Health Confidence Survey - 1998 Press Release

HCS Logo RELEASE: Embargoed for Release
April 30, 1998, 9 a.m. EDT
CONTACT: Maureen Richmond, 202-775-6341

Health Confidence Survey Finds
Americans Satisfied, Mixed Up & Worried

Washington DC--April 30, 1998--Americans are satisfied with their health care providers' performance, but who are these providers? According to the first annual Health Confidence Survey (HCS) released today by the Employee Benefit Research Institute (EBRI) and Mathew Greenwald & Associates (MGA), Americans are overwhelmingly confused about the country's health care system. They also have grave concerns about costs related to health care and the impact of increasing costs on their ability to access quality care in the future.

Managed Care: The Health Care Conundrum
Americans are massively confused about what type of health insurance they have, and that confusion begins with a lack of understanding of managed care. The HCS found that, although 83 percent of Americans covered by private health insurance are in some form of managed care today, 56 percent of managed care enrollees surveyed state they have never been in managed care. Even a majority of those who label their current plan as an HMO, PPO, or POS plan say they have never been in managed care (51 percent).

The majority of Americans think the health care system needs major change (59 percent). At the same time, they are generally satisfied with the quality of the health care they are receiving today. Almost 60 percent (59 percent) report they are extremely satisfied or very satisfied with the quality of their current care. Those who are currently enrolled in private non-managed care plans are more satisfied with their quality of care (71 percent v. 57 percent of managed care participants).

Even though they don't completely understand the type of care they are in, Americans in general think "managed care" is OK. One in five rate managed care excellent or very good for quality of care, choice of doctors or hospitals, and access to specialists. Three in five HMO-type plan participants rate managed care excellent, very good, or good (62 percent), compared with just one-half of participants in PPO-type and traditional fee-for-service plans (52 percent and 51 percent, respectively). HMO-type participants also rate hospital selection and preventive care access higher than those in PPO-type and traditional fee-for-service plans. (See note below.) "This massive confusion among Americans about managed care should send up a red flag to legislators and all other policymakers. It has the potential to send the wrong signals about Americans' real health care needs and concerns," said EBRI President Dallas Salisbury. On the other hand, he noted, "It's hard to blame the average American for being confused about what has become a health system described by an alphabet soup of acronyms--HMOs, PPOs, POSs, and a host of others."

The Cost Paradox
A large majority of Americans (81 percent) think health care costs have gotten worse over the last 5 years. In reality, costs have increased modestly, and in some areas, such as employee contributions for family coverage and out-of-pocket expenses, they have remained the same or decreased.

This paradox between Americans' perceptions about cost increases may underlie fears about the future. One in five Americans (22 percent) is highly confident that he or she will be able to afford health care without suffering financial hardship in the next 10 years. Forty-two percent are not confident in their ability to afford health care in the next 10 years without suffering financial hardship. Only one-third (33 percent) are highly confident that they will have access to quality health care in the next 10 years.

Health Care Attitudes: Lots of Similarities; Some Key Differences
According to Mathew Greenwald, President of Mathew Greenwald and Associates, the cost paradox is one of the surprising findings of the HCS, as is the frequent consensus among age groups and between genders. The survey also shows some marked differences between minorities and white Americans when it comes to confidence in the system today and in its future.

Minorities' Perceptions

  • More than one-half of minorities (57 percent) rate health care in the United States as fair or poor, compared with 44 percent of whites.
  • Minorities are more confident than whites about the future of Medicare, including their ability to get treatment (27 percent v. 15 percent) and the freedom to choose medical providers (23 percent v. 14 percent). Working minorities are more confident that Medicare will provide them with health insurance benefits throughout their retirement (45 percent v. 35 percent).

Gender Gaps

  • Women are more satisfied than men with the health care they have received in the past two years (50 percent of women v. 42 percent of men).
  • Women are more likely than men to indicate that the health care system needs major change (64 percent v. 53 percent).

Generation Gaps

  • Middle-aged Americans (45Ð54) have the most pessimistic view of health care. Seventy percent feel it needs major change.
  • Managed care rates particularly high among those under age 35. Nearly two-thirds (67 percent) rate the quality of care under managed care as excellent, very good, or good v. 47 percent of those ages 55-64.

"It is clear that the "young and invincible" generation is more comfortable with managed care than those older than 35. This may be a function of their limited interaction with the health care system, or the fact that they are only familiar with a world in which the majority of health care is delivered by managed care providers," stated Greenwald's HCS Project Director Jennifer Hicks.

Saving Medicare: Americans Choose Higher Taxes
When it comes to saving the Medicare system, Americans hold similar views across generations. When forced to make a choice:

  • By 54 percent to 40 percent, Americans prefer higher payroll taxes for workers to increasing co-payments and deductibles for Medicare recipients.
  • By 50 percent to 46 percent, Americans choose higher payroll taxes over increasing the Medicare eligibility age to 67. Workers and retirees respond very differently when forced to make similar choices:
  • Workers are more likely to prefer increasing payroll taxes over a change in the eligibility age. While 53 percent of workers favor an increase in payroll taxes, only 39 percent of retirees choose that option.
  • Workers are more likely than retirees to prefer increasing co-payments and deductibles (50 percent of workers favor v. 40 percent of retirees) over increasing the Medicare eligibility age to 67.

Americans and the Uninsured
Today, 41.7 million Americans are uninsured, compared with 224.2 million with health insurance. When respondents were asked how many Americans they believe are not currently covered by any form of health insurance, including Medicare or Medicaid, 57 percent underestimate the number. According to 61 percent of Americans, the number of uninsured will increase in the future. When asked what policies they would support to guarantee universal health insurance access:

  • Sixty-eight percent support allowing the uninsured to buy into Medicare.
  • Seventy-seven percent support requiring all employers to offer health insurance to employees.
  • Raising income taxes has the smallest amount of support (42 percent) and the greatest number who oppose it (54 percent).

"1998 is a vital year for this ongoing HCS project, as the survey's results will provide a benchmark to measure upcoming years' results. Over the years, we anticipate identifying areas where attitudes are changing and where confidence is increasing or decreasing," stated EBRI's HCS Project Director Paul Fronstin.


The 1998 Health Confidence Survey (HCS) was sponsored by the Employee Benefit Research Institute, a private, nonprofit, nonpartisan public policy research organization based in Washington, DC, and Mathew Greenwald & Associates, Inc., a full-service market research and consulting firm based Washington, DC.

The survey was conducted in February 1998, through 20-minute phone interviews with 1,002 individuals ages 20 and older. The survey is representative of the United States population. The margin of error for questions asked of all respondents is approximately +/-3percent.

Note: Plan type is categorized by the number of managed care plan design features (out of a total of four) a respondent reports as describing his or her health plan. Individuals enrolled in plans with all four plan design features are considered to be in "HMO-type" managed care plans; individuals enrolled in plans with at least one of these features are considered to be in "PPO-type" managed care plans; and individuals enrolled in plans with none of the four features are considered to be in "traditional" fee-for-service insurance plans. All respondents older than age 65 are considered to be Medicare participants.

The 1998 HCS was underwritten by 18 private and public organizations.

For more information on the survey, visit the HCS online at http://www.ebri.org/

 Mathew Greenwald & Associates, Inc.