EBRI Issue Brief

Public Attitudes on the U.S. Health Care System: Findings From the Health Confidence Survey

Nov 1, 2004 24  pages



This Issue Brief presents the findings from the 2004 Health Confidence Survey (HCS), which focuses on Americans’ satisfaction with the health care system today and their confidence in the system’s future. It examines Americans’ attitudes about employment-based health benefits, health savings accounts (HSAs), and benefits in the work place. The Issue Brief also looks at long-term trends in satisfaction and confidence with the health care system since the first HCS was conducted in 1998.

One indicator of Americans’ concern about health care is its continuing identification as a critical issue for the nation. More than 2 in 10 Americans consider health care to be the most critical issue facing America today. Health care ranks ahead of the economy, the war, education, the budget deficit, and taxes as the most critical issue. It ranks evenly with terrorism/national security.

Few Americans give the health care system top marks. Just 4 percent of Americans say it is excellent and another 1 in 10 say it is very good, while 3 in 10 say it is poor. Americans are now twice as likely as they were in 1998 to indicate it is poor.

Americans’ ratings of their own health plan have remained relatively stable since 1998. In 2004, nearly one-half of Americans with health insurance were extremely or very satisfied with their current plan, and more than one-third were somewhat satisfied.

Americans are increasingly dissatisfied with the cost of health care. One-fourth of Americans are not at all satisfied with the cost of their health insurance in 2004, compared with less than 2 in 10 in 1998. Almost 3 in 10 are not at all satisfied with the costs of heath care services not covered by their insurance, compared with 20 percent in 1998. Satisfaction with the health care received by Americans has not declined since 1998.

Americans have coped with increased costs in a variety of ways. One-quarter experiencing increased costs report they have decreased their contributions to a retirement plan and almost half report they have decreased their contributions to other savings. Nearly 2 in 10 say they have had difficulty paying for basic necessities, while 3 in 10 report difficulty paying other bills. Onequarter indicate they have used up all or most of their savings and some have borrowed money.

While more Americans are dissatisfied with the current health care system than in the past, many are not eager to switch to a system that assigns them more responsibility for their health care. Despite the fact that more than half agree that more direct involvement in health care decisions would improve health care, a majority of Americans do not currently seek to take up this responsibility, though Americans who do not currently have a high-deductible plan express some interest in this type of plan.