Data Brief | | November 2024

Idaho Survey Respondents Worry about High Hospital Costs, Have Difficulty Estimating Quality and Cost of Care; Express Bipartisan Support for Government Action

Hospitals provide essential services and are vital to the well-being of our communities. However, a survey
of more than 1,300 Idaho adults, conducted from September 6 to September 30, 2024, revealed
widespread concern about hospital costs and bipartisan support for government-led solutions.

Hardship and Worry About Hospital Costs

80% of Idaho respondents reported being worried about affording health care both now and in the future.
Likewise, 47% reported experiencing a cost burden due to medical bills, and over 3 in every five (61% of)
respondents reported being “worried” or “very worried” about affording medical costs in the event of a
serious illness or accident. These concerns may be justified — of the 21% of respondents who reported
receiving an unexpected medical bill in the past year, 42% say that at least one came from a hospital.

Skills Navigating Hospital Care, Cost, and Quality Information

Idaho respondents are fairly confident in their ability to recognize when to seek emergency care. Sixty-
seven percent (67%) of respondents are very or extremely confident that they know when to visit the
emergency department as opposed to an urgent care center or a primary care provider. However, they
are less confident in their ability to find hospital costs and quality information. Thirty-nine percent (39%)
of respondents are not confident in their ability to find the cost of a procedure in advance, and less than
half lack confidence in their ability to find quality ratings for doctors (44%) or hospitals (41%).

Those figures may be reflected in the low rates of searching for hospital price and quality information.
Only 43% of all respondents attempted to find the cost of a hospital stay ahead of time, and 14% needed a hospital stay but did not search for cost information. Among the respondents who tried to find hospital
cost information or needed a hospital stay, 48% were able to find the information they needed; 27%
attempted to find hospital cost information but were unsuccessful; and 25% did not attempt to find
information when they needed a hospital (see Figure 1).

Similarly, nearly half (48% of) respondents reported searching for hospital quality information, and 14%
reported needing a hospital stay but not searching for quality information. Of those who did search for
hospital quality information or needed a hospital stay, 49% were successful in their search; 27% searched
for hospital quality information but were unsuccessful; and 23% did not attempt to find quality
information despite needing a hospital stay (see Figure 1).

Notably, a small number of respondents reported that cost or quality is not important to them (10 and 6%,
respectively). Additionally, despite federal price transparency mandates for hospitals, hospital costs and
quality ratings are still not always accessible.¹ This is reflected in the most frequently cited reasons
respondents gave for not searching for cost or quality information, which include:

• 30% — They followed their doctors’ recommendations or referrals;
• 26% — Looking for information felt confusing or overwhelming;
• 25% — They did not know where to look;
• 18% — They did not have time to look; and
• 16% — It did not occur to them to look for provider quality or price information.

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Respondents who were unsuccessful in their search for hospital cost information described several
challenges. Forty-five percent (45%) reported that the available cost information was confusing; 31%
reported that their provider or hospital would not provide a price estimate; 37% reported that their
insurer would not provide a price estimate; and 24% reported that the price information was insufficient.
Likewise, among respondents who were unsuccessful in their search for hospital quality information, 30%
reported that the resources were confusing, and 13% reported that the quality information was not
sufficient.

However, among those who were successful in their search for cost or quality information, 37% reported
they were able to find enough information to successfully compare the costs of a hospital stay between
two or more options, and 34% reported finding enough information to compare quality ratings across
hospitals (see Figure 2). Many of these respondents reported that the comparison ultimately influenced
their choice of which provider to seek care from. 83% of respondents who compared the cost of a
primary care provider or specialist visit, 80% of those who compared the cost of medical test providers
and 76% of those who compared the cost of a hospital stay reported that the comparison influenced their
choice of hospital or provider. Likewise, 88% of respondents who searched for hospital quality
information reported that the comparison influenced their decision of hospital.

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Impact of and Worry Related to Hospital Consolidation*

In the past year, 27% of respondents reported that they were aware of a health provider or facility closure
in their community—of those respondents, 37% reported that they or a family member were unable to
access their preferred health care organization because of a closure that made their preferred
organization out-of-network. Out of those who reported being unable to access their preferred health
care provider due to a closure:

• 37% — skipped recommended follow-up visits due to a closure;
• 34% — delayed or avoided going to the doctor or having a procedure done because they could no longer access their preferred health care organization due to a closure;
• 31% — changed their preferred doctor or hospital to one that is in-network;
• 29% — have changed their preferred provider due to a closure resulting in a service closure;
• 25% - skipped filling a prescription medication;
• 21% — changed their health plan coverage to include the preferred doctor or hospital;
• 20% — have switched to telehealth options to continue seeing their preferred provider; and
• 8% —stayed with their preferred health care provider and now pay out-of-network prices.

Out of those who reported that the closure caused an additional burden for them or their families, the top
three most frequently reported issues were:

• 29% — The closure created an added wait time when searching for a new provider
• 22% — The closure created an added financial burden
• 19% — The closure created a gap in the continuity of my care

While a smaller portion of respondents reported being unable to access their preferred health care
organization because of a closure, far more respondents (79%) reported being somewhat, moderately or
very worried about the impacts of closures in their health care organizations. When asked about their
largest concern respondents most frequently reported:

• 31% — I’m concerned I will have fewer choices of where to receive care
• 19% — I’m concerned my doctor may no longer be covered by my insurance
• 19% — I’m concerned I will have to travel farther to see my doctor
• 18% — I’m concerned I will have to pay more to see my doctor
• 9% — I’m concerned I will have a lower quality of care

To ascertain additional information on the specific ways that health system consolidation impacts Idaho
residents, survey respondents were asked to share their experiences following hospital consolidation (see
Table 1).

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Support for Solutions Across Party Lines

Hospitals, along with drug manufacturers and insurance companies, are viewed as a primary contributor to high health care costs. Out of fifteen possible options, Idaho respondents most frequently reported
believing that the reason for high health care costs is unfair prices charged by powerful industry
stakeholders, such as:

• 64% — Drug companies charging too much money
• 63% — Insurance companies charging too much money
• 62% — Hospitals charging too much money
• 52% — Large hospitals or physician groups using their influence to increase payments from insurance companies

Respondents endorsed a number of strategies to address high health care costs, including:

• 91% — Require hospitals and doctors to provide up-front cost estimates to consumers;
• 89% — Set standard payments to hospitals for specific procedures;
• 88% — Strengthen policies to drive more competition in health care markets; and
• 85% — Impose price controls on contracts between insurers and health care providers;
• 84% — Establish an independent entity to rate doctor and hospital quality.

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Conclusion

The poll findings indicate that while some Idaho respondents are motivated to search for hospital cost and
quality information to inform their decisions and plan for future medical expenses, over half did not seek
this information at all. This suggests that price transparency initiatives alone may not effectively influence
consumer behavior. The lack of knowledge of hospital quality and potential costs may impede Idaho
residents’ ability to plan for needed care and budget for the expense of a hospital stay, which can be
costly, particularly for residents who are uninsured or under-insured.²

Unsurprisingly, Idaho respondents strongly support government-led solutions to make price and quality
information more accessible and to help consumers navigate hospital care. Many favored solutions would
reduce the burden on consumers, such as standardizing payments for specific procedures, requiring cost
estimates from hospitals and doctors, and establishing an independent entity for quality reviews.
Policymakers should consider these and other policy options to address the bipartisan call for government
action.

Notes

1. As of January 1, 2021, the Centers for Medicare and Medicaid Services (CMS) requires hospitals to make public a
   machine-readable file containing a list of standard charges for all items and services provided by the hospital, as well as a consumer-friendly display of at least 300 shoppable services that a patient can schedule in advance. However, Compliance from hospitals has been mixed, indicating that the rule has yet to demonstrate the desired effect. https://www.healthaffairs.org/content/forefront/hospital-price-transparency-progress-and-commitment-achieving-its-potential
2. According to Health Forum, an affiliate of the American Hospital Association, hospital adjusted expenses per inpatient day in Idaho were $3,666 in 2021, similar to the national average. See: Kaiser Family Foundation, State Health Facts Data: Hospital Adjusted Expenses per Inpatient Day. Accessed November 11, 2024. https://www.kff.org/health-costs/state-indicator/expenses-per-inpatient-day/

Methodology

Altarum’s Consumer Healthcare Experience State Survey (CHESS) is designed to elicit respondents’ views on a wide range of health system issues, including confidence using the health system, financial burden and possible policy solutions. This survey, conducted from September 6 to September 30, 2024, used a web panel from Dynata with a demographically balanced sample of approximately 1,300 respondents who live in Idaho. Information about Dynata’s recruitment and compensation methods can be found here. The survey was conducted in English or Spanish and restricted to adults ages 18 and older. Respondents who finished the survey in less than half the median time were excluded from the final sample, leaving 1,365 cases for analysis. After those exclusions, the demographic composition of respondents was as follows, although not all demographic information has complete response rates:

Percentages in the body of the brief are based on weighted values, while the data presented in the demographic table is unweighted. An explanation of weighted versus unweighted variables is available here. Altarum does not conduct statistical calculations on the significance of differences between groups in findings. Therefore, determinations that one group experienced a significantly different affordability burden than another should not be inferred. Rather, comparisons are for conversational purposes. The groups selected for this brief were selected by advocate partners in each state based on organizational/advocacy priorities. We do not report any estimates under N=100 and a co-efficient of variance more than 0.30.