Volume Vol. 26, No. 11
Although battered by rising health care costs, a majority of Americans remain well satisfied with the quality of the care personally received in the last two years, the 2005 Health Confidence Survey (HCS) shows. But Americans tend to view cost as one of the least important factors when considering health care quality, the survey suggests. <A href="http://www.ebri.org/pdf/PR_718_18Oct05.pdf">Press release</A>
• The HCS: The 2005 Health Confidence Survey (HCS) represents the eighth wave of an annual survey to assess the attitudes of the American public regarding the health care system in the United States. It is co-sponsored by the Employee Benefit Research Institute (EBRI), a private, nonprofit, nonpartisan public policy research organization, and Mathew Greenwald & Associates, Inc., a Washington, DC-based market research firm, and funded by grants from 13 private organizations.
• Cost not considered part of quality: Findings from the 2005 HCS appear to confirm the notion that Americans tend to view cost as one of the least important factors when considering health care quality. In particular, they are less likely to see a relationship between quality and the comparative costs of health care providers.
--> While almost all Americans consider the characteristics of their own health care providers to be very important when judging the quality of health care, considerably fewer indicate that information on the cost of alternative providers is very important (63 percent).
--> A majority of Americans feel that increased access to information about the effectiveness of treatment options (65 percent) and the quality of health care providers (59 percent) would improve the quality of the health care they receive. They are less likely to say that more information about the actual cost of services would improve quality (28 percent).
• But cost increases are affecting use: At the same time, many Americans say that health care cost increases have affected the way they use health care and their financial well-being.
--> Insured Americans who have experienced an increase in health care costs in the past year indicate they have changed the way they use health care. Some reported changes in behavior are positive, such as choosing generic drugs (79 percent) or taking better care of themselves (71 per-cent). Others, such as not taking prescribed medications (21 percent), could have long-term negative consequences.
• Poor most affected by higher costs: The increasing cost of health care has disproportionately affected lower-income Americans. They are less likely to express satisfaction with health care and more likely to report shifting resources or changing health care usage to cope with the cost increases they have experienced.
• Care rated highly, costs are not: More than half of Americans are extremely or very satisfied with the quality of the health care they have received in the past two years, but only about one-quarter are satisfied with the cost of coverage or the costs of health care services not covered by insurance.
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A their own of health care would im ericans ar health plan are g majority ue em e e re xtrport the ploy emely ment-based hea (15 percent) or e py nerally rove if the have sought i favo y rable and had increas lth coverage above the ve nfo ryr m (42 percent) satisfied with t ation from have re ed accem ss to infor their provi ained actual dollar relatively mder ation. Tw (57 percent) t he qualit stable since the am o-thirds say yount that of o the help t m edical hem Increasing health care costs continue to be strongly related to dissatisfaction with the health care Figure 9 E B RI Figure 1 EBRI Notes i e that the quality inception mploy care they make d ers pay of the HCS. Most A ecisio toward the care. When e of the m have received in the past two ns in the pas edical care they meri t six cans receive m m with health insu onths, ployy ed A ears, a sli and al would im merm icans with rance coverage continue ght increase ove o prove if t st half have health coverage are a hey had access to asked r 2004 (52 pe their to be satisfied with t pharm mrcent). At the sa o srked whether they e information on acist for inform heir me ti ation me, system, and those who have experienced increased costs within the past year are more likely than those Changes in Health Care Usage Resulting From Cost Increases, Characteristics Considered When Judging Cost and Quality Not Linked the effectiven would prefer current healt less than (48 percent). Half of A hess of tr $6,7 benefits. More than half are 3 i 00 i n 10 are eat n emplo ment options (65 percent). extr y mm e ee rmely icans report nt-based health ins (7 percent) or extr they eme recentl lySix in 10 believe quality (17 percent in 200 uve rance coverage or an ad ryy (21 percent) obtained health care information fro satisfi 5) or w very ditional ed wit ould im (37 percen h the cost of $6,7 prove if they 00 in t) satisfied m taxable their health their friends had who have not to be dissatisfied their current health plan and other aspects of the health care. Among Those With Health Coverage, by Household Income, 2005 E MP LO YE E Quality of Health Care Received, 2005 by Ruth Helman, Mathew Greenwald & Associates, and income, 8 in access to with their current plan, and m insurance, and even fewer are satisfie or relatives to m mo 10 choose t re information on the ake de he e om reci ploy than one-third are sions (49 pe quality of health ment-based heal rcent). Pe d with somewhat car th c the c e providers (59 percent). In addition, 47 overage ( ople are less osts of health satisfied (35 percent). Onl 80 percent). Two-thirds likely care s to ervices have used other sources of not covered by insurance y 1 in would prefer 10 sa percent y they A majority of Americans with health coverage have experienced health care cost increases in the past EBRI Employee Benefit Re search Institute Notes (ISSN 1085 Notes -4452) is publisheVery d monthly b Somewhat y the Employee BenefiNot t Research Household Income PauB l F E N ronstin, E E F I T BRI say em are ploy Institute, 212 it woul not too inform ment- d i (6 percent) or b ation. m 1 K ased coverage to an increase in income prove if they had m Street, NW, Suit One-third or less not at all e 600, Washingt o satisfied (4 percent). Moreover, re responsib say they on, DC 2003 have used ility f 7-18 or their own even if 96, at $300 pe independent Internet an em medical decisions (Figure r year or i satiploy sfactio s included er paid $10,000 toward the n has re sites (7 percent as pa (34 percent), their health covered fro rt of a me 2). extremel mbership m t y,h 14 per- e year. More than half say the dollar amount they contribute toward their healt Important Important h insurance pImportant remium has Figure 7 Less Than $35,000– $75,000 or subscription. Periodicals postage rate paid in Washington, DC, and additional mailing offices. POSTMASTER: Send address coverage (66 slight dip Am insurance com eri m cans ar easured in 200 percent) (Figure 11). Further e less likely to think The sk pany ill, ex ( 4, when 15 31 p perienc ercent), newspapers or periodi e, and tr pethat increas rcent reported be aining more, th of youred infor is doc preference fo tors ing mnot t ation about cals (28 p oo or not at all r e 97% m ploy ecost or cha rcent), television or radio ment3% satisfied with -based coverage e cent nges in very <0.5% how ). In addit their health medica m (24 percent), ergesl ion, increased (55 percent), and about half report the amounts they pay for prescription drugs (51 percent) and R Total $35,000 $74,999 More E S E AR C H Selected Health Care Satisfaction Statistics, changes to: EBRI Notes, 2121 K Street, NW, Suite 600, Washington, DC 20037-1896. Copyright 2005 by Employee Benefit regardless of plan (Figure care is paid for would and prescription drug com 5). demographic characte Your pro impact qualit vider’s communic panies (15 percent) in the past six ristic y. I as. n tion fact, a m skills and willingne ajority isndicate there would s months. be no Am change in ericans c qualit ontinue y if to be doctor visits (48 percent) have increa Overview sed. In addition, 4 in 10 have experienced an increase in their health Choose generic drugs when Research Institute. All rights reserved, Vol. 26, no. 11. by Household Income, 2005 I N S TI TU TE ® November 2005, Vol. 26, No. 11 to listen and explain thoroughly 90 9 1 they knew the full price of Currently only a mavailable 79% the health c inority of people seek inform are services they receive, not just what t ation from82% sources other than 78% heym pa ore likely y (63 percent) or if health care providers, 75% than in 1998 to insurance deductible within the past Findin gs from the 2005 Health Confidence Surv year (41 percent). Half indicate other out-of-pocket costs hav ey (HCS) appear to confirm the notion that e Total Household Income The deg Try to taree of ke bette corntrol you h care of ave in decisions made A they paid for mericans te friends, and nd to more of their health care directly view cost relatives. as one of the least i Yet half of A , ra m meric ther port Figure 5 Figure 11 ans than thro ant say factors they ugh w would be an insurance co hen considering health care quality extrm em say pany e the ly or (5 y are 1 ve percent). ry not t likely oo . In or to use not at increased (50 percent) (Figure 8). Those with employment-based coverage and those who report their Less than $35,000– $75,000 or The Employee Benefit Research Institute (EBRI) was founded in 1978. Its mission is to yourself 71 82 65 58 regarding your health care 90 9 <0.5 information about doctors’ quality of care and specia $35,000 $74,999 lty areas (54 percent) or hospitals’ more all satisfied about costs quality of care health status has gotten worse over the past five particular, they are less likely Satisfaction to see a relationship With Curren years are between qual t Health Plan, more likel ity y to report these cost incre and the com 1998–2005 parative costs of health ases. contribute to, to encourage, and to enhance the development of sound employee benefit Talk to the Prefer doctor more ence for Employer carefully -Provided Health Cover ag e vs. The timeliness of getting care and treatments 89 10 <0.5 Rating of health and specializations (49 pe care syst em in America toda rcent) to help them y make health care d ecisions if it were (Figure 6). available through t he care providers. Health Care Decisions and Information 2005 Health Confidence Survey: CHECK OUT EBRI’S WEB SITE! programs and sound public policy through objective research and education. EBRI is the only about treatment options Increased Taxable Income, Among Employed With The ease of getting care and treatments 85 14 <0.5 1998 1999 2000 2001 2002 2003 2004 2005 mail, byExcellent 3% telephone, or on the Internet. Roughl2% y 4 in 10 each indicate they 3% 3% would be willing to use price Not surprisingly, there is At the same time, many Americans say that health care cost increases have affected the way they use Although many say increased access t private, nonprofoi inform t, nonpartisan atio, n would incr Washington, DC-b ease health care quality ased organization committed exclusivel , the large y to Who we are and costs 57 70 49 48 Health Coverage, by Household Income, 2005 Extremely Satisfi The abilityed of y16% our doctor or15% 14% 12% hospital to access your 13% 14% 16% 17% Very good public poli 11 cy research and 7 education on 13 econom19 ic security and employee benefit issues. comparison information (43 percent) or information about the level of persona a considerable difference in lized care offered (40 per- health care an majority Cost and Quality Not Linked of Am d their financ ericans already ial well-being. feel they are able to get the information the , p. y need 2 to make good decisions Figure 8 Go to the doctor only for more Very Satisfied 36 38 36 39 39 36 31 complete medical records 81 Household Inco 16 me 2 37 EBRI’s member EBRI’s W ship includes a eb site is easy to use and packed cross-section of pension funds; businesses; trade associations; Good 22 18 28 20 cent). serious conditions or opinion about health care about health care (86 percent). Nearly The 2005 HCS represents the eighth wave of an 8 in 10 are extrem annual survey ely or very to assess the attit confident theyudes of the American know enough to ask Somewhat Satisfied 35 36 38 35 34 41 36 Changes in Health Care Costs, Among The personal malabor un nner, sen ions; h sitivity, ealth and re carspe e prov ct yo iders and insur u Less Tha e rs; government org n $35,000– anizations; $75,000 or and service firms. 35 Fair 33 symptoms 54 36 30 62 35 54 38 between lower-income Am- public regarding the health care system in the United States. Among its major findings: their doctor questions about their health care (78 percent), and 7 in 10 are confident they know enough to with useful information! Not Too Satisfied 8 6 7 7 Total $35,000 7 7 9 $74,999 More Those With Health Coverage, 2005 receive from health care providers 80 19 1 6 Poor 30 Delay going to the doctor 36 40 27 49 22 37 29 ericans and those with higher choose their own doctors or question their doctor about the appropriateness of different treatment options • Executive Summary: While almost all Americans consider the characteristics of their own health care providers to be Don’t Not At All Satisfied 3 EBRI’s work advances knowledge and unders 3 4 3 6 2 6 tanding of employee benefits and their If employers pay $6,700 per employee each 4 Report being co The cost Switch to o vered byyou p some form of health insu ver-th ay for health e-counter dcare a rugs nd rance 33 39 31 24 Stayed the Know/ importance to the nation’s economy among policymakers, the news income. media, and Amthe public. It ericans with (69 percent e verDon’t y imKnow/Refu ach). How portant when judging the quality sed ever, the perc2 en2 1 2 tages of Am of heal ericans Figure 4 extr th care, con emely1 or s ver iderably<0.5 y confident that they fewer indicate that 2 know year for health insurance coverage 1 Yes 86 Save additional prescription dmoney in a rugs 76 94 79 99 17 4 Increased Same Decreased Refused Look for these special features: does this by conducting and publishing policy research, analysis, and special reports on household income under Employer-provided Rco avera tingge of Health Care Syst80 86 75 em in America Today, 1998–200581 enough to pur inform • cThe HCS: ation on the cost of hase health i Tn hsurance (41 percent) or l e 2005 Heal alternative pr th Confidenc oviders is very im ong-term car e Survey (H portant (63 percent). e CS) represent insurance (32 percent) ar s the eighth e wave of an annual much lower Source: Employee Benefi flexible spending t Research Instit account ute and Mathew Greenwald & Associates, In c., 1998–2005 Heal th Confidence Surveys. No 14 The independent information you have ab24 out the 6 1 employee benefits issues; holding educational briefings for EBRI members, congressional and Additional taxable income 14 10 22 11 W hat we do $35,000 are less than half as (Figure 3) and are similar to the percentage expressing confidence in being able to invest their retirement survey to assess the attitu (among those employed) des of the American pub 31 39 lic regarding 25 the health care sy 32 stem in the • Satisfaction with A majority of Am current health in ericans surance plan feel that increased access to informati on about the effectiveness of quality of care provided by your doctor or hospital 74 22 2 40% The dollar amount you contribute toward federal agency staff, and the news media; and sponsoring public opinion surveys on employee • EBRI’s entire library of research publications starts at Don’t know/Refused 5 4 3 7 Look for cheaper health likely as those with income savings on their own (40 p United States. It is co-sponsored by ercent). the Employee Benefit Research Institute (EBRI), a private, treatment options (65 per Extremely satisfied cent) and the quality 17 17 of health care providers (59 percent) would 16 17 your The information health insurance p you ha benefit issues. remium ve about t EBRI’s Ed he cost of 55% ucation and Re 36% sear ch Fund 4% (EBRI-ERF) performs 5% the charitable, 1998 1999 2000 2001 2002 2003 2004 2005 the main W Figure 6 eb page. Click on EBRI Issue Briefs and insurance 28 39 20 20 of at least $75,000 to Very satisfied 37 33 38 47 If employers pa nonprofit, nonpartisan public polic y $10,000 pe educar emp tional, and loyee scientif y research orga ic functions of the Instit nization, and Ma ute. EBRI-ERF thew Greenwald & Associ is a tax-exempt organization ates, improve the The amount alternative do quality you pay fo of the health cto r pre rs, ho scription spitals, care or treatments they recei ve. They 63 are less likely 31 to say 5 that more Look for less expensive health each year for health insurance co EBRI Notes verage for our in-depth and nonpartisan periodicals. 35% Somewhat satisfied supported b 35 y contributions 35 and grants. 36 29 describe the health care drugs, such as co-payments or informInc., a Washington, DC-based ation about the actual cost of services would im market research prove quality (28 firm, and funded by percent). grants from 13 private Satisfaction With Selected Aspects of Health Care Source: Employee Benefit Research Institute and Mathew Greenwald & Associates, Inc., 2005 Health Confidence care providers 27 35 20 21 Employer-provided coverage 66 74 67 a 61 Not too satisfied 6 6 7 5 co-insurance 51 41 5 3 system as excellent or very organizations. Survey. Received in Past Two Years, 1998–2005 • While most Americans are confident that they have enough knowledge to discuss aspects of their Not take your prescribed EBRI Issue Briefs are periodicals providing expert evaluations of employee benefit issues and Additional taxable income • To get answers to many frequently asked questions about 29 24 28 32 Not at all satisfied 4 7 3 2 The amount you pay for doctor visits, Figure 3 good (9 percent vs. 23 health care with their doctor, only a minority are extremely or very confident they know enough medication 21 trends, as well as critical analyses of emplo33 yee benefit po14 licies and proposals. 14 EBRI Notes is a 30% • Cost not considered part of quality: Don’t know/Refused Findings from 5 2 6 the 2005 HCS appear to confirm6 the notion Satisfaction with quality of medical care received such as co-payments or co-insurance 48 46 2 3 Confidence in Knowing E employee bene? nough to Make Various Health Care Decisions, 2005 ts, click on Bene? t FAQs. Women are more likely than men to consider Quality of Me mdical Care Re any of these characteristi ceived percent). If t cs very im hey have hea portant when lth to purchase health insurance on their ow Source: Employee Benefitmonthly Research period Institute ical providing cu and Ma n (41 thew percent). Greenwald rrent information on a variety & Associates, Inc., 2005 Health Con of employ fidence ee benefit topics. in past two years that A Source: Employee mericans tend to view cost Benefit Research Institute as o and Ma ne of the lea thew Greenwalds & t i Associates, Inc mportant factors ., 2005 Health Con when considering fidence health Your health insurance deductible 41 52 2 5 1998 1999 2000 2001 2002 2003 2004 2005 Survey. judging care. In particular, wo EBRI’s m Pension Investment Report en are more likely to say provides detailed finan the following are cial in ve coverage (an ry fo im rmation on the universe of portant: d 75 percent the degree of of Survey. Our • More than half of Americans are extremely or very satisfied with the quality of the health care Your other out-of-pocket health care quality. In particular, they are less likely to see a relationship between quality and the Extremely satisfied 15 14 18 14 Extremely Satisfied 15% • EBRI’ 13% 12% 13% s reliable health and retirement surveys are just a 13% 15% 15% defined benefit, defined contribution, and 401(k) plans. EBRI Fundamentals of 14% Employee control the Extremel y have in decision-m y Confident Very Confident aking (92 percent vs Somewhat Confi . 88 dentpercent), their provide Not Too Confidentthose with inco Not At All Confident r’s communimcation skills e less than 25% they have received in the past two years (57 percent), but only about one-quarter are satisfied care costs 50 46 2 2 Very satisfied 42 38 43 49 Very Sati cosfied mparative costs of health care providers. 37 35 37 40 39 37 38 42 About the 2005 HCS Benefit Programs offers a straightforward, basic explanation of employee benefit programs in click away through the topic boxes at the top of the page. and willingness to listen and explain (93 percent vs. 86 percent), the ease of getting care and treat $35,000 have it commpared ents publications Figure 10 with the cos Somewhat satisfi t of coverage (28 percent) or the costs of health care ed 31 35 27 33 services not covered by Somewhat Satisfied 30 31 35 32 34 31 31 31 Source: Employee Benefi the priv t Research ate and p Institute ublic sectors. and Mathew Greenwald EBRI Databook on Employee Ben & Associates, Inc., 2005 Health efits is a statistical reference These findings are part of the eighth annual Health Confidence Survey (HCS), a survey that examines While almost all Americans consider the characteristics of their own health care providers to (91 percent vs. 78 percent), the ability of their doctor or hospital to access with virtually complete m all of those edical records Confidence Survey. Not too satisfied volume on 3 employee benef 3 it programs and work 6 force 1 related issues. insurance (21 percent). Not Too Satisfied 4 6 5 4 5 5 5 3 Ask doctor questions about health and Shifts in Resources Resulting From Cost Increases, Among 20% a broad spectrum of health care issues, • Instantly get e-mail noti? including Americans’ satisfaction with health care toda cations of the latest EBRI data, y, their be very important when 32% judging the quality of hea 47%lth care, considerably19% fewer indicate that (86 percent vs. 75 percent), and the personal manner, sensitivity, and respect they with income at l receive (86 percent vs. east health car Not at all satisfie e d 5 7 4 1 Not At All Satisfied 2 3 4 2 3 3 4 5 • Insured Americans who have experienced an increase in health care costs in the past year indicate Those With Health Coverage, by Household Income, 2005 confidence in the future of the health care system and the Medicare program, and their attitudes toward surveys, publications, and meetings and seminars by information on the cost of alternative providers is very important (63 percent). Contact EBRI Publications, (202) 659-0670; fax publication orders to (202) 775-6312. Satisfaction with 74 percent). cost of health insurance in In addition, women are more apt than men to report independent $75,000), t information about qualit hey are less likely y Don’t Know/Refused 1 1 1 <0.5 1 1 1 <0.5 they have changed the way they use health care. Some reported changes in behavior are positive, Household Income health care reform. The survey was conducted within the United States between June 21 and August 6, past two years Subscriptions to EBRI Issue Briefs are included as part of EBRI membership, or as part of a of care (78 percent vs. 70 Not Applicable 11 percent) and clicking on the Sign Up for Updates box at the top of our 11 cost (66 percent vs. 59 percent) is 6 9 6 8 8 ver to report satisfaction wi y important. Those age 65 3 th Those who have experienced cost incr 15% A majority of Americans feel that increas eases have comped ensacc ated ess to information about the by making changes in the way effectiveness they of such as choosing generic drugs (79 percent) or taking better care of themselves (71 percent). Less Than $35,000– $75,000 or $199 annual subscription to EBRI Notes and EBRI Issue Briefs. Individual copies are available 2005, through 20-minute telephone interviews with 1,003 indi 42% viduals ages 21 and older. Random digit Choose your own doctors 27% 24% and older are also Extremely satisfied more likely than 7 younger Am 6 ericans to consi 9 der 7 many of these char their plan (50 percent acteristics vevs. ry use health care. Some of these changes home page. could be regarded as positive, but others could result in negative Cost of Health Insurance treatment options (65 percent) and the quality of health care providers (59 percent) would Total $35,000 $74,999 More Others, such as not taking prescribed medications with prepayment for $25 each (for printed cop (21 percent), ies) or for $7.50 (as an e-m could have long-term ailed negative electronic file) Orders/ dialing was used to obtain a representative cross section of the U.S. population. Interview quotas were 1998 1999 2000 2001 2002 2003 2004 2005 Very satisfied 21 18 22 19 important. 64 percent extremely or very consequences. Eight in 10 say the increased cost of health care has led them to use generic drugs when improve the Decease your co quality by ntributions to calling EBRI or from of the health care www. they ebri. recei org. Change of Address: ve. They are EB less likely RI, 2121 K Street, NW, Suite to say that more consequences. established by sex of resp 10% ondent and employment status, and the data were weighted by gender, age, Extremel Somewhat satisfi y Satisfied ed 12% 32 7% 7% 30 10% 33 9% 6% 9% 39 7% satisfied). Similarly, they are available (79 percent) and 7 in other saving 600, Washingto 10 rep s ort then, DC 20037, (202) 659-0670; y now 45% try to take better care of 52% fax number, (202) 775-6 41% themselves ( 38% 71 percent). 312; e-mail: information about the actual cost of services would improve quality (28 percent). Question your doctor about the • The increasing cost of health care has disproportionately affected lower-income Americans. There’s lots more! subscriptions Very Satisfied 17 27%17 15 19 42% 17 16 16 26% 21 education, and em Not too ploy satisfied ment to reflect the actual propor 14 14 tions in t14 he populatio 17 n. Publications Subscriptions@ebri.org. Membership Information: Inquiries regarding EBRI Have difficulty paying for appropriateness of different treatments less likely to be satisfied Almost 6 in 10 say cost increases have led them to talk to the doctor more carefully about treatment Figure 2 TheySomewhat are lessSatisfied likely to express 29 30 29 28 satisfaction with health care 27 24 26 and more likely to report shifting 32 • Not at all satisfie But cost incrd eases are affecting use: 19 21 At the same ti 17 me, many 18 Americans say that health care cost membership and/or contributions to EBRI-ERF should be directed to EBRI President/ASEC In theory, the weighted sample of 1,003 yields a statistical precision of plus or minus 3 percentage other bills 34 51 25 18 Visit EBRI on-line today: www.ebri.org with the quality of the options and costs (57 percent); fewer say they now go to the doctor only for more serious conditions or 5% Impact of Changes on the Quality of the Health Care System Not Too Satisfied 16 17 18 15 15 19 11 14 Satisfaction with resources or c costs of hanging health care usage t health care services not o cope with the cost increa ses they have experienced. increases have affect Chairman Dallas ed the way Salisbur they use hea y at the lth care a above address, ( nd their financial well-bein 202) 659-0670; e-mail: salisbur g. email@example.com points (with 95 percent confidence) of what the resu Use up all or most of your lts would be i f the entire populatio n age 21 and o lder medical care received symptoms (54 percent). Four in 10 have delayed going to the doctor (40 percent). Less frequent covered by insurance in past two years Purchase health insurance on your Don’t know/ Not At All Satisfied 13 13 19 15 21 21 23 19 No savings 15% 26% 29 45 31% 21 12% 8 14% were surveyed with complete accuracy. However, there are other possible sources of error in all surveys ow n Insured Americans who have experienced an increase in health care costs in the past year (51 percent vs. 63 percent) responses to the increase in health care costs include switching to over-the-counter drugs (33 percent), Editorial BDon’t oar Know/Refu d: Dallas L. Salisbury, publisher; Steve Blakely, sed 1 2 1 2 editor. Any views expr Better essed in t2 1 1 Difference Worse his publication and those of th1 e author Refuse s sh d ould Extremel Decrease y satisfied your contributions 7 to a 8 9 4 Health Care and Quality that may be more serious than theoretical calculations of sampling error. These include refusals to be 0% not be ascribed to the officers, indicate they trust have changed the way ees, members, or other sponsors of the E they use health mploye ca e Benefit Research re. Some repoInstitute, the EBRI Educ rted changes in behavior a ation and re Not Applicable If you had access to mo12 re information on the 15 9 12 8 12 and the costs of health care 13 6 saving additional money in a flexible spending account (31 percent of those employed), looking for Very satisfied retirement plan, such as a 14 11 13 22 Americans want qualit Excellent y health care, but Very Goowhat, preci d sely, constitutes Good “quality care”? The Fair vast majority Poor Research Fund, or their staffs. Nothing herein is to be construed as an attempt to aid or hinder the adoption of any pending legislation, regulation, interviewed and other forms of nonresponse, the effects of question wording and question order, effectiveness of t positive, such as choosing reatment options generic drugs (79 percent) 65% or taking bett 32% er care of themselves (71 1% 2% per- services not covered by cheaper health insurance (28 percent), and looking for less expensive h Health Costs Not Covered by In ealth care providers (27 percent). surance Figure out how to Somewhat satisfi invest your ed 30 27 32 29 401(k), 403(b), or 457 plan, or interpretative rule, or as legal, accounting, actuarial, or other such professional advice. 13% 27% 33% 12% 13% of Americans say that factors relating to their health care provider are very important when judging the interviewer bias, and scre If you had access to mo ening. While re information on the quality attempts are made to minimize these factors, it is im possible to retirement savings on your own cent). Others, such as n 1998 1999 2000 2001 ot taking prescribed medications (21 percent), 2002 2003 2004 could have long- 2005 term insurance (19 percent vs. Most alar mingly Not too , alm satisfied oor an IRA st a quarter (2 in 10) report 16 16 26 cost increase 15 27 s have cause 20 32 d them to not take their 17 Source: Employee Benefit Research Institute and Mathew Greenwald & Associates, Inc., 1998–2005 Health Confidence Surveys. of health care providers, such as doctors quality of the health care they receive. Virtually all consider the skill, experience, and training of their quantify the errors that may result from them. Extremely Satisfied 7% 5% 5% 7% 5% 4% 6% 7% EBRI Notes is registered in the U.S. Patent and Trademark Office. ISSN: 1085 -4452 1085 -4452/90 $ .50+.50 negative consequences. Not at all satisfie Have difficul d ty paying for ba 22 sic 25 20 14 27 percent) (Figure 7). prescribed medication (21 percent) (Figure 9). Again, lower-income Americans and those in poorer and hospitals 59 38 1 2 doctors is very important (97 percent), 9 in 10 indicate the provider’s communication skills and The HCS is Very Satisfied co-sponsored b13 y the Em15 14 17 ployee Benefit Research Institute (EBRI), a private, nonprofit 15 14 13 14 , necessities, like food, heat, Other groups are also health are more likely to report making each of these changes. Source: Employee If you had mor Benefi et Research responsibility Institu for te your and Ma own thew Greenwald & Associates, Inc ., 2005 Health • Poor most affected by higher costs: The increasing cost of health care has disproportionately Buy long-term care insurance 12% 20% 37% 13% 16% willingness to listen and explain are very Somewhat Satisfied 27 28 28 28 important (90 percent), and 8 in 26 25 26 10 think the personal manner, 30 Did you read this as a pass-along? Stay ahead of employee benefit issues with your own subscription to EBRI nonpartisan public policy research and housing organization, 24 and Mathew Greenwal 38 15 d & Associ7 ates, Inc., a Confidence Surveys. Satisfaction With Health Care medical decisions 47 45 less likely 4 than their counter- 4 Increased health care costs have also affected household finances, and many of those who have affected lower-income Americans. They are less likely to express satisfaction with health care Not Too Satisfied 16 18 18 15 18 21 15 16 Notes for only $89/year electronically e-mailed to you or $199/year printed and mailed. For more information sensitivity, and respect they receive Borrow money from their health c 18 are provider a 29 re very important (80 13 percent). Other 6 Washington, DC-based market research firm. The 2005 HCS data collection was funded by grants from If you knew the full price of your health care Regardless of how they define quality, few Americans give the health care system today high marks. parts to rate health care highly. These include those in poorer health, those who have experienced a gap experienced cost increases have coped by reducing the amount they save or by depleting their savings. and more likely to report shifting resources or changing health care usage to cope with the cost aboNot ut subscri At All Satisfied ptions, visit our 18 Web site at 15 22 18 www.ebri.org or complete the for23 23 26 m below and return it to EBRI. 22 characteristics that a large majority of Americans consider very important in judging health care quality Source: Employee 0% Benefi 10% t Research 20% Institu 30% te and Ma 40% thew Greenwald 50% & Associates, Inc 60% 70%., 2005 80% Health Con 90% fidence 100% 13 private organizations. services, treatme Staffing was donated b nts, and prescription drugs, y E not BRI and Greenwald & Associates. HCS materials and Only 3 percent of Americans say it is excellent and just 1 in 10 say it is very good (11 percent). Instead, in coverage in the past year, and those without drug coverage. In addition, Americans with privately One-quarter report they have decreased their contributions to a retirement plan as a result of the increased Don’t Know/Refu increase Survey. sed s they have experienced. 3 2 2 2 4 2 2 2 just what you pay 28 63 6 3 are the degree of control Name they have in decisions regarding health care (90 percent), the t imeliness of can be accessed at the EBRI Web site: www.ebri.org/hcs. more than 2 in 10 describe it as good (22 percent), one-third say it is fair (33 percent), and another 3 in 10 purchased coverage (9 percent) are less likely than those with employment-based (15 percent) or cost of health care (26 percent), and alm Not Applicable 16 17 11 13 ost half report they have decreased their contributi 8 11 13 ons to other 10 If you paid for more of your health care costs directly getting care and treatments (89 percent), the ease of getting care and treat Organiz • a Care rated highly, costs are not: tion More than half of Americ ments ( ans a 85 percent), the ability re extremely or very satisfied of Underwriters of the 2005 HCS include: AARP; Blue Cross and Blue Shield Association; Buck Source: Employee Benefit Research Institute and Mathew Greenwald & Associates, Inc., 2005 Health Confidence Survey. say it is poor (30 percent). In fact, the HCS has found that the percentage of Americans rating the health government (14 percent) coverage to describe the health care system as excellent or very good. savings as a result of the increas instead of through an insu es (45 percent). One- rance company quarter say 16 they have 51 had difficulty pa 28 ying for basic 5 (34 percent). Three in 10 indicate they have used Source: Employee Benefit Research Institute and Mathew Greenwald & Associates, In up all or cm ., 1998– ost of their savings (29 percent), and 18 2005 Health Confidence Surveys. the doctor or hospital to access their complete medical records (81 percent), the cost they pay for health A addresswith the quality of the health care they have received in the past two years, but onl y about one- Consultants; The Commonwealth Fund; Deere & Company; Fidelity Employer Services Company; IBM; care sy Statistics stefor m 1998 as –2004 were fair or p recalcu oor has been gradually lated and may not agree wi increasing over tim th previously published data. e, rising from 4 in 10 An intervening question screenin in 1998 (49 per- g necessities, like food, Source: Employee heat, and housing (24 Benefit Research Institute and Ma percent) thew Greenwald , while one- & Associates, Inc third report ., 2005 di Health Con fficulty pa fidence yi Survey. ng other bills percent have borrowed money. Not surprisingly, those with household income of less than $35,000 are care and prescription dr out respondents who repor ugs (79 percent), and in ted these questions were not ap depe plicable was omi ndent inf tte od fr rmation about om the 2005 HCS. th These r e qualit esponde y of nts have care provided been quarter are satisfied with the cost of coverage or the costs of health care services not covered by National Rural Electric Co City/State/ZIP operative Association; Paci fic Life; Pfizer, Inc.; Principal Financial Group; cent) to almost two-thirds in 2005 (63 percent) (Figure 4). especially added to the likely “not applicable” ca to have resorted to these str tegory to achieve rough compatibili ategies t ty with 20 o0 cope with health care 5 data. cost increases (Figure 10). by their doctor or hospital (74 percent). Though s insurance. till a majority, considerably fewer say information Procter and Gamble; and RCM Co. Mail to: EBRI, 2121 K Street, NW, Suite 600, Washington, DC 20037 or Fax to: (202) 775-6312 Poor health also appears to increase the likelihood of making these adjustments. about the cost of alternative doctors, hospitals, or treatments (63 percent) are very important (Figure 1). A monthly publication from the EBRI Education and Research Fund © 2005 EBRI © 2005, Employee Benefit Research Institute -Education and Research Fund. All rights reserved. www.eb www.eb www.eb www.eb www.eb www.eb www.eb www.eb www.eb www.ebri.o ri.or ri.or ri.or ri.or ri.org g g g g ri.or ri.or ri.or ri.org g g g rg 10 2 8 6 4 3 9 5 7