The passage of health reform in the U.S. has not enhanced peoples’ confidence in the American health system. In fact, U.S. health consumers’ high confidence level in the future of employer-sponsored health benefits has eroded over the past ten years, according to the Employee Benefit Research Institute‘s (EBRI) 2011 Health Confidence Survey: Most Americans Unfamiliar with Key Aspect of Health Reform.

Most people are dissatisfied with the U.S. health system overall, with 27% of U.S. adults rating the system as “poor” and 29% giving a rating of “fair.”

High costs may be at the root of peoples’ dissatisfaction with the U.S. health system. Only 18% of people are satisfied with the cost of health insurance; only 15% satisfied with the cost of health services not covered by insurance.

EBRI looked into peoples’ health-consumer behaviors, detailed in the chart. Most people who have visited doctors ask them to explain why a test is needed, as well as inquire about risks of treatments and medications and their success rates. Nearly one-half of people ask about less costly treatment options often or always.

Consumers also adjust their health care utilization when facing higher health care costs:

  • 74% of U.S. adults try to take better care of themselves
  • 69% choose generic drugs when available
  • 64% talk to the doctor more carefully about treatment options and costs
  • 59% go to the doctor only for more serious conditions or symptoms
  • 44% delay going to the doctor
  • 36% switch to over-the-counter (OTC) drugs
  • 34% look for cheaper health insurance
  • 31% look for cheaper health providers
  • 25% skip medication doses or don’t fill prescriptions.

Health care costs are eating into peoples’ savings contributions: 56% of people say they have decreased contributions to other savings due to health cost increases, and 33% have difficulty paying for other bills beyond health care.

The Health Confidence Survey interviewed 1,001 U.S. adults over age 21 in May and June 2011 via telephone.

Health Populi’s Hot Points: The future of health care in the U.S. feels very uncertain to the nation’s health citizens: “confidence about the health care system decreases as Americans look to the future,” EBRI found. 57% of Americans say they’re confident about their ability to get treatment they need today. However, only 30% of people are confident they’ll be able to get needed treatment over the next 10 years. Only 20% are confident they’ll get necessary treatment when they’re eligible for Medicare.

In the immediate term, with health consumers concerned about costs, they’re responding by seeking information about their providers, treatments and costs, shown in the second chart. While “all” of the information people seek about health care isn’t available for any of the types of information sought, most people are finding “some” of the information they seek. The most popular kind of information sought is comparing treatments’ disadvantages and advantages, sought by 54% of U.S. adult. However, only 1 in 4 people found all of the information they sought on comparisons. 31% of people look for the full costs of different treatments: only 23% of people found all of this information.

Consumer empowerment requires information transparency. As health citizens in the U.S. continue to take on more financial responsibility for health, they appear to be trying to take that role of health “consumer” seriously. To do that requires information that’s available in accessible, understandable forms via media channels and platforms people want to use. While there’s a proliferation of these services emerging — Castlight Health, Change:healthcare, and QuickenHealth, among them — most health consumers aren’t aware of or accessing these services yet.

It’s a long, winding and bumpy ride on the road to consumers’ empowerment in health. It will get bumpier without health plan sponsors’ linking their enrollees to services that will truly empower them to make sound decisions on how to use the health system.