Summary

Hospitals provide essential services and are vital to the well-being of our communities. However, a recent survey of over 1,350 Michigan adults, conducted from June 30 to July 29, 2025, revealed widespread concern about the cost of hospital care, a lack of confidence in navigating the health care system, understanding their cost sharing obligations, and bipartisan support for government-led solutions. These challenges are sometimes attributed to insufficient levels of health insurance literacy or health literacy, which is associated with poorer health outcomes, lower patient satisfaction and higher costs.^1,2,3 This brief surfaces respondents’ experiences operating within the health care system, interpreting their cost-sharing obligations and highlights support for related policy solutions.

Concern about Affording Hospital Services

A majority of Michigan respondents report being concerned about their ability to afford care. In fact, 76% of Michigan respondents reported being worried about affording health care, both now and in the future, and nearly three in every five (58% of) respondents reported being “worried” or “very worried” about affording medical costs in the event of a serious illness or accident. Additionally:

• Fifty-eight percent (58%) of respondents reported being “worried” or “very worried” about affording medical cost when elderly.
• Sixty-two percent (62%) of respondents reported being ‘worried” or “very worried” about being able to afford home health care services.

Some respondents also reported cost burdens following care. In total, 37% reported experiencing a financial burden due to medical bills and 38% of respondents reported receiving an unexpected medical bill in the past year. Among respondents who reported receiving an unexpected medical bill in the past year, nearly half (53%) said at least one of those bills came from a hospital.

Confidence Seeking Hospital Care, Quality, Billing Information

Limited knowledge of health care quality or costs can hinder consumers’ ability to budget for care, which can be especially detrimental to the under- and uninsured.⁴ Michigan respondents are fairly confident in their ability to recognize when to seek emergency care, follow directions provided by their doctor, and their ability to fill a prescription. Sixty-one percent (61%) 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 (see Figure 1).

However, respondents are less confident in their ability to find hospital costs and quality information before a service. They are also less confident in their ability to resolve concerns related to financial obligations, such as disputing a medical bill. Out of all respondents:

• Fifty-two percent (52%) of respondents reported they were not confident in their ability to have enough money to cover their usual necessary medical cost;
• Sixty-five percent (65%) of respondents reported they were not confident in their ability to have enough money to cover major unexpected illnesses or injuries;
• Seventy-two percent (72%) of respondents reported they were not confident in their ability to afford home health care services;
• Fifty-two percent (52%) of respondents reported they were not confident in their ability to determine the cost of a medical procedure in advance;
• Sixty percent (60%) of respondents reported they were not confident they could resolve an issue if their health plan was not being responsive;
• Forty-six percent (46%) are not confident in their ability to find quality ratings for doctors; and
• Forty-six percent (46%) are not confident in their ability to find quality ratings for hospitals.

This lack of confidence may be reflected in the low rates of searching for hospital price and quality information. Only 31% of respondents reported trying to find the cost of a hospital stay ahead of time, while 15% of the respondents that reported needing a hospital service did not search for cost information at all. Among the respondents that did search for cost information or who required a hospital service:

• 19% were able to find the information they needed, and
• 12% attempted to find hospital cost information but were unsuccessful.

Similarly, fewer than half (41% of) Michigan respondents reported searching for hospital quality information. Among those that searched, 29% found the information they needed, 12% did not find what they needed, and 16% reported needing a hospital stay but not searching for quality information (see Figure 2). Among those that did search for hospital quality information, 51% were successful in their search, while 21% searched for hospital quality information but were unsuccessful.

Few respondents indicated that cost and quality information was not important to them (10% and 4%, respectively). Despite federal price transparency mandates for hospitals, hospital costs and quality ratings are still not always accessible.⁵ The most frequently cited reasons respondents did not attempt to find cost or quality information include:

• 28% followed their doctors’ recommendations or referrals;
• 28% did not know where to look;
• 24% reported that searching for information felt too confusing or overwhelming;
• 19% did not have time to look; and
• 15% reported that it did not occur to them to look for quality or price information.

The respondents who did attempt to find hospital cost information, but were unsuccessful, described several challenges:

• 30% reported that the available cost information was confusing;
• 28% reported that their insurer would not provide a price estimate;
• 25% reported that their provider or hospital would not provide a price estimate; and
• 22% reported that the price information was insufficient

Similarly, among the respondents who were unsuccessful in their search for hospital quality information, 22% reported that the resources were confusing and 11% reported that the quality information was not sufficient.

Comparing Cost and Quality Information

Among respondents who were able to successfully locate sufficient cost or quality information, 84% reported they were able to find enough information to successfully compare the costs of a hospital stay between two or more options, and 85% reported finding enough information to compare quality ratings across hospitals (see Figure 3). Respondents who were able to successfully compare cost or quality information between multiple providers reported that the comparison ultimately influenced their choice of which provider to seek care from. Specifically:

• 87% of respondents that compared costs for a primary care or specialist visit;
• 87% of those who compared the cost of medical test providers;
• 86% of those who compared the cost of a hospital stay; and
• 83% of respondents who searched for hospital quality information reported that the comparison influenced their decision.

Difficulty Understanding Common Health Terms

Research indicates that nearly half of insured adults find at least one aspect of their insurance difficult to understand.⁶ When given multiple choices, nearly three out of four (73% of) Michigan respondents were able to correctly define “premium,” and a similar amount (71%) were able to correctly define “deductible.” However, fewer than half (45%) were able to accurately define “coinsurance” (see Figure 4). Of note, more educated respondents generally performed better when asked to define these terms (see Table 1).

Impact, Concerns about Hospital Consolidation*

In some cases, health care consolidation, which occurs when hospitals and other health care facilities are joined together through a merger, acquisition, or other change of ownership, can magnify the challenges consumers face when seeking, comparing, and affording care.⁷ Although the number of survey respondents who reported they have been impacted by a consolidation transaction is too small to report reliable estimates, the survey results indicate that some encountered new challenges following consolidation.

There have been four changes in ownership (CHOW) involving Michigan hospitals through mergers, acquisitions, and other transactions involving health care organizations since 2017.⁸ Michigan requires that the State Attorney General must be notified of nonprofit hospital transactions, who has approval authority over transactions involving both nonprofit and for-profit hospitals.⁹ In total, 39% of respondents reported that they are aware of a health care consolidation transaction in their community.

Out of the 39% of respondents who reported being aware of a health care consolidation transaction, over one in ten (15%) reported that they or a family member lost access to a preferred health care organization due to changes arising from the merger. Among respondents who lost access to their preferred provider:

• 40%—switched to an in-network provider;
• 39%—skipped filling a prescription medication;
• 37%—skipped one or more recommended follow-up appointment(s) due to a merger;
• 30%—changed their health insurance plan to keep their preferred provider;
• 29%—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 merger;
• 19%—switched to telehealth options to continue seeing their preferred provider;
• 19%—continued seeing their provider but must now pay out-of-network prices; and
• 6%—had to change their preferred provider due to a merger resulting in a service closure

Some respondents reported additional challenges beyond losing access to their preferred health care provider. Out of those who reported that the merger caused an additional burden for them or their families, the most frequently reported consequences include:

• 28%—reported that the merger created an added financial burden;
• 22%—reported that the merger created an added wait time burden when searching for a provider who accepts new patients;
• 21%—reported that the merger led to additional transportation burdens; and
• 19% reported that the merger created a gap in the continuity of my care

Some respondents also provided examples of how they have been personally impacted following hospital consolidation. Examples include:

• “I cannot access my previous lab results due to the merger.”
• “I lost the physical therapist I’ve been working with for three years. They offered her another position over an hour away from her home. She declined. Her replacement has caused me a lot of pain ever since. Still working through that with a new place.”
• “After the merger my preferred doctor was no longer in-network, forcing me to switch providers and delaying needed care due to unfamiliar system and referrals.”
• “I lost a psychiatrist I had been working with for 5 years.”
• “Wait times for appointments became much longer after the merger.”

Although only a small number of respondents indicated that they have been personally impacted by health care consolidation, far more respondents (53%) reported being somewhat, moderately or very worried about the potential impacts of a consolidation transaction should one occur. When asked about their biggest concerns:

• 28% are concerned that their doctor may no longer be covered by their insurance;
• 22% reported that they are worried they would have fewer choices for care;
• 22% are concerned that they will have to pay more to see their doctor;
• 14% are concerned that the consolidation will result in lower quality of care; and
• 11% are concerned they will have to travel farther to receive care.

Respondent Perceptions of Health Care Systems, Policy Solutions

Hospitals, along with drug manufacturers and insurance companies, are viewed as a primary contributor to high health care costs. Out of eleven possible options, Michigan respondents most frequently reported believing that the reason for high health care costs due to powerful industry stakeholders, such as:

• 75%—Drug companies charging too much money
• 71%—Insurance companies charging too much money
• 69%—Hospitals charging too much money

Respondents endorsed a number of strategies to address high health care costs and transparency-oriented strategies, including:

• 93%—Show what a fair price would be for a specific procedures;
• 92%—Require insurers to provide up-front cost estimates to consumers;
• 91%—Require hospitals and doctors to provide up-front cost estimates to consumers;
• 87%—Set standard payments to hospitals for specific procedures;
• 86%—Strengthen policies to drive more competition in health care markets;
• 83%—Establish an independent entity to rate doctor and hospital quality, such as patient outcomes and bedside manner;
• 90%—Lower cost of follow-up care and treatment for people with chronic conditions like diabetes, liver disease and cancer.
• 82%—Require routine health services to cost the same no matter what facility those services are conducted at; and
• 84%—Establish limits on health care spending growth.

The survey findings indicate that while some Michigan 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 Michigan 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.¹⁰

Michigan respondents reported support for government-led solutions to make price and quality information more accessible and to help consumers navigate hospital care. Many favored solutions could 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.

1. A person’s ability to seek, obtain, and understand health insurance plans, and once enrolled, use their insurance to seek appropriate health care services. ↩︎
2. A person’s ability to obtain, process, and understand basic health information and services needed to manage one’s health and make appropriate health decisions. ↩︎
3. Shahid, R., Shoker, M., Chu, L.M. et al. (2022). Impact of low health literacy on patients’ health outcomes: a multicenter
   cohort study. BMC Health Serv Res 22, 1148. https://doi.org/10.1186/s12913-022-08527-9 ↩︎
4. 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-itspotential ↩︎
5. According to Health Forum, an affiliate of the American Hospital Association, hospital adjusted expenses per inpatient day
   in Michigan were $2,595 in 2023. See: Kaiser Family Foundation, State Health Facts Data: Hospital Adjusted Expenses per
   Inpatient Day, (Accessed August 2025). ↩︎
6. Pollitz, K., Pestaina, K., Montero, A., Lopes, L., Valdes, I., Kirzinger, A., Brodie, M., KFF Survey of Consumer Experiences with Health Insurance, (KFF, June 15, 2023) https://www.kff.org/report-section/kff-survey-of-consumer-experiences-with-healthinsurance-methodology/ (Accessed December 5, 2024). ↩︎
7. A CHOW typically occurs when a Medicare provider has been purchased (or leased) by another organization. The CHOW results in the transfer of the old owner’s identification number and provider agreement (including any Medicare outstanding debt of the old owner) to the new owner…An acquisition/merger occurs when a currently enrolled Medicare provider is purchasing or has been purchased by another enrolled provider. Only the purchaser’s CMS Certification Number (CCN) and tax identification number remain. Acquisitions/mergers are different from CHOWs. In the case of an acquisition/merger, the seller/former owner’s CCN dissolves. In a CHOW, the seller/former owner’s CCN typically remains intact and is transferred to the new owner. A consolidation occurs when two or more enrolled Medicare providers consolidate to form a new business entity. Consolidations are different from acquisitions/mergers. In an acquisition/merger, two entities combine but the CCN and tax identification number (TIN) of the purchasing entity remains intact. In a consolidation, the TINs and CCN of the consolidating entities dissolve and a new TIN and CCN are assigned to the new, consolidated entity. Source: Missouri Department of Health and Senior Services, Change of Ownership Guidelines—Medicare/State Certified Hospice. Retrieved December 5, 2024, from https://health.mo.gov/safety/homecare/pdf/CHOW-GuidelinesStateLicensedHospice.pdf ↩︎
8. Centers for Medicare and Medicaid Services. (2023). Hospital Change of Ownership. Retrieved June 5, 2024, from
   https://data.cms.gov/provider-characteristics/hospitals-and-other-facilities/hospital-change-of-ownership. ↩︎
9. The Source on Health Care Price and Competition, Merger Review, Retrieved December 5, 2024 from https://sourceonhealth care.org/market-consolidation/merger-review/ ↩︎
10. According to Health Forum, an affiliate of the American Hospital Association, hospital adjusted expenses per inpatient day
    in Michigan were $2,595 in 2023. See: Kaiser Family Foundation, State Health Facts Data: Hospital Adjusted Expenses per
    Inpatient Day, (Accessed August 2025). ↩︎