Americans' healthcare paradox: 'angst' on costs, overconfidence on quality
- More than three in four Americans expect healthcare costs to increase over the next few years and result in "significant and lasting damage" to the U.S. economy, according to a survey by nonprofit West Health and Gallup. And 69% were "not at all" confident policymakers will fix the situation.
- Given the choice between a 10% increase in income or a complete five year freeze of healthcare costs, 61% of people said they'd choose the latter, in line with the almost half of Americans concerned that a major health event would lead to bankruptcy for their family. In the past year alone, 12% have borrowed money to pay for care and 10% had foregone treatment due to cost.
- However, although just 39% of those surveyed were pleased with the U.S. healthcare system as a whole, 64% were satisfied in how it worked for their households. Roughly half believe the quality of U.S. healthcare is either the "best in the world" or "among the best."
Frustrations faced by Americans in paying for healthcare are understandable given that the U.S. ranks first among the 36 OECD developed nations in healthcare cost per person.
But their belief in the supremacy of the U.S. healthcare system is misplaced at best.
The U.S. ranks 31st among the OECD group in terms of infant mortality, a key indicator of overall quality, and a depressing 28th in overall life expectancy.
While healthcare is more regulated in nearly every other developed country, mammoth bills pack a bigger punch because they can come out of nowhere in the U.S. Some 47% of Americans reported never knowing what a visit to the emergency room will cost before receiving care. Just 19% of respondents said they "always" knew their out-of-pocket costs before visiting the ER.
Outpatient surgery, visits to a physical therapist or chiropractor, and check-ups and physicals didn't fare much better, with only 17%, 23% and 39% of respondents respectively saying they always knew their out-of-pocket costs at those sites of care.
Obfuscation of prices may lead to "risky and unhealthy behavior," according to the West Health report. It found 41% of Americans surveyed reported forgoing a visit to the ER over the past year due to cost concerns.
And this fear over costs is affecting people at every rung of the socioeconomic ladder. West Health and Gallup found the concern wasn't just unique to people struggling financially — it was consistent up to the top 10% of earners.
"Angst is a very appropriate word to use when you see the data," Mike Ellrich, healthcare portfolio leader at Gallup said at the West Health Healthcare Costs Innovation Summit on Tuesday.
Political debate over fixing this problem has centered of late on drug prices, surprise medical bills, pre-existing conditions and lowering insurance premiums, which are rising faster than income. And CMS has prodded providers and payers to make out-of-pocket costs more transparent for patients.
But Americans largely don't think politicians will be able to fix the problem, with more than two-thirds of Republicans and Democrats alike not at all confident that elected officials will be able to achieve bipartisan legislation to lower costs.
However, perceptions of quality diverged among party lines. West Health and Gallup found 67% of Republicans view the U.S. healthcare system as delivering the best or among the best care in the world. Just 38% of Democrats agreed.
"I'm all for patriotism, but this is a disconnect from reality," Ellrich said. "This issue is not red or blue."
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