A survey in fifteen communities and nationwide of consumers' opinions
about changes in their local health care system reveals that Americans
are surprisingly positive about recent changes in their personal acce
ss to and quality of care and consistently negative about changes in t
he cost of care. Although many consumers think that changes in the sys
tem are making things worse, they are optimistic about the trend towar
d managed care. Subgroup analysis shows that uninsured persons and per
sons with health problems reported high rates of concern about many of
the health system issues we explored, while Medicaid recipients, Hisp
anics, and African Americans reported positive changes in their access
to and quality of care.