How Americans Perceive the Health Care System

A nationally projectable poll of 1,011 American households conducted December 18-22, 1996, reveals a disturbing lack of confidence among the majority of Americans with the state and direction of health care and concern about health care quality, cost and coverage.

      The telephone poll, conducted by International Communications Research, was commissioned by The National Coalition on Health Care. The survey findings from a representative cross section of American households have a range of variation of no greater than plus or minus three percentage points.

      Their responses to a series of statements show that most people have little confidence in the ability of the system to care for people. The vast majority of Americans (79%) agree with the statement “there is something seriously wrong with our health care system,” 87% agree that “the quality of medical care for the average person needs to be improved,” and only 15% have “complete confidence” in hospital care. Less than half of people (44%) say they have “confidence in the health care system to take care of me.”

      Eight in ten Americans believe that the quality of medical care is being compromised in the interest of profit. They feel that “quality medical care has become unaffordable for the average American” (79% agree), that “hospitals have cut corners to save money” (74% agree), that “quality care is often compromised by health insurance companies to save money” (80% agree), and that “quality of medical care has gone down while costs have increased” (64% agree). These views are held by people in fee-for-service plans as well as those in managed care plans.

      There is a hunger to be better informed: 83% say they “would like to be better informed about how to evaluate quality of medical care from doctors and hospitals,” and 72% “would like more information so [they] would feel more confident about decisions about medical care.”

      People are frightened by stories they’ve heard of medical care “mistakes made that have hurt or even killed people” (75%).

      More than half the respondents (57%) agree that “hospital care is not very good” and they risk being “made sicker or more injured by mistakes made by poorly trained or overworked staff.”

      While the majority feel confident that they could get quality medical care for themselves, they also believe there are serious problems with the quality of health care.

      Contrary to the widely publicized view that government should stay out of health care, the vast majority of Americans feel that “the federal government can play an important role in making health care better” (69%) and “more affordable” (72%). These beliefs were shared by Republicans, Democrats, and Independents.

      The poll reveals a divided population regarding peace of mind and satisfaction of health care. About two-fifths of Americans are strongly alienated from the health care system. Many of those with annual household incomes of $25,000 or less are highly troubled by their experiences with cost, coverage and treatment.

      Even though they consider their current health care satisfactory, a large proportion of middle class respondents are also strongly troubled by what they see as serious flaws in the system related to quality, costs and access.

      Four of every ten people polled have had reductions in coverage and are “worried that they may lose their health insurance” and feel they “cannot afford medical insurance.”

      On a positive note, four in every ten people “strongly agree” that their “medical plan makes good health care affordable” and over one-third (36%) “strongly agree” that they are “satisfied with the quality of [their] health care.” Over one-quarter (28%) “strongly agree” that they “like the way their medical plan works” and that “[their] medical plan provides the best quality care they could want.”

      In general, people over sixty-five years of age, and therefore covered by Medicare, are more satisfied with quality and coverage than are those in their thirties and forties. Not surprisingly, higher income families ($50,000 annual income) express more confidence and satisfaction with their health care than do those from households with middle or lower incomes.

      Four in ten Americans report having had a “bad” experience with treatment or care, don’t have confidence in the system to take good care of them, or believe hospitals have cut corners to save money, thus endangering patients.

      Focus group interviews recently completed in five cities prior to the survey amplify the findings of the polls. They reveal a depth of anger, fear and betrayal combined with a sense of frustration and pessimism for the future of health care. The prevailing view expressed in these interviews was that improvements in the health care system were being held hostage by partisan politics. Respondents in the focus groups displayed great cynicism about the motives and goals of the health care system.

      The respondents showed impatience with the lack of progress in controlling costs, improving quality and access. Many of those who felt they were adequately protected by their insurance expressed concern and dismay at the plight of many people who they felt were unprotected and poorly cared for. Many had friends, neighbors and close relatives who lost their health insurance and were struggling to pay for or receive good health care. Their anxieties were underscored by the belief that even though they were currently protected, they could soon join the ranks without access to quality medical care.

    Detailed Findings

      Forty statements were read to survey respondents, one at a time, and after reading each statement to the respondents the interviewer asked whether they agreed or disagreed with what was said. Next the respondents were asked whether they agreed or disagreed “strongly” or “somewhat.” In this way the survey was able to measure a comprehensive set of perceptions and beliefs about health care and determine how strongly held these perceptions and beliefs were.

      A. Perceptions of Quality

      Thirteen statements dealt directly with perceptions of quality of health care. The responses to many of these statements reveal very high levels of dissatisfaction with and concern about health care quality. The statement that generated the most agreement was “the quality of medical care for the average person needs to be improved.” 59% of the survey participants agreed “strongly” with this view and an additional 28% agreed “somewhat.”

      Health care was broadly criticized by eight in every ten respondents who agreed with the statement “there is something seriously wrong with our health care system.”

      A more direct indictment of the quality of care was made by 75% who agreed that “there are serious problems with the quality of health care.”

      Many Americans perceive the drive for profits is taking precedence over concern for quality or people.

      Half of the survey participants disagreed with the statement that “quality treatment is the most important thing to health insurance companies,” while 29% agreed “strongly” with this statement. Eighty percent of Americans agree that “quality care is often compromised by insurance companies to save money.”

      Disturbing stories about the quality of care have taken their toll on the confidence people have in the system. Three quarters of people agreed with the statement “I’ve heard some disturbing stories about medical care and mistakes that hurt or even killed people.” Four in ten Americans report they have had a bad experience with medical treatment or care.

      Hospitals came under severe criticism. Three quarters of people agreed that “cuts in service endanger patients.” Only 15% would agree “strongly” that they had “complete confidence in hospital care.” To the statement that “hospital care is not very good– you’re likely to get sicker or more injured by mistakes made by poorly trained and overworked staff,” 24% agreed “strongly” and 24% agreed “somewhat.” Only 19% were in “strong disagreement” with this statement.Table 1

	% Agree Completely	% Agree Somewhat	% Disagree Somewhat	% Disagree Completely
The quality of medical care for the average person needs to be improved.	59%	28	8	4
There is something seriously wrong with our health care system.	52	27	14	5
Cuts in hospital service endanger patients.	50	22	10	16
Quality care is often compromised by insurance companies to save money.	49	25	15	6
Hospitals have cut corners to save money.	47	33	10	6
I’ve heard some disturbing stories about medical care and mistakes that hurt or even killed people.	43	26	11	18
There are serious problems with the quality of health care.	40	35	16	7
I am satisfied with the quality of my health care.	36	37	14	10
Medical care costs have increased but quality of care has gone down.	36	28	21	11
Quality treatment is the most important thing to a health insurance company.	29	20	25	24
My medical plan provides me the best quality care I could want.	27	30	22	16
Hospital care is not very good–you’re likely to get sicker or more injured by mistakes made by poorly trained or overworked staff.	24	24	30	19
I have complete confidence in hospital care.	15	28	31	24

      B. Perceptions of Cost

      Nine statements concerned the cost of medical care, health insurance and the relationship between cost and quality. It should be noted that to most people the term “health insurance companies” is virtually synonymous with managed care as well as traditional indemnity plans.

      People perceive costs rising, coverage decreasing and quality going down at the same time. This equation adds up to anger, fear and cynicism. Nearly six in every ten people “strongly” agreed that “quality health care is almost unaffordable for the average person” and an additional 22% “somewhat” agreed. To the statement “health insurance premiums have gone up and coverage has gone down,” 44% “strongly” agreed and 27% “somewhat” agreed.

      The cynicism of people is evident in their responses. They feel they are paying more and getting less while providers are profiting. This view is reflected in the agreement with the statement that the “high cost of medical care is due in part to greed of the insurance companies” (43% “strongly” agree, 26% “somewhat” agree). Only 10% agreed strongly that “health insurance companies put the needs of customers ahead of profits” while 43% “strongly” disagreed with this favorable view of their insurers. Nearly two-thirds of people agree (36% “strongly”) that “medical care costs have gone up but quality of care has gone down.”Table 2

	% Agree Completely	% Agree Somewhat	% Disagree Somewhat	% Disagree Completely
Quality health care is almost unaffordable for the average person.	57	22	14	5
The federal government can play an important role in making health care more affordable.	50	22	10	16
Health care insurance premiums have gone up and coverage has gone down.	44	27	14	9
The high cost of medical care is due in part to greed of the insurance companies.	43	31	14	8
I worry that I will not be able to afford quality medical care for a serious illness.	39	19	21	19
My medical plan makes good health care affordable.	38	33	13	12
Medical care costs have increased but quality of care has gone down.	36	28	21	11
We cannot afford medical insurance.	28	12	23	35

      The population is divided on the impact of cost. Four out of every ten people “worry that they will not be able to afford quality medical care for a serious illness” (39% “strongly” agree and 19% “somewhat” agree) and feel that “the costs of health insurance have put a serious dent in our budget” (40% “strongly” agree and 19% “somewhat” agree). An equal proportion of people say that “my medical plan makes good health care affordable” (38% “strongly” agree, 33% “somewhat” agree). Over one quarter of respondents feel that they cannot afford medical insurance (28% “strongly” agree and 12% “somewhat” agree).

      Contrary to much of the rhetoric surrounding the debate on health care reform, most people believe the federal government can play an important role in making health care better and more affordable (50% strongly agreed, 22% somewhat agree).

      C. Trust and Confidence

      The survey responses reflect a lack of trust and confidence in the health care system. A system which people depend on seems to have turned into a big profit-generating business that cares little for the needs and feelings of the individual. A woman from California who participated in a recent focus group summed up this feeling by saying “there’s not much care left in health care these days.”Table 3

	% Agree Completely	% Agree Somewhat	% Disagree Somewhat	% Disagree Completely
Medical care has become a big business that puts profits ahead of people.	52	30	11	4
The high cost of medical care is due in part to greed of the insurance companies.	43	31	14	8
Health insurance companies put the needs of customers ahead of profits.	10	14	31	43
I am not very optimistic about the future of health care.	32	26	27	13
There is not much care left in health care these days.	30	23	29	13
I or a family member have had a bad experience with medical treatment or care.	30	14	25	30
Health insurance companies really care about their customers.	9	23	32	33
Quality treatment is the most important thing to a health insurance company.	29	20	25	24
I don’t have much confidence in the health care system to take care of me.	20	24	33	20
I feel I can trust my health insurance company to do the right thing for me.	20	29	26	33

      Nearly one-third of Americans are troubled by what they see as a health care system that will not take care of them. They have little confidence in the future. “I’m not very optimistic about the future of health care” found 32% in “strong” agreement and an additional 26% “somewhat” in agreement. An industry that “puts profits ahead of people” was seen by 52% (“strongly” agree). Only 10% of respondents agreed strongly that “health insurance companies put the needs of their customers ahead of profits” while 43% disagreed strongly with this statement.

      When asked whether they can “trust their health insurance company to do the right thing for me,” 20% agreed strongly while 33% were of the opposite opinion.

      A desire to be better informed is driven in part by a lack of trust. Over half the respondents (55%) agreed strongly that they “would like to be better informed about how to evaluate quality of medical care from doctors and hospitals.”

      D. Coverage

      The population is divided between those who feel they have good health care coverage and are not worried about losing it and those who feel unprotected and vulnerable to losing their insurance.

      About one-quarter of the respondents strongly agreed that they worried about losing their coverage. A similar proportion agreed that their coverage “keeps changing and getting less.”

      Three out of every ten survey respondents strongly agreed that they were “not worried about their health insurance,” and that they “liked the way their medical insurance works.”

      While over one-third of people feel that their coverage is satisfactory they are troubled by what they see as an erosion of quality and inequities in care, access and coverage for the population at large.Table 4

	% Agree Completely	% Agree Somewhat	% Disagree Somewhat	% Disagree Completely
Health care insurance premiums have gone up and coverage has gone down.	44	27	14	9
I worry that I will not be able to afford quality medical care for a serious illness.	39	19	21	19
My medical plan makes good health care affordable.	38	33	13	12
I am worried about our medical insurance coverage.	30	18	25	25
I like the way our medical insurance works.	28	30	18	20
I am concerned that we could lose our health insurance coverage.	23	18	21	34
My medical insurance keeps changing and my coverage keeps getting less.	23	16	27	29
I don’t have much choice in doctors with the medical plan I have.	20	14	24	38
I feel I can trust my health insurance company to do the right thing for me.	20	29	26	33

      E. Perceived Role of Government

      Contrary to much of the rhetoric that surrounded the health care reform debate, the public sees an important role for government. Most people feel that the federal government, state and local government, and Congress can help make health care more affordable and raise the standards of quality.

      When asked if “the federal government can play an important role in making health care more affordable,” 50% agreed strongly and 22% agreed somewhat. When the role for federal government was described as “making health care better,” 43% agreed strongly. In answer to the question “government should stay out of health care altogether,” 28% were in “strong” agreement, 12% “somewhat”, and 29% were in “strong” disagreement.Table 5

	% Agree Completely	% Agree Somewhat	% Disagree Somewhat	% Disagree Completely
The federal government can play an important role in making health care more affordable.	50	22	10	16
The federal government can play an important role in making health care better.	43	26	11	18
Government should stay out of health care altogether.	28	12	28	29

      When given a list of possible roles for federal government in health care, assuming government would be involved in some way, the vast majority of people said “yes” to setting quality standards (86%), making sure everyone has access to quality medical care regardless of their ability to pay (84%), and stepping in when organizations do not meet standards (84%).

      Conclusion

      Concerns raised by those polled were system-wide, relating to quality of care delivered, cost of health care and accessibility of care for the average American. While those surveyed had confidence in their personal health care delivery, there was a notable lack of confidence in the health care system at large. These anxieties crossed gender, political, age, economic and regional boundaries. Additionally, there is a widely held perception that the future of health care does not look goodóthere is little confidence that the quality of health care delivery can be improved or that health care will be available to the average American. (Click here if you would like to read the press release about this survey.)