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As economic conditions worsen, the public is increasingly worried about the affordability and availability of care, with many postponing or skipping medical treatments because of cost in the past year and a notable minority forced into serious financial straits because of medical bills, according to the Kaiser Family Foundation's first healthcare tracking poll of 2009.


Slightly more than half (53%) of Americans say that their household cut back on healthcare because of cost concerns in the past 12 months. The most common actions reported are relying on home remedies and over-the-counter drugs rather than visiting a physician (35%) or skipping dental care (34%). Roughly one in four (27%) report putting off healthcare they needed, one in five (21%) say they have not filled a prescription, and one in six (15%) say they cut pills in half or skipped doses to make their prescription last longer.


The 27% of the public who reported that they had "put off or postponed getting healthcare they needed&" were asked about the specific types of care they had foregone. The most common responses were delaying going to the physician for a temporary illness (19%) or for preventive care (19%). But nearly as many (16%) report putting off care for a more serious problem, either postponing a physician's visit related to a chronic illness such as diabetes or delaying major or minor surgery.


Not all medical care can be postponed, however, and the survey indicates that roughly one in five (19%) people experienced serious financial problems recently because of family medical bills. Specifically, 13% say that they have used up all or most of their savings trying to pay off high medical bills in the past 12 months, and just as many say that their medical debt means that they have difficulty paying other bills. A similar proportion (12%) say that they have been contacted by a collection agency, while a smaller share (7%) report being unable to pay for basic necessities like food, heat, or housing.


Beyond actual financial hardship due to medical care, the survey also indicates a rise in worries associated with healthcare costs. Nearly half of Americans (45%) report that they are "very worried&" about having to pay more for their healthcare or health insurance, the highest proportion measured in Kaiser polls since late 2006. Roughly four in 10 (38%) are very worried about affording healthcare they need-a number that rises to 56% among those who believe that someone in their household will lose a job this year.


Fully one-third (34%) of those with health coverage are worried they will lose it. While these concerns are prevalent among low-income Americans, one-third of households earning between $30,000 and $75,000 per year are also "very worried&" about losing their healthcare benefits.


Healthcare ranks as one of the top issues on the nation's policy agenda. The economy dominates (71%) the public's priorities for the president and Congress, followed by making Medicare and Social Security more financially sound (49%)-a new issue added to the list this month. Terrorism (42%) and healthcare (39%) rank third and fourth, respectively.


While health reform remains popular, the public has high expectations for how easily reform might be achieved. Most Americans (58%) say that if policymakers made the right changes, they could reform healthcare "without spending more money to do it." This majority view is shared across political party identification, age group, and income level. A majority (56%) of the public also believes that the health system can be reformed "without changing the existing healthcare arrangements of people like yourself."


When Americans hear policymakers talk about healthcare reform, they predominantly are thinking about cost and coverage. When asked what "healthcare reform&" means to them, 40% of the public respond with a cost concern-people paying less for care, care being more affordable, or lowering the prices of medical goods such as prescription drugs. Just as many (39%) describe reform as providing insurance to more people or helping the uninsured. Quality or delivery system reform did not leap to the minds of Americans, with only 9% mentioning it in their responses.


The survey was conducted February 3 through February 12, 2009, among a nationally representative random sample of 1204 adults aged 18 years and older. Telephone interviews conducted by landline (903) and cellular phone (301, including 123 who had no landline telephone) were carried out in English and Spanish. The margin of sampling error for the total sample is +/-3 percentage points. For results based on subgroups, the margin of sampling error is higher.


The full question wording, results, charts, and a brief on the poll can be viewed online at


The Kaiser Family Foundation is a nonprofit private operating foundation, based in Menlo Park, CA, dedicated to producing and communicating the best possible information, research, and analysis on health issues.