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By Steven Meyers for DH Insights
It’s report card season, and U.S. healthcare affordability is getting mostly poor and failing grades from Americans, who are poised to act on this issue in the upcoming November elections. The West Health-Gallup 2022 Healthcare in America Report is based on their joint survey conducted in late June on a representative sample of more than 5,500 Americans.
Overall, healthcare scores a D or F grade from 44% of Americans, with only 22% giving good A or B grades. In terms of cost, the U.S. healthcare system is largely failing Americans, with around 75% grading healthcare affordability a D or F. Health equity fares only slightly better, with poor or failing grades from 56% of Americans.
Women, Asian and Hispanic Americans surveyed were the most critical of the overall healthcare system.
Driving the dismal grades are Americans’ fears over ability to pay for healthcare as they age, as well as gaps in care access and quality, and having to skip or ration treatment and medication.
“When members of my family have needed surgeries or medications [they] have to really consider how much medical debt they’re willing to go into. Our healthcare system forces us to try and make calculations between financial security and health just because of how expensive things are, and that’s even with health insurance, so I can’t imagine if you didn’t have health insurance how fraught that would be,” said Stef Schloo, age 28, Pennsylvania, in the report.
Cost of Care: Average grade of D-
Atop the list of concerns, cost of care received poor grades from most respondents. Gallup noted more than a quarter (27%), which represents about 70 million Americans, said they would not be able to afford quality care today. For 13% there was a time in the prior three months when they could not afford needed medications.
The affordability issue cuts almost evenly across the quilt of American demographics, including race/ethnicity and gender, as well as across all socioeconomic groups. There are, however, some differences in terms of the consequences of costs, as women, Hispanic and Black Americans having to cut back on healthcare at disproportionately higher rates to pay household expenses. Age is another key differentiator when it comes to needing to cut back on care. Possibly due to Medicare programs, those 65 years of age and older are less likely than those under 50 (21%) and 50 to 64 (19%) to trim healthcare services in favor of other expenses, according to the report.
Another telling data point in the report is that nearly 40% of Americans are either cost desperate or cost insecure on the healthcare affordability index. This means they either avoid treatment due to cost, forgo prescribed medicines due to cost, or lack immediate access to quality healthcare.
Quality of care: Average grade of C+
America has some of the best clinicians and health systems, including technology, so the scores on quality of care aren’t as devastating as they are in other grading areas. Still, less than half (47%) of respondents awarded A (excellent) or B (good) ratings, and women were less likely to give high marks for quality—a 19 percentage points difference. Racially, more White Americans (552%) gave higher grades for quality than Hispanics and Blacks (36%).
Value is another way to look at the quality and cost of care, and the report found only 7% of Americans consider U.S. healthcare a high value. On the flip side, the report’s value index shows 57% perceive an inconsistent value, and 36% see a poor value.
Access to care: Average grade of C
The ability to obtain quality health care appears impact demographics differently, as men and White respondents tended to give higher scores compared to women, Hispanics, Asians and Blacks. Age may also be a factor, as 15% of those aged 65 and older said they would not have access to affordable quality care if they needed it today. The percentage climbs to 26% among those aged 50 to 64. Access to prescription drugs is a connected concern for older Americans.
“A friend of mine, her husband just recently died… During his later days before his death…she couldn’t even get the doctor on the phone or to return her calls,” said Deni Hagains Goss, age 70, in the report. “That was due to accessibility.”
In some ways technology has improved access for groups historically challenged to obtain in-person care, but it also comes with cost and operational challenges. Telehealth rocketed to the front of care during the peak of he pandemic, but not everyone has good internet access. Even with connectivity, many Americans struggle to master the technology enough for remote care.
One-third of U.S. adults reported using telehealth visits for themselves or a dependent in 2020, but Medicare recipients (44%) had the highest usage rates, according to a survey from the Bipartisan Policy Center and Social Sciences Research Solutions (SSRS). Rural patients were also more likely to use telehealth than non-rural patients. Yet, 45% pf adults reported technology-related difficulties accessing telehealth, including digital literacy, high-speed connectivity and appropriate devices. Broadband access was a challenge for more rural respondents than those in non-rural areas.
Equity of care: Average grade of D+
Rating only slightly better than cost, healthcare equity—defined by the survey as “the ability every person to get quality care when they need it regardless of personal characteristics such as gender, race, geographic location, or socioeconomic status—received a poor grade from 56% of respondents.
“For the richest country on earth I think we have the most deplorable healthcare system…due to its inequity, mainly due to the way it all depends on how much money somebody has whether they get good healthcare or not,” said Anne Courtney Davis, age 71, Ohio, in the report.
Black and Asian Americans were more likely to give the healthcare system a D or F grade for equity, 9% to 13% more than Hispanics and Whites. Also, more women (61%) and men (50%) gave poor or failing grades for equity.
“I think that there’s a lot of factors that go against certain groups being able to access affordable healthcare. And then the fact that it is tied to your work makes it really challenging… So that equitability piece I think is really challenging,” said Isabel Zacharczuk, age 28, California, in the report.
Election 2022: Healthcare on the ballot
The Gallup/West Health project also asked Americans how healthcare factors into their voting this election season. Overall, almost nine in ten U.S. voters consider healthcare prices very or somewhat important to their selections at the polls this November. What’s more telling is almost half of Americans indicated they would be very and/or somewhat likely go outside their party to vote for a candidate who is focused on lowering healthcare costs.
More Democrats (57%) than Republicans (~30%) rated healthcare affordability as very important, and Black (65%) and Hispanic (60%) voters are more likely than White voters (41%) to consider a candidate’s plan to lower healthcare costs as very important. More women (52%) than men (43%) consider healthcare costs a very important issue.
It may come as no surprise that the cost of prescription drugs is very important to more seniors (52%) than younger groups (~45%), but 86% of overall Americans said a candidate’s plan to reduce drug costs is very or somewhat important.