As Health Care Costs Take a Toll, Some Changes Win Broad Backing

Given their dissatisfaction and future concern, uninsured Americans overwhelmingly prefer a universal health care system to the current one, and are more likely than insured people to think it would improve the quality, costs and availability of their own care.

Asked why they're uninsured, most people say it's because they can't afford coverage. Among the rest, about one in seven say they've been refused insurance because of ill health or similar reasons; as many say it's because their employer doesn't offer it or they're not eligible under their employers' plan.

Problems Paying -- As noted, 25 percent of Americans say they or another family member in their household have had problems paying medical bills in the past year. That's ranged from 18 to 23 percent in five previous polls by Kaiser dating to 1997.

There's also been a change in the severity of these problems: Among those who report problems paying, the number who say such bills have had a "major impact" on their family has risen from 48 percent in 2000 to 55 percent in 2003 and 61 percent now.

Similarly, 28 percent of Americans now say that within the past year they or a family member have put off medical treatment because of the cost; that's ranged previously from 14 to 25 percent in polls since 1991. Among those who've put off treatment, 70 percent say it was for a serious condition or illness – about the same as in 2003, but up from a low of 52 percent in a 1991 Gallup poll.

WOMEN and CARE --In a striking result, women are nearly twice as apt as men to say they or someone in their family have put off treatment because of the cost -- 36 percent of women say they've done so, compared with 19 percent of men.

That peaks particularly among women with children, among whom 46 percent – nearly half -- say they or someone in their family have put off care. And these women are no less apt than anyone else to say the postponed care was for a serious illness or condition.

A 2002 poll by the Kaiser foundation also found a gap, but a smaller one, between men and women in postponing medical care because of costs. (Women, it's worth noting, tend to be heavier users of the health care system, increasing their opportunity to put off care.) That 2002 poll specified personal care, while this survey asks about postponed care for anyone in the family.

Women also are likelier than men to report problems paying medical bills in the past year, albeit by somewhat less of a margin – 30 percent of women, 20 percent of men. Again, problems paying medical bills peaks in particular among women with children.

Among other groups, people in bad health are much more likely than those in good health to have put off needed medical care, and to report problems paying medical bills. Problems paying medical bills also are higher in groups including younger and lower-income Americans, racial minorities and the unemployed.

Causes -- As far as the cause of higher health costs, the public's biggest suspicion is profiteering by drug and insurance companies -- 50 percent call this one of the single biggest factors. Fraud and waste, the cost of medical malpractice suits and doctors and hospitals making too much money also come in for substantial concern.

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