Cost of majorities, health care equity in the United States negatively

Editor’s Note: The research detailed below was conducted in partnership with West Health, a family of nonprofit, nonpartisan organizations focused on reducing health care costs to enable successful aging.

WASHINGTON, DC – A plurality of Americans rate the U.S. health care system overall as poor or failing, and the majority rate its accessibility and equity equally, according to the West Health-Gallup Healthcare Americas 2022 Report. Access to health care and quality of care are considered somewhat better, although neither receives positive ratings at the majority level.

In total, 21% of American adults rate the healthcare system with an “A” or a “B”, 34% with a “C” and 44% with a “D” or an “F”. D or F grades are even higher for cost (75%) and fairness (56%) of care. Although access to health care receives negative ratings, overall its poor or failing ratings are lower (38%). Meanwhile, 47% of Americans rate the quality of care in the United States as excellent (A) or good (B).

The survey was conducted via the Internet from June 21-30, 2022 among more than 5,500 American adults via the Gallup probability-based panel. Full results can be found in the West Health-Gallup America’s Healthcare Report 2022which explores the current difficulties Americans face in paying for necessary care and their concerns about the future of health care costs.

Americans agree health care affordability falls short

Ratings of health care affordability in the United States are consistently low regardless of annual household income, with 72% to 78% of American adults in all income groups giving it D or F grades.

###Incorporate###

In a follow-up interview, survey respondent Deni Hagains Goss of Pennsylvania explained her score for the cost of health care: “I [grade it an] F … I have pre-existing illnesses. … I have asthma. And the drugs for that are so astronomical. … I pay a lot of copayments. … My general co-payment just to see a doctor is [about] $40. Recently I had a heart ultrasound…and it was like $200…after my insurance coverage.”

Ratings of equity, access and quality differ by gender and race/ethnicity

While there is general agreement across demographic subgroups that the high cost of health care merits a low or failing grade, ratings on equity, access, and quality differ by region. gender and race/ethnicity.

• Women are more likely than men to assign D or F grades to each of these three dimensions of health care, by a margin of 8 to 12 percentage points.
• Blacks (66%) and Asian Americans (64%) are more likely than White and Hispanic Americans to assign D or F grades for fairness.
• People of color are more likely than white adults to rise to a rank with a D or an F.
• Black and Hispanic Americans are more likely than White and Asian Americans to rate quality as a D or F.

###Incorporate###

Americans face major challenges and consequences due to cost of care

Just over one in four Americans (27%), or about 70 million adults, say that if they needed access to quality care today, they couldn’t afford it. As a result, Americans continue to make difficult trade-offs when deciding to seek the health care they need. Six in 10 adults say cost is an “extremely important” (28%) or “important” (33%) consideration in deciding whether to follow their doctor’s advice to continue treatment, with women (66%) being more likely than men (55%) to say so.

A significant proportion are skipping care entirely just to pay for household needs, as one in six adults say they have cut back on healthcare in the past year for this reason. This includes more than 20% of black and Hispanic women and adults.

###Incorporate###

Brandon Shaw of Minnesota explains his calculation this way: “Unless it’s life threatening — life, limb, or sight — I don’t want to incur those costs. I don’t think the cost-benefit ratio [is] there to justify the expense.”

As Americans struggle to pay for care, they face serious health challenges

The inability to afford treatment for their health problems today leads to a potential deterioration in the current and future health of Americans. Nearly one in five adults (18%), or about 47 million Americans, report that their health problems have worsened in the past year due to an inability to afford treatment. Women and Hispanic Americans report worsening health outcomes at the highest rates.

###Incorporate###

This can have disastrous consequences. Five percent of American adults – about 14 million people – say a friend or family member has died due to an inability to pay for necessary health care. Black and Hispanic Americans (9% each) are almost twice as likely as the general population to report the death of a loved one due to healthcare costs. These results provide strong evidence of inequity in the health system.

Americans deeply concerned about affordability

Going forward, Americans lack confidence in their own ability to pay for health care. Half of Americans are not very or not at all confident that they will have the financial resources to pay for the health care they will need as they age, with women (55%) more likely than men (45%) d express this concern.

###Incorporate###

Diana Rael from New Mexico explains her concerns about paying for care in the future: “Especially as we age, [there] is the issue of long-term care. We see this a lot. Personally, I have a family member who probably should be in a nursing home, but can’t afford it. So the family has to take care of that person, and the impact is significant.”

Such concerns stem in part from skepticism about the future availability of Medicare and Social Security. Overall, two-thirds of Americans say they rely on Medicare, and nearly six in 10 on Social Security, to pay for health care as they age. While two in three adults under 65 worry that Medicare won’t be available when they become eligible, three in four adults under 62 have similar fears about Social Security.

###Incorporate###

Obstacles to lowering healthcare costs, but agreement on key policy solutions

When asked what stands in the way of lowering health care costs in the United States, nearly eight in 10 Americans cite lobbying and partisan politics as a “major obstacle” (79% each), and seven out of 10 indicate a lack of price regulation.

At the same time, majorities of adults – all political parties – support limits on how much people can pay for health care, via federal government regulations.

###Incorporate###

Sharon Cook of New Jersey sees the issue as a political issue: “It doesn’t seem to be that important to our members of Congress — our representatives — that we cut costs, that we make things accessible. I don’t see any movement in that direction. »

Final Thoughts

The West Health-Gallup Healthcare Americas 2022 Report adds an important ranking metric to assess key aspects of the US healthcare system. It found that millions of people, including higher rates of black and Hispanic women and adults, are skipping treatment because they can’t afford it, and many are getting sicker or dying as a result. These consequences of a high-cost healthcare system have created concerns for the future. Most Americans express high levels of uncertainty and worry about paying for health care as they age.

Policy makers have started to react to this crisis. In August, President Joe Biden signed into law the Cut Inflation Act of 2022. Among its health care provisions, this landmark legislation for the first time allows Medicare to negotiate certain prescription drug prices with pharmaceutical companies. This is an important step in reducing costs. However, the results of the negotiations don’t take effect until 2026, are limited to 10 prescription drugs in that first year, and only affect Medicare beneficiaries.

This study, part of a growing body of research from West Health and Gallup, shows that the problem of high health care costs is large and pressing, and affects a cross-section of Americans.