Nearly one in four Americans put off medical treatment in the last year for fear they could not afford it, according to a Los Angeles Times Poll that has found widespread dissatisfaction with the accessibility of health care in the United States.
The nationwide survey found that nearly half of all Americans believe they would be unable to afford good care if they became critically ill, and that blacks, Latinos and the poor feel especially ill-prepared to face the threat of major sickness or surgery.
The poll also found significant disparities in the experiences of different groups within the health-care system, and a pervasive impression that the rich get the best care and the poor get the worst.
Blacks were especially critical of the system. They were more pessimistic about its ability to meet the nation's health-care needs, and more inclined than many others to blame rising costs on doctors, rather than on malpractice suits and inadequate government controls.
Latinos and the elderly, by contrast, appeared more sanguine. They were more likely than others to feel satisfied with the services they receive. And they were more inclined to believe that Americans get the best health care in the world.
"The feeling is not that the care is so bad " said I.A. Lewis, who directed the nationwide telephone survey of 2,046 Americans, conducted between Jan. 21 and 24. "It's the frustration with the cost. The cost is the big, big issue."
The poll examined public attitudes about the cost and quality of health care in the United States. It queried rich and poor, black and white, young and old, insured and uninsured on subjects ranging from emergency room care to nursing homes.
The findings suggest that experiences and attitudes differ widely:
* Blacks and Latinos are much less likely than others to get a correct diagnosis on their first visit to a doctor. Only one in three said they usually learn what is wrong on the first visit, compared to more than half of all Anglos and higher-income people.
* More than a third of all blacks, Latinos and those with incomes under $20,000 a year find themselves inadequately insured against the cost of major illness and major surgery. Fewer than a quarter of Anglos and the elderly, and only 11% of richer people are in the same position.
* Forty-eight percent of everyone polled said they would be unable to afford good care if they became critically ill. That feeling is especially acute among blacks, Latinos, the poor and the uninsured.
* Yet blacks, the elderly and the poor are more likely than others to be in ill health. Those same groups are more likely than others to have seen a doctor or been hospitalized in the last six months.
* Blacks and the poor are more likely to have put off treatment of a serious condition for fear of the cost. Nearly one in four blacks and one in five poor people said they had done so in the last year, compared to one in 10 Anglos and one in 20 of those making over $40,000 a year.
Perhaps as a result of those experiences, attitudes toward the system also differ.
Two-thirds of everyone polled agreed that the rich get the best health care in the United States. While more than half agreed that the poor get the worst care, blacks were twice as likely as others to suspect that they, in fact, get the worst care.
While most people feel the government must ensure that emergency room care is available to everyone, that feeling is almost universal among blacks--nearly one in five of whom reported using emergency rooms for routine care, compared to just one in 33 Anglos.
Latinos and the elderly are less likely than others to express dissatisfaction with the system. For example, the elderly were less critical of nursing-home care and less likely than others to express dissatisfaction with the cost of hospital care.
Latinos, too, are less likely to feel entitled to government-funded services and more likely to be happy with what they have. They are more likely to feel they have some control over the quality of health care, and less likely to feel victimized by costs.
However, the poll results also suggest considerable confusion.
While more than one in two Americans is convinced that U.S. health care is top-notch and worth the extraordinary expense incurred, two-thirds nevertheless say they would prefer the less expensive Canadian system of national health insurance.
"The thing that pervades this study is the anxiety and frustration people feel over health care costs, which almost everybody feels have gotten out of hand," said Lewis. "I think it says something when half the people in the United States say if they really got sick, they couldn't afford care."
The poll's margin of error is estimated to be three percentage points in either direction.
VIEWS ON HEALTH CARE The Los Angeles Times Poll surveyed 2,046 men and women throughout the United States about the cost and quality of health care. It found widespread dissatisfaction with the accessibility of care and a consensus that the rich get the best care and the poor get the worst.
Which group of people receives the best health care in the U.S.?* Rich people: 67%
People with insurance: 26%
People in military service: 20%
Families of doctors: 17%
High-ranking officials: 17%
People who live in big cities: 6%
Don't know: 4%
Which group of people receives the worst health care in the U.S.?* Poor people: 54%
Old people: 42%
People who live in rural areas: 12%
American Indians: 10%
Don't know: 8%
Do you think Americans receive the best health care in the world? Best in the world: 45%
Equal to other industrialized nations: 20%
Better than most industrialized nations: 12%
Worst of any industrialized nation: 8%
Don't know: 15%
* Adds up to more than 100% because of multiple answers.
SOURCE: Los Angeles Times Poll