Many Americans who have experienced a serious illness or injury within the past 12 months are concerned about the financial costs of medical care, and struggle to ensure that their care is appropriate, according to a new poll released today by the Robert Wood Johnson Foundation (RWJF), NPR and Harvard School of Public Health. RWJF commissioned the poll to better understand Americans’ experiences and attitudes related to cost and quality of U.S. medical care.
A large majority of the general public (87%) thinks the cost of care is a serious problem for the country. In addition, about two-thirds of the general public (65%) believes the cost of care has gotten worse over the last five years.
In addition to surveying the general public, this poll also examined sick Americans’ experiences with and perceptions of the costs and quality of medical care over the last year. “Sick Americans” (27% of adults surveyed) are defined as those who said they had a serious illness, medical condition, injury, or disability requiring a lot of medical care or who had been hospitalized overnight in the past 12 months.
Many sick Americans reported having problems due to the cost of their own medical care. More than 40 percent say that the cost of their medical care over the last 12 months has caused a “very serious” (20%) or “somewhat serious” (23%) problem for their or their family’s finances. They also reported that high health care costs affected their ability to access care. One in six sick Americans say that there was a time in the past 12 months when they could not get the medical care they needed (17%). Among the sick Americans who could not receive care, 52 percent report that it was because they could not afford the needed care, and 24 percent say it was because their insurers would not pay for it. Lastly, about one in ten sick Americans (11%) report being turned away by a doctor or hospital for financial or insurance reasons at some time during the past 12 months when they tried to receive care.
The financial barriers to accessing care were more pronounced for sick people who were uninsured at some point in the last year. Forty percent of sick people who were uninsured at some time in the past 12 months say there was a time when they needed medical care but could not get it. In comparison, only 10 percent of those who were sick and who had health insurance for the entire 12 months said they could not access needed care.
“The rising cost of medical care affects everyone, but people who have been unwell know firsthand that an illness or injury can mean financial hardship or ruin,” said Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation. “These findings confirm how thinly individuals and families have been stretched. Having access to high-quality, affordable, comprehensive health coverage is crucial, but we know that even with insurance, rising health care costs leave many Americans with the burden of higher out-of-pocket spending."
The poll also finds nearly three out of five people in the general public believe the quality of health care is a serious problem for the country (57%). About four in five people said not being able to afford to get the tests or drugs they need is a major reason for quality problems (78%). Similarly, 64 percent of the general public says the influence of health insurance plans on treatment decisions is a major reason for quality problems.
Many of the sick respondents complained of quality of care problems during their treatment. Findings show:
- For instance, about one in eight sick Americans believe they were given the wrong diagnosis, treatment, or test (13%).
- About a quarter of sick Americans say that their condition was not well-managed (26%).
- A quarter of sick Americans report that a doctor, nurse, or other health professional did not provide all the needed information about their treatment or prescriptions (25%) – or they had to see multiple medical professionals, and no single doctor understood or kept track of all the different aspects of their medical issues and treatments (23%).
- Three in 10 hospitalized Americans say there was poor communication among the doctors, nurses and other health care professionals involved in their care (30%).
- About one in six sick Americans believe they did not get the tests they thought they needed (18%), while 15 percent of sick Americans surveyed were tested or treated for something they believed to be unnecessary.
- Nearly three-quarters of sick Americans say they want their doctor to spend time with them discussing other, broader health issues that might affect their long-term health (72%), as opposed to just talking about their specific medical problem (21%).
The poll, entitled Sick in America, was conducted by researchers at the Harvard School of Public Health, led by Robert J. Blendon, a noted expert in polling consumers on health care issues.
“Listening to the experiences of sick people provides a good barometer of what’s happening in health care in America.” said Blendon. “What is most striking is the significant number of people whose care has not been well-managed, and who have been turned away from care.”
The poll was designed and analyzed by a team of researchers at the Harvard School of Public Health under Blendon’s direction. Interviews were conducted via telephone by SSRS, an independent research company, with a representative national sample of 1,508 adults age 18 and over from March 5 to 25, 2012. The margin of error for the total sample is plus or minus 3.1 percentage points. The margin of error for the “sick” population is plus or minus 5.3 percentage points. Possible sources of non-sampling error include non-response bias, as well as question wording and ordering effects. Non-response in telephone surveys produces some known biases in survey-derived estimates because participation tends to vary for different subgroups of the population. To compensate for these known biases, sample data are weighted to the most recent Census data available from the Current Population Survey for gender, age, race, education, region and number of adults in the household. Other techniques, including random-digit dialing, replicate subsamples, and systematic respondent selection within households, are used to ensure that the sample is representative.
The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime.
Harvard School of Public Health is dedicated to advancing the public’s health through learning, discovery and communication. More than 400 faculty members are engaged in teaching and training the 1,000-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children’s health to quality of care measurement; from health care management to international health and human rights. For more information on the school, visit www.hsph.harvard.edu.
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