The Robert Wood Johnson Foundation Health Care Consumer

The Robert Wood Johnson Foundation Health Care Consumer

The Robert Wood Johnson Foundation Health Care Consumer Confidence Index A monthly survey of Americans’ attitudes about health care June Findings Ju...

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The Robert Wood Johnson Foundation Health Care Consumer Confidence Index A monthly survey of Americans’ attitudes about health care

June Findings

July 2009

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Robert Wood Johnson Foundation  Health Care Consumer Confidence Index     July 2009 Report  Results for June 2009

Introduction  This report provides results for the Robert Wood Johnson Foundation Health Care Consumer Confidence Index (RWJF Index) for June 2009. The RWJF Index is a monthly snapshot of how adults in the United States perceive their financial access to health care. The data used to produce the RWJF Index come from the University of Michigan Surveys of Consumers. The Surveys of Consumers are monthly telephone interviews conducted by the Survey Research Center at the University of Michigan using list-assisted random digit dialing. The surveys use a rotating panel design. Each month, a new cross-sectional sample of households is drawn. Respondents from this sample are re-interviewed six months later. Approximately 500 adults (age 18+) respond monthly, of which about 60% of respondents are new, while 40% are being interviewed for a second time (six months from when they were last interviewed). The sample is designed to be representative of all households in the coterminous United States (that is, the United States plus the District of Columbia, excluding Hawaii and Alaska). Results in this report have been weighted to be representative of all adults living in private households in the coterminous United States. The core of the Surveys of Consumers questionnaire is composed of 50 questions designed to track different aspects of consumer attitudes and expectations. The monthly response rate is approximately 39% (using the AAPOR RR2 calculation). More information about the University of Michigan Surveys of Consumers is available at http://www.sca.isr.umich.edu/. These analyses are supported by a grant from the Robert Wood Johnson Foundation (RWJF). The State Health Access Data Assistance Center (SHADAC) developed the RWJF Index from selected survey items using baseline data established in spring 2009. The RWJF Index is itself composed of two sub-indices, the Recent Health Cost Barriers Index (RHCB Index) and the Future Health Cost Concerns Index (FHCC Index), which measure recent problems with access to health care due to cost, and future worries about access to health care or health insurance due to cost, respectively. This report provides a description of the methodology of the Index, as well as tables of the results. For methodological inquiries, please contact the State Health Access Data Assistance Center at 612-624-4802, [email protected], or visit their web site at www.shadac.org.

  Robert Wood Johnson Foundation Health Care Consumer Confidence Index, July 2009 Report 

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Methods  The Robert Wood Johnson Foundation Health Care Consumer Confidence Index (RWJF Index) is the sum of two sub-indices, the Recent Health Cost Barriers Index and the Future Health Cost Concerns Index.

Recent Health Cost Barriers Index (RHCB Index)  The RHCB Index measures whether respondents experienced barriers in access to health care in the past year, including: • Delaying seeing a doctor when it was necessary due to cost, • Skipping a recommended medical test, treatment, or follow-up due to cost, • Not filling a prescription due to cost, and • Having difficulty paying for medical bills. Refer to the “Index Questions” section of this report for exact question wording. These questions were chosen after exploratory factor analysis indicated that they were highly related to the same underlying construct. The Cronbach’s alpha, a common measure of the internal consistency of a scale, was calculated at 0.82 for the baseline data. To calculate the RHCB Index, we first computed the relative scores (RHCB Score) for each of the four index questions (the percent of respondents giving “no” replies, minus the percent giving “yes” replies, plus 100 points for x1 ...x4 listed below). Using the formula shown below, we summed the four relative scores, and divided by the baseline total of 6.28.

6.28

Future Health Cost Concerns Index (FHCC Index)  While the RHCB Index utilized survey items that asked about cost barriers in access to health care in the past 12 months, the FHCC Index uses measures of worry about barriers in access to health care due to cost in the near future. Many people may be concerned about paying for health care in the future, even if they haven’t experienced difficulty in the recent past. Specifically, the FHCC Index uses items that asked respondents about: • Worry about losing health insurance coverage, • Worry about not being able to afford treatment for serious illness, • Worry about not being able to afford all of the routine health care services needed, • Worry about not being able to afford prescription drugs, and • Worry about going bankrupt from not being able to pay medical bills. Refer to the “Index Questions” section of this report for exact question wording. Questions included in the FHCC Index were highly related to the same underlying construct in the initial factor analyses. The inclusion of the question about worry about losing health   Robert Wood Johnson Foundation Health Care Consumer Confidence Index, July 2009 Report 

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insurance coverage makes calculation of the FHCC Index slightly more complex than the calculation of the RHCB Index. People who had indicated that they were uninsured were not asked this question. The Cronbach’s alpha for the insured is 0.85 and for uninsured 0.87, indicating that these variables work together well to measure concerns about paying for health care in the future. Because of this difference in the number of questions, the FHCC Score is computed separately for insured and uninsured respondents, and then combined, weighting by the percent that were uninsured. As before, we first computed the relative scores for each of the Index questions (the percent of respondents saying “not worried” minus the percent saying “worried,” plus 100 points), using the “not worried” and “worried” percentages specific to the insured and uninsured groups. Then we summed the relative scores from each item, and divided by the baseline total of 6.33.

5 4

1 6.33

In this equation, p equals the percent insured and (1 - p) equals the percent uninsured. In the baseline period, the uninsurance rate is 11.8 percent. We then multiplied the FHCC Scoreuninsured by 5/4 to give greater weight to the value for the uninsured, since they were asked one less question.

Robert Wood Johnson Foundation Health Care Consumer Confidence Index  (RWJF Index)  As stated before, the RWJF Index is the sum of the RHCB Index and the FHCC Index. This is equivalent to adding the sub-scales and dividing by the base period score 12.61.

12.61 While the two sub-indices measure recent barriers and near-future concerns, our analyses show that they can be combined into a single index measuring overall security about health care cost. Exploratory factor analyses showed the nine measures were strongly related to a single underlying construct. For our baseline, Cronbach’s alpha for all nine items together is 0.86. Standard errors were computed using Taylor Series and adjusting for weighting and sample selection issues associated with the survey.   Robert Wood Johnson Foundation Health Care Consumer Confidence Index, July 2009 Report 

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Index Questions  The Health Care Cost Index is derived from the following ten questions: x1: In the past 12 months, was there any time when you (or someone in your family living there) delayed seeing a doctor when it was necessary because of the cost? (Yes/No) x2: In the past 12 months, was there any time when you (or someone in your family living there) skipped a recommended medical test, treatment or follow-up because of the cost? (Yes/No) x3: In the past 12 months, was there any time when you (or someone in your family living there) did not fill a prescription because of the cost? (Yes/No) x4: In the past 12 months, did you (and your family living there) ever have difficulty paying for your medical bills? (Yes/No) x5: At this time, how worried are you that you will lose your health insurance coverage in the next 12 months? Are you very worried, somewhat worried, not too worried or not worried at all? (Asked of and calculated for respondents who reported that they had health insurance coverage.) x6: Thinking about the future, how worried are you that you will not be able to afford treatment if you (or someone in your family living there) become(s) seriously ill? (Are you very worried, somewhat worried, not too worried or not worried at all?) x7: Thinking about the future, how worried are you that you will not be able to afford all of the routine health care services you (and your family living there) might need? (Are you very worried, somewhat worried, not too worried or not worried at all?) x8: Thinking about the future, how worried are you that you will not be able to afford all of the prescription drugs you (and your family living there) might need? (Are you very worried, somewhat worried, not too worried, or not worried at all?) x9: Thinking about the future, how worried are you that you will go bankrupt from not being able to pay your (family’s) medical bills? (Are you very worried, somewhat worried, not too worried or not worried at all?) Note: For x5 to x9, response categories were dichotomized as follows: Very worried/somewhat worried = “Worried” for relative score for Index calculation Not too worried/not worried at all = “Not worried” for relative score for Index calculation

  Robert Wood Johnson Foundation Health Care Consumer Confidence Index, July 2009 Report 

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Tables  Chart 1. RWJF Indices Tracking Chart  120 115 110 105

Recent Health  Cost Barriers

RWJF Health Care  Consumer Confidence 

100 95

Future Health  Cost Concerns

90

Apr 2010

Mar 2010

Feb 2010

Jan 2010

Dec 2009

Nov 2009

Oct 2009

Sep 2009

Aug 2009

Jul 2009

Jun 2009

May 2009

Baseline Apr 2009

85

Table 1a. Current RWJF Index Levels     Measure  Recent Health Cost Barriers  Future Health Cost Concerns  RWJF Health Care Consumer Confidence 

Index  Estimate SE  101.3                  2.01   103.3                  2.85   102.3                  2.13  

    Table 1b. Recent RWJF Index Levels  RWJF  Health Care  Recent  Future  Health Cost  Health Cost  Consumer  Period   Barriers  Concerns  Confidence  Jun 2009  101.3  103.3 102.3 May 2009  100.0  97.4 98.7 Baseline  100  100 100 Note:  The June Index levels are not statistically significant changes from May. 

  Robert Wood Johnson Foundation Health Care Consumer Confidence Index, July 2009 Report 

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Table 2. Percent Concerned and Index Values by Demographics, June 2009    

   Overall     Age Categories  18‐34  35‐49  50‐64  65+  Total     Race  White Non‐Hispanic  Other  Total     Income Categories  Bottom Third  Middle Third  Top Third  Total     Education  HS or less  Some college  College degree  Grad studies  Total     Sex  Male  Female  Total     Health Status  Excellent  Very good  Good  Fair/Poor  Total     Insurance Status  Insured  Private insurance  Public insurance  Uninsured  Total 

Percent with any of concern type Recent  Future  Health Care  Health Cost  Health Cost  Consumer  Barriers  Concerns  Confidence  37.9%  55.8% 63.1%      Percents 38.3%  55.5% 63.0% 44.8%  56.8% 68.0% 42.0%  65.3% 71.6% 24.3%  42.6% 46.6% 37.9%  55.8% 63.1%

38.1%  37.0%  37.9% 

Percents 52.4% 70.0% 55.7%

60.4% 74.6% 63.0%

49.2%  46.5%  21.8%  38.3% 

Percents 70.7% 62.1% 39.8% 56.6%

76.9% 69.7% 47.5% 63.8%

38.0%  52.6%  31.6%  30.8%  38.0% 

Percents 63.9% 64.4% 46.0% 48.2% 55.7%

68.2% 74.0% 55.1% 54.8% 63.0%

29.6%  44.4%  37.9% 

Percents 46.8% 62.8% 55.8%

55.3% 69.2% 63.1%

21.7%  31.3%  45.0%  56.2%  37.9% 

Percents 42.3% 54.9% 59.7% 66.8% 55.8%

49.6% 60.2% 70.2% 73.2% 63.1%

34.9%  34.0%  31.7%  66.0%  37.9% 

Percents 52.7% 52.5% 48.6% 85.1% 55.8%

60.5% 60.2% 54.9% 88.1% 63.1%

Index  Recent  Future Health  Health Care  Health Cost  Cost  Consumer  Barriers  Concerns  Confidence           101.3           103.3             102.3      Index               97.4           106.2             101.9              95.1           100.2                97.7              98.4              91.8                95.1           114.4           120.2             117.3           101.3           103.3             102.3      Index            102.2           109.5             105.9              97.2              76.6                86.9           101.2           103.4             102.3      Index               93.7              81.4                87.5              93.4              98.2                95.8           112.8           123.1             118.0           100.6           102.0             101.3      Index               99.8              93.3                96.5              89.9              94.6                92.3           105.2           113.5             109.4           110.1           113.9             112.0           101.2           103.6             102.4      Index            106.8           111.8             109.3              96.9              96.8                96.9           101.3           103.3             102.3      Index            112.1           125.9             119.1           109.8           106.7             108.3              95.3              95.7                95.5              84.3              83.6                84.0           101.3           103.3             102.3      Index            104.4           108.6             106.5           105.0           110.0             107.5           105.0           108.0             106.5              71.6              53.3                62.4           101.3           103.3             102.3 

Source:  Robert Wood Johnson Foundation Health Care Consumer Confidence Index for June 2009. Standard errors are shown  in Table 6.    Robert Wood Johnson Foundation Health Care Consumer Confidence Index, July 2009 Report 

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Table 3. Health Care Quality, Health Reform Importance, and Coverage Loss by  Demographics, June 2009    

Received Quality  Health Care* 

Health Reform  Important** 

  

Percents 

Overall    

87.9%    

Age  18‐34  35‐49  50‐64  65+ 

84.7%    

87.9%    

   16.4%  27.9%  26.1%  18.6% 

84.7%    

Race 

23.3%    

Percents 

White Non‐Hispanic  Other  Total    

23.3% 

Percents  96.1%  87.8% 82.8% 76.2%

76.6%  88.2% 86.1% 96.6%

Total    

Worried may lose  coverage*** 

90.7%  78.4% 88.4%   

81.4%  97.0% 84.3%   

20.4%  38.0%  23.2%    

Income  Bottom Third  Middle Third  Top Third 

85.2% 85.9%  91.5%

Percents  94.0% 84.1%  77.5%

31.9%  26.4%  15.8% 

Total 

87.7% 

84.8% 

23.7% 

  

  

Education  HS or less  Some college  College degree  Grad studies 

88.1%    

   Percents  92.8%  87.2% 81.2% 76.6%

85.1%  82.3% 91.4% 94.3%

Total    

  

24.3%  28.9%  19.5%  20.6% 

84.9%    

Sex 

23.1%    

Percents 

Male  Female 

87.4%  88.2%

78.3%  89.7%

21.0%  25.2% 

Total 

87.9% 

84.7% 

23.3% 

  

  

  

Health Status 

   Percents 

Excellent  Very good  Good  Fair/Poor 

94.7%  90.1% 90.1%  74.3%

76.6%  84.3% 88.0%  89.8%

15.2%  20.0%  25.6%  35.0% 

Total 

87.9% 

84.7% 

23.3% 

  Robert Wood Johnson Foundation Health Care Consumer Confidence Index, July 2009 Report 

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Insurance Status  Insured 

   Percents  84.7%  83.9%  83.0% 84.5%

23.3%  22.6%  25.7% 

Uninsured 

90.4%  90.6%  90.8% 63.7%

Total 

87.9% 

84.7% 

23.3% 

Private insurance  Public insurance 

Source:  Robert Wood Johnson Foundation Health Care Consumer Confidence Index for June 2009. Standard errors are shown  in Table 7.  *Percent responding that health care received was "excellent", "very good", or "good" quality   **Percent responding that it was "very important" or "somewhat important" to the question, "How important is it that  President Obama include health care reform as part of his approach to addressing the economic crisis of the United States?"  ***Percent responding that they were "very worried" or "somewhat worried" 

  Robert Wood Johnson Foundation Health Care Consumer Confidence Index, July 2009 Report 

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Table 4. Survey Results, June 2009    Health Status  Excellent  Very good  Good  Fair  Poor  Total     Delayed care because of cost  Yes  No  Total     Skipped care because of cost  Yes  No  Total     Did not fill prescription because of cost  Yes  No  Total     Did not get mental health because of cost Yes  No  Total     Trouble paying medical bills  Yes  No  Total     Have health insurance  Yes  No  Total     Covered by employer sponsored insurance (ESI) (of insured) Yes  No  Total     Covered by directly purchased insurance (of insured) Yes  No  Total 

Percent  22.4%  30.7%  26.1%  15.8%  5.0%  100.0%  Percent  19.5%  80.5%  100.0%  Percent  18.2%  81.8%  100.0% 

SE  1.94%  2.15%  2.08%  1.78%  1.04%  0.00%     SE  1.93%  1.93%  0.00%     SE  1.88%  1.88%  0.00% 

Percent  SE  18.6%  1.92%  81.4%  1.92%  100.0%  0.00%  Percent  SE  7.2%  1.30%  92.8%  1.30%  100.0%  0.00%  Percent  SE  25.8%  2.13%  74.2%  2.13%  100.0%  0.00%  Percent  SE  90.5%  1.49%  9.6%  1.49%  100.0%  0.00%     Percent  SE  66.5%  2.31%  33.5%  2.31%  100.0%  0.00%     Percent  SE  29.6%  2.21%  70.4%  2.21%  100.0%  0.00% 

  Robert Wood Johnson Foundation Health Care Consumer Confidence Index, July 2009 Report 

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   Covered by public insurance (of insured)  Yes  No  Total     Worried will lose coverage (of insured)  Very worried  Somewhat worried  Not too worried  Not worried at all  Total     Worried employer will stop coverage (of ESI) Yes  No  Total     Worried might lose job (of ESI or Direct)  Yes  No  Total     Worried might get job without coverage (of ESI or public) Yes  No  Total     Worried will not afford current coverage (of insured) Yes  No  Total     Worried about cuts to public coverage (of public) Yes  No  Total     Worried cannot afford future care  Very worried  Somewhat worried  Not too worried  Not worried at all  Total     Worried cannot afford future routine care Very worried  Somewhat worried  Not too worried  Not worried at all  Total 

   Percent  SE  39.4%  2.39%  60.6%  2.39%  100.0%  0.00%     Percent  SE  6.8%  1.30%  16.5%  1.87%  28.4%  2.22%  48.3%  2.46%  100.0%  0.00%     Percent  SE  13.3%  1.92%  86.7%  1.92%  100.0%  0.00%     Percent  SE  17.3%  2.02%  82.7%  2.02%  100.0%  0.00%     Percent  SE  7.6%  1.52%  92.4%  1.52%  100.0%  0.00%     Percent  SE  14.5%  1.80%  85.5%  1.80%  100.0%  0.00%     Percent  SE  19.0%  2.32%  81.0%  2.32%  100.0%  0.00%     Percent  SE  15.8%  1.78%  27.5%  2.13%  33.5%  2.22%  23.2%  1.93%  100.0%  0.00%     Percent  SE  14.3%  1.73%  25.5%  2.07%  34.6%  2.24%  25.7%  2.00%  100.0%  0.00% 

  Robert Wood Johnson Foundation Health Care Consumer Confidence Index, July 2009 Report 

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   Worried cannot afford future prescriptions Very worried  Somewhat worried  Not too worried  Not worried at all  Total     Worried must keep current job for coverage (of ESI and not retired) Very worried  Somewhat worried  Not too worried  Not worried at all  Total     Worried will go bankrupt from medical bills Very worried  Somewhat worried  Not too worried  Not worried at all  Total     Rating of health care quality received  Excellent  Very good  Good  Fair  Poor  Total     How important it is that Obama includes health reform in addressing  economic crisis  Very important  Somewhat important  Not very important  Not at all important  Opposes health reform (if vol.)  Total 

   Percent  16.3%  22.7%  30.0%  31.0%  100.0%  Percent  6.4%  9.7%  14.5%  69.4%  100.0%  Percent  11.0%  11.9%  29.9%  47.2%  100.0%  Percent  25.6%  35.8%  26.5%  6.9%  5.2%  100.0% 

Percent  64.3%  20.4%  4.3%  9.7%  1.4%  100.0% 

SE  1.83%  1.98%  2.16%  2.14%  0.00%     SE  1.49%  1.91%  2.15%  2.85%  0.00%     SE  1.57%  1.53%  2.17%  2.35%  0.00%     SE  2.00%  2.27%  2.09%  1.26%  1.15%  0.00%     SE  2.27%  1.92%  0.96%  1.38%  0.52%  0.00% 

Source:  Robert Wood Johnson Foundation Health Care Consumer Confidence Index for June 2009.  Note: SE= Standard Error 

  Robert Wood Johnson Foundation Health Care Consumer Confidence Index, July 2009 Report 

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Table 5. Demographics, June 2009  Age  18‐34  35‐49  50‐64  65+  Total     Race  White Non‐Hispanic  Other  Total     Income  Bottom Third  Middle Third  Top Third  Total     Education  HS or less  Some college  College degree  Grad studies  Total     Sex  Male  Female  Total     Health Status  Excellent  Very good  Good  Fair/Poor  Total     Insurance Status  Insured  Private insurance  Public insurance  Uninsured  Total 

Percent  15.2%  28.4%  31.9%  24.5%  100.0%     Percent  81.4%  18.7%  100.0%     Percent  31.6%  31.7%  36.7%  100.0%     Percent  28.4%  22.6%  28.8%  20.2%  100.0%     Percent  43.8%  56.3%  100.0%     Percent  22.4%  30.7%  26.1%  20.8%  100.0%     Percent  90.5%  78.4%  39.4%  9.6%  100.0% 

SE 1.86% 2.15% 2.15% 1.95%

SE 1.93% 1.93%

SE 2.33% 2.27% 2.33%

SE 2.14% 2.01% 2.13% 1.83%

SE 2.35% 2.35%

SE 1.94% 2.15% 2.08% 1.96%

SE 1.49% 2.01% 2.39% 1.49%

Source:  Robert Wood Johnson Foundation Health Care Consumer Confidence Index for June 2009.  Note: SE= Standard Error 

  Robert Wood Johnson Foundation Health Care Consumer Confidence Index, July 2009 Report 

page 12 

Table 6. Standard Errors for Percent Concerned and Index Values by Demographics, June 2009      

Age Categories  18‐34  35‐49  50‐64  65+  Total     Race  White Non‐Hispanic  Other  Total     Income Categories  Bottom Third  Middle Third  Top Third  Total     Education  HS or less  Some college  College degree  Grad studies  Total     Sex  Male  Female  Total     Health Status  Excellent  Very good  Good  Fair/Poor  Total     Insurance Status  Insured  Private insurance  Public insurance  Uninsured  Total 

Recent  Health  Cost  Barriers  6.6% 4.5% 4.0% 4.0% 2.3%

Percents Future  Health  Health Care  Cost  Consumer  Concerns  Confidence  6.8% 6.6% 4.4% 4.1% 3.7% 3.5% 4.5% 4.5% 2.3% 2.2%

Index  Recent  Health  Cost  Barriers           6.28           4.06           3.48           2.68           2.01 

Health  Future  Care  Health Cost  Consumer  Concerns  Confidence            8.08            6.43            5.55            4.15            4.94            3.68            4.78            3.14            2.85            2.13 

2.6% 5.7% 2.4%

Percents 2.6% 5.2% 2.4%

2.5% 4.9% 2.3%

         2.14           5.64           2.04 

 Index             3.01             7.33             2.89  

         2.28           5.50           2.15 

4.5% 4.3% 3.3% 2.4%

Percents 4.0% 4.1% 3.9% 2.4%

3.7% 3.8% 3.9% 2.3%

         4.14           3.97           2.63           2.12 

 Index             5.70             5.00             4.11             2.98  

         4.01           4.07           2.94           2.22 

4.4% 5.1% 4.2% 4.7% 2.3%

Percents 4.3% 4.8% 4.4% 5.0% 2.3%

4.1% 4.3% 4.3% 5.0% 2.2%

         3.95           4.77           3.59           3.32           2.02 

 Index             5.62             6.24             5.05             5.57             2.86  

         4.05           4.82           3.84           3.95           2.13 

3.4% 3.1% 2.3%

Percents 3.6% 2.9% 2.3%

3.6% 2.8% 2.2%

         2.84           2.78           2.01 

 Index             4.21             3.80             2.85  

         3.02           2.89           2.13 

4.0% 3.9% 4.7% 5.3% 2.3%

Percents 4.9% 4.1% 4.5% 5.0% 2.3%

4.9% 4.1% 4.1% 4.6% 2.2%

         3.40           2.67           4.18           5.43           2.01 

 Index             4.65             4.80             5.78             6.97             2.85  

         3.29           3.11           4.34           5.64           2.13 

2.4% 2.5% 3.7% 7.8% 2.3%

Percents 2.4% 2.6% 3.9% 5.6% 2.3%

2.4% 2.5% 3.8% 5.2% 2.2%

         1.96           2.07           3.44           8.52           2.01 

 Index             2.86             2.98             4.90             9.11             2.85  

         2.08           2.15           3.58           7.83           2.13 

Source:  Robert Wood Johnson Foundation Health Care Consumer Confidence Index for June 2009. 

  Robert Wood Johnson Foundation Health Care Consumer Confidence Index, July 2009 Report 

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Table 7. Standard Errors for Health Care Quality, Health Reform Importance, and Coverage  Loss by Demographics, June 2009    

Percents

Age  18‐34  35‐49  50‐64  65+  Total 

Received  Quality Health  Care*  5.8%  3.0%  3.0%  1.8%  1.6% 

  

  

Race  White Non‐Hispanic  Other  Total     Income  Bottom Third  Middle Third  Top Third  Total     Education  HS or less  Some college  College degree  Grad studies  Total     Sex  Male  Female  Total     Health Status  Excellent  Very good  Good  Fair/Poor  Total 

Health Reform  Important**  2.7% 3.1% 3.1% 3.8% 1.7%

Worried may lose  coverage***  5.7% 4.4% 3.8% 3.7% 2.1%

1.6%  4.9%  1.6% 

Percents 2.0% 1.9% 1.7%

2.2% 6.5% 2.2%

3.4%  3.2%  2.4%  1.7% 

Percents 2.2% 3.2% 3.2% 1.7%

4.8% 4.0% 3.0% 2.2%

3.3%  4.1%  2.7%  2.3%  1.6% 

Percents 2.2% 3.3% 3.5% 4.3% 1.7%

4.2% 4.9% 3.7% 4.3% 2.1%

2.6%  2.1%  1.6% 

Percents 3.0% 1.9% 1.7%

3.1% 3.0% 2.1%

2.2%  2.7%  3.0%  4.9%  1.6% 

Percents 4.2% 3.1% 2.8% 3.3% 1.7%

3.8% 3.5% 4.4% 5.5% 2.1%

1.6%  1.6%  2.6%  8.1%  1.6% 

Percents 1.8% 1.9% 2.8% 5.9% 1.7%

  

  

  

  

   Insurance Status  Insured  Private insurance  Public insurance  Uninsured  Total 

2.1% 2.2% 3.5% 2.1%

Source:  Robert Wood Johnson Foundation Health Care Consumer Confidence Index for June 2009.  *Percent responding that health care received was "excellent", "very good", or "good" quality   **Percent responding that it was "very important" or "somewhat important" to the question, "How important is it that  President Obama include health care reform as part of his approach to addressing the economic crisis of the United States?"  ***Percent responding that they were "very worried" or "somewhat worried"      Robert Wood Johnson Foundation Health Care Consumer Confidence Index, July 2009 Report 

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Survey Questionnaire  Q1. Next we have some general questions about health care. Would you say that in general your health is excellent, very good, good, fair or poor? 1. EXCELLENT 2. VERY GOOD 3. GOOD 4. FAIR 5. POOR Q2a. In the past 12 months, was there any time when you (or someone in your family living there) delayed seeing a doctor when it was necessary because of the cost? 1. YES 5. NO Q2b. In the past 12 months, was there any time when you (or someone in your family living there) skipped a recommended medical test, treatment or follow-up because of the cost? 1. YES 5. NO Q2c. In the past 12 months, was there any time when you (or someone in your family living there) did not fill a prescription because of the cost? 1. YES 5. NO Q2d. In the past 12 months, was there any time when you (or someone in your family living there) did not get mental health care that was needed because of the cost? 1. YES 5. NO Q3. In the past 12 months, did you (and your family living there) ever have difficulty paying for your medical bills? [INTERVIEWER PROBE: “This would include doctor or hospital bills, dentist bills, bills for prescription drugs, nursing home bills or home care bills.”] 1. YES 5. NO Q4. Do you, yourself, have any kind of health care insurance or health plan at this time? This would include any private insurance plan through your (or your (spouse’s/partner’s)) employer   Robert Wood Johnson Foundation Health Care Consumer Confidence Index, July 2009 Report 

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or that you purchased yourself, including an HMO, or a government program such as Medicare or Medicaid. 1. YES 5. NO * GO TO Q7a *V Q5a. Are you currently covered by health insurance through your (or your (spouse’s/partner’s)) current or former employer or union? 1. YES 5. NO Q5b. Are you currently covered by health insurance purchased directly from an insurance company by you or another family member? 1. YES 5. NO Q5c. Are you currently covered by health insurance through Medicare, Medicaid, TRICARE, military health care, the VA or Veterans’ Administration or any other state or government plan? 1. YES 5. NO Q6. At this time, how worried are you that you will lose your health insurance coverage in the next 12 months? Are you very worried, somewhat worried, not too worried or not worried at all? 1. VERY WORRIED 2. SOMEWHAT WORRIED 3. NOT TOO WORRIED 4. NOT WORRIED AT ALL Q6_0. INTERVIEWER CHECKPOINT: 1. IF HAS EMPLOYER-SPONSORED HEALTH INSURANCE ONLY (Q5a=YES/Q5b AND Q5c=NO/DK/NA) --> GO TO Q6a-Q6d (SKIP Q6e) 2. IF HAS SELF-PURCHASED HEALTH INSURANCE ONLY (Q5b=YES/Q5a AND Q5c=NO/DK/NA) --> GO TO Q6b-Q6d (SKIP Q6a AND Q6e) 3. IF HAS GOVERNMENT HEALTH INSURANCE ONLY (Q5c=YES/Q5a AND Q5b=NO/DK/NA) --> GO TO Q6c-Q6e (SKIP Q6a-Q6b) 4. IF HAS EMPLOYER-SPONSORED AND SELF-PURCHASED HEALTH INSURANCE (Q5a AND Q5b=YES/Q5c=NO/DK/NA) --> GO TO Q6a-Q6d (SKIP Q6e)   Robert Wood Johnson Foundation Health Care Consumer Confidence Index, July 2009 Report 

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5. IF HAS EMPLOYER-SPONSORED AND GOVERNMENT HEALTH INSURANCE (Q5a AND Q5c=YES/Q5b=NO/DK/NA) --> GO TO Q6a-Q6e 6. IF HAS SELF-PURCHASED AND GOVERNMENT HEALTH INSURANCE (Q5b AND Q5c=YES/Q5a=NO/DK/NA) --> GO TO Q6b-Q6e (SKIP Q6a) 7. OTHERS --> GO TO Q6a-Q6e Q6a. Next I will read some reasons why people might worry about losing health insurance coverage. For each one, please say yes or no for your own situation during the next 12 months. Are you worried about losing coverage because your (or your (spouse’s/partner’s)) employer will stop providing coverage? 1. YES 5. NO 6. RETIRED; NOT WORKING (IF VOL.) Q6b. Are you worried about losing coverage because you (or your (spouse/partner)) might lose a job? 1. YES 5. NO 6. RETIRED; NOT WORKING (IF VOL.) Q6c. Are you worried about losing coverage because you (or your (spouse/partner)) might get a new job or position that does not offer coverage? 1. YES 5. NO Q6d. Are you worried about losing coverage because you (and your family) will not be able to afford the increasing costs of your current coverage? 1. YES 5. NO Q6e. Are you worried about losing coverage because the government might make cuts to your public health insurance program? 1. YES 5. NO Q7a. The next several questions are about the future. For each of the next questions, please tell me whether you are very worried, somewhat worried, not too worried or not worried at all. First, thinking about the future, how worried are you that you will not be able to afford treatment if you (or someone in your family living there) becomes seriously ill? Are you very worried, somewhat worried, not too worried or not worried at all?   Robert Wood Johnson Foundation Health Care Consumer Confidence Index, July 2009 Report 

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1. VERY WORRIED 2. SOMEWHAT WORRIED 3. NOT TOO WORRIED 4. NOT WORRIED AT ALL Q7b. Thinking about the future, how worried are you that you will not be able to afford all of the routine health care services you (and your family living there) might need? Are you very worried, somewhat worried, not too worried or not worried at all? 1. VERY WORRIED 2. SOMEWHAT WORRIED 3. NOT TOO WORRIED 4. NOT WORRIED AT ALL Q7c. (Thinking about the future,) how worried are you that you will not be able to afford all of the prescription drugs you (and your family living there) might need? (Are you very worried, somewhat worried, not too worried or not worried at all?) 1. VERY WORRIED 2. SOMEWHAT WORRIED 3. NOT TOO WORRIED 4. NOT WORRIED AT ALL Q7d. [IF Q6_0=1-2,4-7:] (Thinking about the future,) how worried are you that you will have to stay in your current job instead of taking a new job for fear of losing health benefits? (Are you very worried, somewhat worried, not too worried or not worried at all?) 1. VERY WORRIED 2. SOMEWHAT WORRIED 3. NOT TOO WORRIED 4. NOT WORRIED AT ALL Q7e. (Thinking about the future,) how worried are you that you will go bankrupt from not being able to pay your (family’s) medical bills? (Are you very worried, somewhat worried, not too worried or not worried at all?) 1. VERY WORRIED 2. SOMEWHAT WORRIED 3. NOT TOO WORRIED 4. NOT WORRIED AT ALL Q8. In general, how would you rate the quality of health care you (and your family living there) receive –- would you say that it is excellent, very good, good, fair or poor? 1. EXCELLENT 2. VERY GOOD 3. GOOD   Robert Wood Johnson Foundation Health Care Consumer Confidence Index, July 2009 Report 

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4. FAIR 5. POOR Q9. How important is it that President Obama include health care reform as part of his approach to addressing the economic crisis of the United States? Is it very important, somewhat important, not very important or not at all important? [INTERVIEWER PROBE: “This would include increasing health insurance coverage, increasing access and reducing cost.”] 1. VERY IMPORTANT 2. SOMEWHAT IMPORTANT 3. NOT VERY IMPORTANT 4. NOT AT ALL IMPORTANT 6. R OPPOSES HEALTH CARE REFORM (IF VOL.)

  Robert Wood Johnson Foundation Health Care Consumer Confidence Index, July 2009 Report 

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