A 2024 survey of more than 1,600 Ohio adults, conducted from September 26 to October 14, 2024, found that many respondents face challenges confidently navigating the health care system and understanding their cost-sharing obligations. 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.

CONFIDENCE OBTAINING CARE, UNDERSTANDING COST, RESOLVING ISSUES

Many Ohio respondents report being confident in their ability to fill a prescription or follow directions provided by their doctor. However, fewer are confident in their ability to resolve concerns related to financial obligations, such as disputing a medical bill or determining how much a procedure may cost. For example, more than two in five (47% of) respondents feel very or extremely confident they could resolve an issue if their a health plan was not responsive to their concerns (see Figure 1).

FINDING/INTERPRETING HEALTH CARE COST AND QUALITY 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 Among Ohio respondents, more than half (52%) of respondents feel confident in their ability to find the cost of a procedure in advance. In fact, among those who reported that they did not search for cost or quality information before a required procedure, 29% reported that the act of looking for information felt confusing or overwhelming, and 35% reported that they did not know where to look.

Although most respondents who searched for cost or quality information were successful, there were some who reported that they were unable to find the information they needed (see Figure 2). Fewer than half (41%) of respondents who searched for, but could not find hospital cost information, reported that the available cost information was confusing, 26% reported that their provider or hospital would not provide a price estimate, 30% reported that their insurer would not provide a price estimate and 29% reported that the price information was insufficient.

Likewise, among respondents who were unsuccessful in their search for hospital quality information, 31% reported that the resources were confusing, and 17% reported that the quality information was not sufficient. Notably, a small number of respondents reported that cost or quality is unimportant to them (17 and 7%, respectively). These challenges persist despite federal hospital price transparency mandates.⁵

Research shows little correlation between the quality and the price of medical services.⁶ However, 38% of respondents reported that they would be willing to pay more to see a doctor with higher quality rankings.Additionally, 54% of Ohio respondents reported that the out-of-pocket costs would a “very” or “extremely” important deciding factor if they had to choose between two providers with similar quality ratings. Likewise, 54% reported that quality ratings are an important factor when deciding between two physicians providing services for the same price.

DIFFICULTY UNDERSTANDING COMMON HEALTH CARE TERMS

Research indicates that nearly half of insured adults find at least one aspect of their insurance difficult to understand.⁷ When given multiple choices, three out of four (74% of) Ohio respondents were able to correctly define “premium,” and a similar amount (74%) were able to correctly define “deductible.” However, fewer than half (48%) were able to accurately define “coinsurance”(see Figure 3).  Of note, more educated respondents generally performed better when asked to define these terms (see Table 1).

UNEXPECTED MEDICAL BILLS

Twenty-two percent of Ohio respondents received a surprise medical bill in the past year. Among those, respondents with employer-sponsored health insurance most frequently reported receiving a surprise medical bill (26%), followed by respondents who purchase their own insurance (e.g., through the health care Marketplace) (25%); respondents enrolled in Health First Ohio, the state Medicaid program (21%); and those enrolled in Medicare coverage (18%).

When asked about the nature of their surprise medical bill, nearly half (49%) of respondents reported that the amount was higher than anticipated, and 36% reported that the bill was from a provider that they didn’t expect to receive a bill from. In smaller numbers, 17% reported being charged out-of-network rates by a provider they believed was in-network, 8% reported being charged for services they did not receive and 17% reported experiencing something else unexpected.

Beyond describing the nature of and/or reason the bill was unexpected, respondents also reported various attempts to resolve the issue. Of those who received an unexpected medical bill in the past year, nearly half (42%) took more than one step in their attempt to resolve their unexpected medical. Many contacted their health plan (40%) or provider (41%), some paid the bill without disputing it (15%), and few (10%) filed an insurance appeal (see Table 2).

Only 41% of respondents with an unexpected medical bill indicated that the issue was resolved to their satisfaction (see Table 3). Notably, satisfied respondents often reported employing more direct resolution strategies, such as contacting their health plan, whereas respondents who reported being dissatisfied with the resolution were more likely to have paid the original bill without disputing.

Regardless, the majority of respondents reported that they settled their bills by paying in full (31%) or through a payment plan (19%), while a smaller number successfully negotiated a lower bill (12%) or had their bill dismissed (9%) (see Table 4). In a small number of cases, (<1%) respondents reported filing for bankruptcy due to an unexpected medical bill. Some respondents (13%) also reported being contacted by a collection agency.⁸

SUPPORT FOR SOLUTIONS ACROSS PARTY LINES

The burden of health care costs and the widespread support for reform indicate that elected leaders and other stakeholders must prioritize addressing these consumer challenges. Ohio respondents overwhelmingly endorsed several transparency-oriented strategies, including:

• 94% — Show what a fair price would be for specific procedures;
• 92% — Require drug companies to provide advanced notice of price increases;
• 92% — Require insurers to provide up-front cost estimates to consumers;
• 91% — Require hospitals and doctors to provide up-front cost estimates to consumers;
• 88% — Establish standard payments to hospitals for specific procedures;
• 87% — Strengthen policies to drive more competition in health care markets;
• 86% — Impose price controls on contracts between insurers and health care providers;
• 86% — Set up an independent entity to rate doctor and hospital quality, such as patient outcomes and bedside manner; and
• 82% — Establish limits on health care spending growth.

Support for these solutions extended across the aisle, reflecting bipartisan agreement on the need for greater health care price transparency and policies designed to reduce the frequency of surprise medical bills (see Table 5). It must be noted that, although price transparency tools can help identify unwarranted price variation, these tools alone do not make markets more efficient and generally fail to encourage consumers to shop for lower-priced services.⁹ Instead, policymakers should consider a combination of transparency tools and evidence-based policies to effectively address these issues.

CONCLUSION

While Ohio respondents report confidence in following their doctor’s directions or filling prescriptions, they are less confident in handling cost issues and resolving problems with providers, health plans, and hospitals. Furthermore, poor understanding of common terms can make it difficult to anticipate out-of-pocket costs and budget for health care expenses. These difficulties may contribute to unexpected medical bills, increased affordability burdens, and challenges in resolving bills satisfactorily. State legislators and advocates should consider a variety of interventions, including price transparency resources and evidence-based policies, to improve health literacy, health insurance literacy and access to comprehensive health care cost and quality information.

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 26 to October 14, 2024, used a web panel from Dynata with a demographically balanced sample of approximately 1,700 respondents who live in Ohio. 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 1,670 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.