How Confident are Consumers about Their Health Care?

Using the University of Michigan's Surveys of Consumers to measure health care consumer confidence

Field of Work: Health consumer confidence

Problem Synopsis: With the economy in recession and unemployment rates high, many Americans were concerned about maintaining their access to stable and affordable health insurance coverage. Although previous surveys had attempted to measure health care insecurity, no work to track this information over time was underway when this grant was made.

Gathering data about health care confidence gave RWJF credible newsworthy information it could use on an ongoing basis to help inform the debate among policy-makers on health care reform leading up to and following passage of the Affordable Care Act in March 2010.

Synopsis of the Work: RWJF and the State Health Access Data Assistance Center (SHADAC) at the University of Minnesota developed survey questions to measure consumer confidence in their ability to afford health care. The University of Michigan's Survey Research Center tested, refined and fielded those questions from April 2009 through March 2011 as part of its monthly surveys of consumers.

SHADAC analyzed the data, which became the basis of the RWJF Health Care Public Perception Index. RWJF published monthly results and also produced reports that examined trends over time.

Key Findings/Results: Fluctuations in health care consumer confidence were relatively modest during the two years in which surveys were conducted, despite the ongoing health reform debate. With baseline confidence levels set at 100 points in the spring of 2009, confidence peaked in October 2009 (at 104.4 points) and reached its lowest point in May 2010 (at 95.8 points).

The surveys documented persistent disparities in consumer confidence by health insurance status and income. From January through December 2010:

  • Confidence levels among those with insurance were consistently above 100 while those without insurance had confidence levels ranging from 47.5 to 69 points. The gap between the two groups averaged 47 points.
  • Confidence levels among those with higher incomes (in the top one-third income category) ranged from 89.9 to 104.7, compared to a range from 71.5 to 86.3 among those with lower incomes (in the bottom one-third). The gap averaged 35 points.

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