff. Legislators were more likely than staff to trust information from unions.

Confidence in sources, all respondents
Scale 1 (low) to 10 (high confidence)

In general, more frequent sources were more trusted, with a few exceptions. Both legislators and staff get a good deal of information about health care from the media, but they do not trust it. Both also get a fair amount of information from the insurance industry, but don't trust it. There was a smaller disconnect between frequency and trust from provider organizations. Both legislators and staff get little health policy information from academic sources, but it is highly trusted.

When asked for issue areas that policymakers need more information about, most often noted were health care for the uninsured, behavioral health, long term care and health care financing. Thirteen respondents checked every box. In answer to an open question asking for other areas of information need, one respondent suggested Economics 101.

Information needs, all respondents
percent

When asked how they prefer to receive information, legislators and staff are split. Legislators prefer mailed reports on a regular basis and responses to their questions in person or by phone. Staff prefer to receive information from a website or listserv. Answers varied on this question with no clear universal choice.

There was considerable agreement, both for staff and legislators, in what form they prefer to receive health policy information -- one or two page fact sheets. Some of the strongest comments of the survey were in response to this question. Brief memos were the second preference. There was very little interest in comprehensive papers, briefings or conferences.

In response to an open question asking for predictions of upcoming health care challenges affecting Connecticut, there was wide variation between respondents and significant differences between staff and legislators. The most common theme was meeting the needs of the uninsured/universal coverage. The second most common concern was cost - both paying for public programs and affordable coverage for businesses and consumers. Also noted by both staff and legislators was the challenge of meeting the needs of an aging population and the health care needs of the elderly.

After those three concerns, staff and legislators' perceptions diverged. Legislators are concerned with long term care, prescription drug prices, patients' rights/managed care reform, and hospital capacity and survival. Staff are more concerned with mental health services, prevention, culturally appropriate services/diversity and the declining number of health care professionals in certain professions.

Some comments from legislators:

• "We have plenty of information, [but] lack the political will to change."
• "[The] system is seriously flawed, provider/consumer movement is needed"
• "At present, [we] cannot expand good pilot programs because [we] cannot get support for them in the state budget. We do symbolic projects, but they reach too few at-risk people."
• Several noted that they are overwhelmed by information; they don't have time to digest it all, to make it useful. They noted a need for analysis and summary.
• Many stressed the importance of being brief in any information to legislators.

Some comments from staff:

• "I think one of the main challenges is clarity or purpose and understanding - cutting through misconceptions and statistical fog to enable everyone [to be] on the same playing field. The system and issues are so complex - there is no one place to go for a plain-language bird's eye view of the needs; options; issues; solutions; progress. It's all over the place and often policymakers have issues framed for them by newspaper articles rather than rigorous, informed analysis."
• "System of health care finance [is] beginning to unravel - BBA cuts, growing uninsured population, etc. - everyone is looking at their own books, not at the whole picture/system. Long-term consequences to access/quality are frightening."
• "The fact that people are living longer and we can treat/cure more diseases means a tug of war for resources among generations. Do we spend more on the elderly? Or should we focus on kids?"
• "I think a state health policy conference would be a terrific learning experience for legislators, staff, providers, etc. A great opportunity to share ideas and discuss issues."

Conclusions

State policymakers need brief, clear, useful health policy information they can trust. The need crosses dozens of issue areas. Many policymakers are getting information from the media, but they don't trust the source. Conversely, few are getting information from academia, but they trust it. There is some distrust of information from interested sources, particularly from the insurance industry. The greatest needs for information were predictably in complex issue areas -- health care for the uninsured, behavioral health, long term care and health care financing.

There is a universal preference for brief, one or two page fact sheets. Advocates are advised to be brief if they want to be heard. Those looking for an easy, universal mechanism to communicate with all policymakers will not find it here.

There was general agreement on upcoming challenges facing Connecticut, consistent with the areas cited as information needs. Common themes are covering the uninsured/universal coverage, costs and the health care needs of an aging population.