More Americans Dissatisfied With Health Care and Lack Confidence About the Future of the System Concerns strongest among women and the ill

November 3, 2000
Danny Devine
(202) 775-6308, EBRI
Paul Fronstin
(202) 775-6352, EBRI

WASHINGTON, DC--Americans are becoming more critical about many aspects of the health care system, are growing more confused about managed care, and are more concerned about escalating medical costs, according to the results of a new survey by the nonpartisan Employee Benefit Research Institute (EBRI).

The findings are from EBRI's 2000 Health Confidence Survey (HCS), which examines Americans' attitudes toward aspects of the health care today and their confidence in managed care, Medicare, and the system's future. The survey was sponsored by EBRI, the Consumer Health Education Council (CHEC), and Mathew Greenwald & Associates. It is the third such annual survey.

Although managed care has been around for a number of years and the vast majority of Americans with health insurance are enrolled in some type of managed care program, respondents tend to be less likely than in previous years to say they are familiar with managed care. The percentage describing themselves to be somewhat familiar with managed care has dropped from 29 percent in 1998 to 23 percent in 2000, the HCS found. At the same time, the percentage saying they are not at all familiar with it has increased from 28 percent to 39 percent.

The HCS found that Americans' views of the health delivery and financing system are complex. These concerns are accompanied by continued concern about escalating health care costs and a lack of confidence about the future of the health care system, particularly among women and those in poorer health. At the same time, respondents tend to believe that their employer is better able than they are to choose a health insurance plan.

Another area of concern is that several groups tend to be less satisfied and less confident about the American health care system. These include individuals in managed care, those in poorer health, and women.

“This HCS clearly shows a need for more complete education of the public about the current health care system,” said EBRI President Dallas Salisbury. “These are significant policy challenges, and the details of the 2000 HCS will help focus the energies of employers, health insurers, the media, and policymakers in their efforts to improve consumers' understanding of the often complex health care system."

Among the key findings from the 2000 Health Confidence Survey:

  • Twenty-seven percent of respondents report feeling that health care in general has gotten better in the last five years, but 4 in 10 feel it has gotten worse (39 percent). In comparison, 3 in 10 respondents in 1998 felt health care had gotten better (31 percent) and one-third felt it had gotten worse (35 percent).
  • Among those respondents who have received care in the past two years,
  • Four in 10 are extremely or very satisfied with the care they have received in general (39 percent, down from 46 percent in 1998).
  • More than 4 in 10 are extremely or very satisfied with the quality of the medical care they received (43 percent), compared with almost half in 1998 (47 percent).
  • Twenty-two percent of respondents to the 2000 HCS named health care as the most critical issue facing America today (up from 16 percent in 1999 and 14 percent in 1998). This places health care just behind education (25 percent) and ahead of crime (16 percent), Social Security (11 percent), gun control (10 percent), and taxes (9 percent) as the issue considered to be most critical.

Just as women are more likely than men to identify health care as the most critical issue facing America today (25 percent of women versus 18 percent of men), they are more likely to be concerned about their ability to get health care once they are eligible for Medicare. Women are more likely than men to be not confident that they will be able to afford health care without financial hardship once they are eligible for Medicare (54 percent of women not confident versus 44 percent of men), that they will have enough choice about who provides their medical care (51 percent versus 41 percent), and that they will be able to get the treatments they need (42 percent versus 33 percent).

"These findings certainly point to the importance of tailoring useful educational materials for diverse health care stakeholders, said Consumer Health Education Council President Ray Werntz. "Education about the value of health care and health care coverage is vital to strategies to reduce the number of uninsured in this country."

The entire survey can be found at

EBRI is a private, nonprofit, nonpartisan public policy research organization based in Washington, DC. Founded in 1978, its mission is to contribute to, to encourage, and to enhance the development of sound employee benefit programs and sound public policy through objective research and education. EBRI does not lobby and does not take positions on legislative proposals. EBRI receives funding from individuals, employers of all types, unions, foundations, and government.

CHEC is part of the Employee Benefit Research Institute Education and Research Fund (EBRI-ERF), a 501(c)(3) organization. Like its parent organization, CHEC is a nonpartisan group that does not lobby and does not take positions on specific policy proposals. EBRI-ERF, as a nonpartisan and nonlobbying research organization, has been conducting objective and widely utilized analyses of health and retirement issues for more than 20 years. CHEC was formed in 1998 with initial funding provided by the American Hospital Association, the Employee Benefit Research Institute (EBRI), the Health Insurance Association of America, the Association of American Medical Colleges, and the Milbank Memorial Fund.

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