Americans Speak on Health Reform: Report on Health Care Community Discussions

I. Overview of Health Care Community Discussions

D. Analysis

The response to the request to participate in this project was enormous. Roughly 9,131 Americans from every state signed up to host a Health Care Community Discussion. Of these sign-ups, 3,276 groups submitted Health Care Community Discussion reports through the reporting Web site on Change.gov, either by uploading documents or writing comments in a text box, that were used in this analysis⁵. In addition, Participant Survey data for about 30,603 attendees submitted by group hosts was logged and analyzed. This extensive and intense engagement of the public in policy development by the Federal government is unprecedented and historic.

The Health Policy Transition Team, volunteers and, after January 20, a small number of U.S. Department of Health and Human Services employees committed not just to read every response but also to assess, synthesize, and summarize the responses and present them to the President. This information is crucial to the President's commitment to engage all Americans in reforming our health care system to provide affordable, accessible, and high-quality health care for all Americans. To thoroughly and accurately synthesize the responses, beginning in December 2008, the Health Policy Transition Team consulted with the nation's leading health services researchers to develop an analytic strategy (see Appendix A). Under the guidance of the experts, the trained volunteers read and "coded" each report using a software program designed for qualitative analysis. These codes, which were developed by the Health Policy Transition Team and qualitative research experts, provided an organized and comprehensive list of the topics participants discussed and the nature of those comments⁶. The codes also helped to identify the major themes or distinct, recurring ideas expressed across all of the reports. The results below describe the number of reports that contained the codes, as well as quotes and examples that illustrate the themes that emerged from the reports. Generally, the analysis focused on topics of discussion mentioned in more than one in ten group reports; numerous additional concerns and solutions were proposed and can be viewed in the reports that are posted at www.HealthReform.gov (see Appendix B for a description of the methodology).

These Health Care Community Discussions were not designed to be a scientific research study, with a pre-determined sampling strategy and structured focus groups (e.g., professional moderator, set questions, and probes) or other structured components (e.g., specific methods used to force participants to make tradeoffs about possible solutions). Nor were these Health Care Community Discussions intended to produce a catalogue of existing and new ideas for reform: this report neither filters out solutions that may already be in the mix nor links solutions to the Administration's policy or existing programs. Instead, this grassroots undertaking gave anyone the chance to exchange ideas with family, friends, neighbors, or acquaintances in the way they considered best. As such, it resulted in discussion and debate on a wide range of topics of greatest interest to them.