Religion and Social Trends

Healthcare Costs, Access Viewed as Most Urgent U.S. Health Problems

Majority favors keeping current system over a new government-run system

GALLUP NEWS SERVICE

PRINCETON, NJ -- A new Gallup Poll shows widespread concern and dissatisfaction with healthcare costs and access to healthcare in the United States. Cost and access top Americans' list of the most urgent health problem facing the United States at this time, placing these well ahead of specific diseases such as cancer and AIDS. Consistent with earlier polls, fewer than one in three Americans rate healthcare coverage in the United States in positive terms, and only about one in five are satisfied with the costs of healthcare in the country. Most Americans say it is the government's responsibility to ensure that all have healthcare, but stop short of endorsing a government-run healthcare system, preferring instead to keep the current system. And despite their dissatisfaction with the costs of and access to healthcare, Americans give very high marks to the quality of healthcare in the United States.

Most Urgent Health Problem

Healthcare costs and access to healthcare are Americans' chief health concerns this year, when Gallup asks the public to name, without prompting, the most urgent health problem facing the country. Twenty-seven percent of the public mentions some aspect of cost in the open-ended format, such as the cost of health insurance, the cost of prescription drugs, or the cost of healthcare more generally. Another 25% mention access to, or the availability of, healthcare, including care for the elderly and the poor.

Since 1991, cost has been a significant health concern for Americans, and has ranked at or near the top of the list of volunteered concerns since 2000. The anthrax scare in the fall of 2001 temporarily displaced cost as Americans' top health concern that year, but cost returned to the top in 2002 as the bioterrorism threat quickly faded from the news. In recent years, there has been growing concern about access to healthcare, and this past year saw a significant spike in the number of Americans who say the most urgent health problem facing the country is access, from 14% last year to 25% now.

What would you say is the most urgent health problem facing this country at the present time? [Open-ended]

 

Cost

Access

Cancer

AIDS

Obe-
sity

Bio-
terror-
ism

Other

No
opin-
ion

%

%

%

%

%

%

%

%

2003 Nov 3-5

27

25

13

8

7

1

13

6

2002 Nov 11-14

25

14

21

8

7

1

14

9

2001 Nov 8-11

14

8

19

7

4

22

18

8

2000 Sep 11-13

25

13

20

18

3

--

14

7

1999 Feb 8-9

13

1

23

33

1

--

23

6

1997 Oct 3-5

9

13

15

29

*

--

29

5

1992 Mar 26-29

30

--

5

41

--

--

20

4

1991 Nov 14-17

20

--

6

55

--

--

16

3

1991 May 2-5

10

2

16

45

1

--

22

4

1987 Oct 23-26

1

--

14

68

3

--

20

3

* Less than 0.5%



The widespread concern with cost and access has crowded out concern with diseases or other health conditions this year. Still, 13% of Americans say cancer is the most urgent health problem in the United States, 8% say AIDS, and 7% say obesity.

Concern with AIDS remains low. Beginning in 1987, when the question was first asked, AIDS was the dominant health concern for Americans and remained so until the year 2000. Since that time, the public has perceived cancer to be the bigger health threat of the two diseases. In recent years, the percentage of Americans citing obesity as the country's chief health threat has increased, putting it on a similar level with AIDS in the 2002 and 2003 surveys. Recently, the Centers for Disease Control and Prevention singled out obesity as the country's greatest health threat, especially since it is linked to health conditions such as heart disease and diabetes.

Ratings of Healthcare in the United States

Most Americans, 68%, think the healthcare system has major problems, including 14% who describe it as being in a state of crisis. This is similar to where it has been in past Gallup Polls. One exception is the November 2001 poll, when just 49% had a negative view of the healthcare system in the wake of the Sept. 11 terrorist attacks.

Which of these statements do you think best describes the U.S. healthcare system today -- it is in a state of crisis, it has major problems, it has minor problems, or it does not have any problems?

These responses vary considerably by age, with younger Americans far less likely to view the healthcare system as troubled. Just 52% of 18- to 29-year-olds think the system has major problems or is in a crisis, compared with 68% of 30- to 49-year-olds, 81% of 50- to 64-year-olds, and 70% of those aged 65 and older.

As the above open-ended data suggest, Americans pinpoint the healthcare system's problems as cost and access. When asked about it directly, 79% say they are dissatisfied with the cost of healthcare in this country, while only 20% are satisfied. The level of dissatisfaction has actually increased slightly in recent years -- from 71% in 2001 -- although it has always been high.

Satisfaction With Healthcare Costs in This Country

Additionally, 29% of Americans rate "healthcare coverage in this country" as "poor," while 28% say it is "excellent" or "good." These ratings have been stable for the past few years.

Public Rating of Healthcare Coverage in This Country

Americans are, however, very positive in their assessment of the quality of healthcare in the United States. Sixty percent say it is excellent or good, a slight improvement over the past two years (55% in 2002 and 53% in 2001).

Prescription for Change?

Despite widespread dissatisfaction with the healthcare system, it is not clear what types of changes Americans support. Consistent with past results, a majority, 59% say it is the government's responsibility to make sure all Americans have health coverage, while 39% say this is not the government's responsibility. Some of the leading Democratic presidential contenders are making universal health coverage a major part of their campaign platforms. This is the type of policy likely to appeal to Democrats, as 72% think the government has this responsibility. That compares with 65% of independents, and 40% of Republicans.

Still, it is unclear exactly how far Americans would want to go to make universal coverage a reality. When asked to choose between replacing the current system with a government-run system and maintaining the current system, the public opts for keeping the existing system by a 57% to 38% margin. Even Democrats are divided in their views, with 50% favoring the current system and 46% wanting a new government setup. Republicans show solid support for the current system (67% to 28%), while independents show a slight preference for it (52% to 41%).

Americans' reluctance to support a new system may come from their generally high level of satisfaction with the quality of healthcare in the United States. While Americans are dissatisfied with the costs of healthcare in the country, generally they tend to be satisfied with their own health insurance and with the costs they have to pay.

Survey Methods

These results are based on telephone interviews with a randomly selected national sample of 1,007 adults, 18 years and older, conducted Nov. 3-5, 2003. For results based on this sample, one can say with 95% confidence that the maximum error attributable to sampling and other random effects is ±3 percentage points. In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls.

11. What would you say is the most urgent health problem facing this country at the present time? [Open-ended]

 

Cost

Acc

CA

AI

OB

HD

SM

BIO

A/D

OTH

DK

%

%

%

%

%

%

%

%

%

%

%

2003 Nov 3-5

27

25

13

8

7

3

1

1

1

8

6

2002 Nov 11-14

25

14

21

8

7

5

2

1

*

7

9

2001 Nov 8-11

14

8

19

7

4

6

1

22

1

10

8

2000 Sep 11-13

25

13

20

18

3

3

1

--

2

8

7

1999 Feb 8-9

13

1

23

33

1

5

3

--

2

13

6

1997 Oct 3-5

9

13

15

29

*

3

2

--

6

18

5

1992 Mar 26-29

30

--

5

41

--

2

--

--

--

18

4

1991 Nov 14-17

20

--

6

55

--

2

--

--

--

14

3

1991 May 2-5

10

2

16

45

1

2

*

--

5

15

4

1987 Oct 23-26

1

--

14

68

3

7

1

--

4

8

3

KEY: Acc Access to health care; AI AIDS; BIO Bioterrorism/Anthrax/Smallpox; CA Cancer; Cost Health care/insurance costs; HD Heart disease; SM Smoking; OB Obesity; A/D Alcohol/Drug abuse; OTH Other; DK No opinion

* Less than 0.5%



Now thinking about health care in the country as a whole,

12. Overall, how would you rate -- [ROTATED] -- as excellent, good, only fair, or poor?

A. The quality of health care in this country

 

Excellent

Good

Only fair

Poor

No opinion

2003 Nov 3-5

18%

42

28

12

*

2002 Nov 11-14

14%

41

32

12

1

2001 Nov 8-11

15%

38

34

12

1

* Less than 0.5%



B. Health care coverage in this country

 

Excellent

Good

Only fair

Poor

No opinion

2003 Nov 3-5

5%

23

42

29

1

2002 Nov 11-14

4%

26

41

27

2

2001 Nov 8-11

5%

25

43

26

1



Thinking again about health care in the country as a whole,

29. Are you generally satisfied or dissatisfied with the total cost of health care in this country?

 

Satisfied

Dissatisfied

No opinion

%

%

%

2003 Nov 3-5

20

79

1

2002 Nov 11-14

22

75

3

2001 Nov 8-11

28

71

1

1993 May 10-12 ^

8

90

2

^

WORDING: Now, thinking about health care in the country as a whole, are you generally satisfied, or dissatisfied, with ... Next, … The quality of health care in this country.



30. Which of these statements do you think best describes the U.S. health care system today -- [ROTATED: it is in a state of crisis, it has major problems, it has minor problems, (or) it does not have any problems]?

 


State of
crisis


Major problems


Minor problems

Does not have any problems


No
opinion

%

%

%

%

%

2003 Nov 3-5

14

54

30

1

1

2002 Nov 11-14

11

54

32

2

1

2001 Nov 8-11

5

44

47

2

2

2000 Sep 11-13

12

58

28

1

1

1994 Sep 6-7 ^

17

52

29

1

1

^

WORDING: Which of these statements do you think best describes the U.S. health care system today--the health care system is in a state of crisis, it has major problems, it has minor problems, or it does not have any problems?



Q.31-32 SPLIT SAMPLED

31. Do you think it is the responsibility of the federal government to make sure all Americans have health care coverage, or is that not the responsibility of the federal government?

BASED ON -- 491 -- NATIONAL ADULTS IN FORM A

 

Yes, government
responsibility

No, not government responsibility

No
opinion

%

%

%

2003 Nov 3-5

59

39

2

2002 Nov 11-14

62

35

3

2001 Nov 8-11 ^

62

34

4

2000 Sep 11-13

64

31

5

2000 Jan 13-16

59

38

3

^

Asked of a half sample.



32. Which of the following approaches for providing health care in the United States would you prefer -- [ROTATED: replacing the current health care system with a new government run health care system, (or) maintaining the current system based mostly on private health insurance]?

BASED ON -- 516 -- NATIONAL ADULTS IN FORM B

 

Replacing the
current system

Maintaining the
current system

No
opinion

2003 Nov 3-5

38%

57

5

2001 Nov 8-11

33%

61

6



Gallup http://www.gallup.com/poll/9703/Healthcare-Costs-Access-Viewed-Most-Urgent-US-Health-Problems.aspx Gallup World Headquarters, 901 F Street, Washington, D.C., 20001, U.S.A +1 202.715.3030