Examining the Content of Health Care Reporting

In schools of public health, everyone is aware that the boomers are coming. That’s because in 2010 the first wave of the Baby Boom generation will be ready for retirement, and health care services will be in even greater demand than they are today. By then the difficult political conundrum of how to pay for Medicare will have had to be addressed. So when the University of North Carolina issued a press release with the headline, “Old Age Won’t Boost Health Care Costs As Much As Some Have Predicted,” I expected that Edward Norton, one of the study’s authors and a colleague of mine, would receive a lot of calls from reporters who would be clamoring for more information. After all, the study’s results challenged the prevailing policy predictions about rapidly rising costs of care as Americans age. What Norton and I hoped was that this study might become a catalyst for a nationwide discussion about the elderly and their health care issues.

This didn’t happen. Coverage stretched as far as brief reports on a local public radio station, CBS radio, and a story in a local newspaper.

Why didn’t a report like this one generate more news stories? I think what happened here is illustrative of a trend in the coverage of health care policy. Health is a multifaceted, trillion-dollar industry. Yet issues involving health care and health care policy do not get the attention they deserve. These stories are not told in proportion to the importance these topics play in our lives, nor does reporting on them even receive its fair share of attention when the overall subject is health. Too often, “health” news consists of reporting on diseases or lifestyle issues, rather than the ways in which health care is delivered and the reasons why.

More health care policy news is justified. A 2002 Pew Research Center survey shows that 71 percent of Americans closely follow health news. More specifically, according to a Kaiser/Harvard School of Public Health survey in July/August 2002, 55 percent of Americans closely followed discussions in Congress about a Medicare prescription drug benefit. By comparison, in the same survey 82 percent of respondents closely followed stories about U.S. military efforts in Afghanistan. Even in the midst of the war on terrorism, Americans sought information about a change in government policy that might affect their health care benefits.

Though news consumers tell us in surveys that they like much of what they find in health coverage, they also have ideas about ways it might be improved. According to a survey conducted by the Kaiser Family Foundation and the National Association of Black Journalists in 1998, about 60 percent of the public believes that the media do a good job of telling them and their families what they need to know about health and health care. But a similar percentage indicated that they would like to see more news coverage of three topics: changes in government policies and the health care industry that might affect their health care or health insurance; Medicare and Medicaid, and how to find a health care plan, doctor, hospital or other health providers to meet their needs. These results suggest that Americans need more information that can help them understand how the health care “system” works and how they interact with it, both when they are well and when they are sick.

New and improved coverage of health care policy could be approached from a variety of angles. As news fodder, health care and health policy have it all: lots of money, drama and conflict; drugs and new technologies, and plenty of just plain contentious issues. Access to health care, for example, challenges us to think about our rights as human beings, and it can also provoke a look at specific consumers’ concerns by asking questions like what an uninsured family can do when a child’s fever reaches 104 degrees and emergency medical care is required. These seem like examples of stories that would entice news audiences and provide news that consumers can use.

Assessing News Content

When health policy stories are reported, how various issues are presented can become a point of contention. For example, some policymakers accuse journalists of repeatedly misrepresenting Republican efforts to cut spending for Medicare. And at a recent academic health conference, I heard a presenter contend that “biased news coverage” of pharmaceutical advertising contributed to increased demand for a particular medication. When faced with critiques of health care policy coverage, I think journalists should be skeptical. It often turns out that such critiques arise typically out of anecdotal evidence. And while specific examples might be illustrative, they actually provide little real insight into what health care news the American public absorbs and acts upon.

There are, however, some reliable studies by which to judge the quality of such news coverage. For example, Julie Lima and coauthor Michael Siegel, a Boston University professor, have shown that newspaper coverage of the 1997-98 tobacco settlements focused on the generation of new revenue rather than highlighting specific mechanisms for preventing and controlling tobacco use. When I looked at news coverage of long-term care issues in 1998, I found that few reports provided an underlying context or described in any depth the issues that were affecting demand for long-term care or the provision of such services. Both Lima’s study and my own demonstrate that the ways in which journalists deal with setting a news story in its broader context and organizing information are not as comprehensive as health policy researchers would like.

The tone of news coverage matters, too. During the 1990’s, some policymakers and insurance industry representatives blamed news reports for the public’s backlash against managed care. Since then, a well-regarded media study—done by Mollyann Brodie, vice president and director of public opinion and media research at the Kaiser Family Foundation, colleagues there, and Princeton Survey Research Associates—has shed light on this connection between news coverage and public perception. Their research found that in the 1990’s, most news coverage of managed care was neutral in tone. However, the tone of the coverage grew more critical as time went by, and its negativity was more in evidence in televised reporting.

The researchers’ assessment of the impact of this news coverage was mixed and offered a good reminder of how one’s sense about something can be proven incorrect once evidence is gathered and analyzed. The researchers did find that a large majority of people believed that rare anecdotal incidents of HMO’s withholding cancer treatment from children—like cases featured in television news programs—occurred often or sometimes. On the other hand, about half of the public viewed media coverage of managed care as fair, and only 22 percent said that this coverage “most influenced” their views of managed care. The authors concluded that “based on our findings, it would be difficult to argue that media coverage is by itself creating whatever backlash currently exists.”

A significant weakness of such studies is the lack of practical advice that emerges from them to benefit reporters. It would help us, as researchers, if journalists demanded that we provide more news about coverage that they can actually use. Journalists’ organizations such as the Association of Health Care Journalists, and AcademyHealth, a professional society for health services research and policy, should bring together reporters and editors, representatives of news audiences, health care providers, researchers and policy analysts to discuss what news the public wants to and needs to know about health care policy. Information gathered in such forums could be used to develop new approaches to aid in the coverage of “old” issues, increase reporters’ access to expert sources, and provide useful guidelines for reporting these stories. With commitment and creativity, internal and external critiques can lead to constructive conversations, training and research that might improve coverage of health care and health policy.

By reporting on the U.S. health care system—and about the public and private policies affecting its ability to function effectively—journalists provide a valuable service to the public. News reports are one of only a few ways that the public is able to keep abreast of the rapid changes in the health care system. And these changes have profound effects on their lives. As reporters and editors consider coverage of possible health stories, priority should be given to issues of health care policy, such as how reductions in Medicaid budgets—which are now happening in many states—will affect families and elderly citizens who depend on this program for medical services. This certainly isn’t the only health policy story out there, but more coverage of what’s happening with Medicaid or the uninsured would signal a promising step in the right direction.

Felicia Mebane is an assistant professor in the Department of Health Policy and Administration in the School of Public Health at the University of North Carolina at Chapel Hill. She conducts research about coverage of health policy and politics with an eye toward improving news coverage. Her study, “Want to Understand How Americans Viewed Long-Term Care In 1998? Start with Media Coverage,” was published in The Gerontologist in February 2001.