Executive Summary 

Hospital care is a major source of financial concern for many Virginia residents. Findings from Altarum’s Consumer Healthcare Experience State Survey (CHESS), conducted among more than 1,300 Virginia adults from July 9 to July 16, 2026, highlight widespread worry about hospital costs. The results also point to challenges understanding hospital costs and quality information and broad support for government action.

Key findings include:

• Worry about hospital costs is widespread: 75% of respondents reported worry about affording health care now or in the future, including hospital services.
• Hospital care is a common source of medical bills: More than one‑third of respondents (37%) experienced a financial burden from medical bills, and 22% reported outstanding medical bills; among those with outstanding bills, over half (62%) reported at least one hospital bill.
• Challenges finding hospital cost and quality information: Respondents reported lower confidence in having enough money or enough health insurance to cover major unexpected illnesses or injury and affording in-home care if the respondent or their family member required long-term support.
• Understanding insurance terms varies across respondents: Fewer than half of respondents correctly defined “coinsurance,” with lower understanding among respondents with less formal education.
• Broad, bipartisan support for solutions: Respondents across political affiliations expressed support for government actions related to hospital pricing, billing practices, and oversight of health system consolidation.

Together, these findings show that hospital care represents a significant source of financial risk for many respondents, often alongside challenges anticipating costs and assessing quality. At the same time, there is broad public support for efforts to improve hospital cost transparency and oversight.

Background

Hospitals provide essential care, but the cost of hospital services can be difficult for consumers to anticipate and afford. Findings from Altarum’s Consumer Healthcare Experience State Survey (CHESS) show widespread concern about hospital costs and gaps in consumers’ ability to find and interpret information about hospital prices, billing and quality.

This brief summarizes responses from more than 1,300 Virginia adults surveyed from July 9 to July 16, 2026, focusing on hospital affordability, access to cost and quality information, and support for related policy solutions. Detailed information on survey methods and respondent characteristics is available in the Appendix.

Worry about Affording Hospital Services

Seventy-five percent (75%) of Virginia respondents reported being worried about affording health care, both now and in the future, including affording services commonly provided in hospitals. Respondents frequently reported worry related to services and situations that may involve high out‑of‑pocket costs, including affording nursing home care or long-term support services (59%), paying for medical costs when elderly (55%), affording medical costs in the event of a serious illness or accident (52%), and experience a coverage denial for a necessary service (49%).

These concerns are reflected in respondents’ experiences after receiving care. More than one-third of respondents (37%) reported experiencing a financial burden due to medical bills and 22% of respondents reported having outstanding medical bills. Among the respondents who reported having outstanding medical bills, over half (62%) said at least one of those bills came from a hospital. Together, these findings show that hospital services are a major source of financial worry and medical bills for many respondents. Challenges affording care and anticipating hospital costs contribute to this concern, especially when information about prices, billing, and quality is difficult to find.

Challenges Finding Hospital Cost and Quality Information

Survey results indicate that hospital care presents distinct challenges related to understanding costs, billing, and quality information before services are provided. While many respondents report confidence navigating routine health care decisions, confidence is lower for tasks that involve anticipating or managing hospital costs and quality information.

Figure 1 illustrates this contrast across common health care-related tasks. Respondents were more likely to report high confidence in successfully completing activities such as filling a prescription to receive a medication at a pharmacy (80%) or following instructions from a provider (80%). In contrast, fewer respondents reported high confidence in tasks that are especially relevant to hospital care, including finding the cost of a procedure in advance (50%), locating quality ratings for hospitals (54%), and disputing a medical bill (51%).

Why This Matters

These gaps in confidence suggest that consumers may have limited ability to plan for potential out‑of‑pocket expenses or assess quality before hospital care. Challenges finding clear, usable hospital cost and quality information may increase the likelihood of unexpected medical bills and make billing problems harder to resolve after care.

Figure 1. Percentage of Respondents Who Feel “Very” or “Extremely” Confident They Can Complete Select Health Care Related Tasks

Source: 2026 Poll of Virginia Adults, Ages 18+, Altarum Healthcare Value Hub’s Consumer Healthcare Experience State Survey

Understanding Insurance Terms

Survey data also indicate that some respondents struggle with health insurance literacy. Although most respondents were able to correctly define “premium,” and “deductible,” fewer than half (46%) were able to accurately define “coinsurance,” a key component of hospital cost‑sharing after a deductible is met (Figure 2). Misunderstanding coinsurance can be particularly consequential for hospital services, where charges are often higher and cost‑sharing amounts are less predictable. 

Figure 2. Percent Who Chose the Correct Insurance Term Definition

Source: 2026 Survey of Virginia Adults, Ages 18+, Altarum Healthcare Value Hub’s Consumer Healthcare Experience State Survey
*Note: Totals may not equal 100% due to rounding.
Definitions: “Premium” is a fee paid on a regular schedule for an insurance policy; “Deductible” is the money you pay before an insurance company will pay a claim; “Coinsurance” is the percentage of a health care bill you pay after the deductible is met; “Copay” is the portion you pay for using specific covered services.

Understanding of insurance terms varied by educational attainment (Table 1). Respondents with lower levels of education were less likely to correctly define key cost‑sharing terms compared to those with a bachelor’s or graduate degree, which may make it harder for some patients to anticipate hospital costs and understand medical bills.

Table 1. Percent Who Correctly Defined Select Insurance Terms, by Education Level

Source: 2026 Survey of Virginia Adults, Ages 18+, Altarum Healthcare Value Hub’s Consumer Healthcare Experience State Survey
*Note: Totals may not equal 100% due to rounding.
**Respondents who reported completing some high school. Graduating from high school, or receiving a GED are represented in the “High School Diploma or GED” row; respondents who reported that they attended some or completed a graduate degree program are represented in the “Graduate School” row.
Definitions: “Premium” is a fee paid on a regular schedule for an insurance policy; “Deductible” is the money you pay before an insurance company will pay a claim; “Coinsurance” is the percentage of a health care bill you pay after the deductible is met; “Copay” is the portion you pay for using specific covered services.

Why This Matters

Understanding how insurance applies to hospital services often requires familiarity with terms that determine what patients pay out-of-pocket, such as deductibles, coinsurance, and copays. Survey results suggest that many respondents have difficulty accurately defining these terms, which can make it challenging to anticipate hospital charges before receiving care. Research indicates that nearly half of insured adults find at least one aspect of their insurance difficult to understand.¹

Perceptions of Who Drives High Costs

Survey respondents identified several factors as contributing to high health care costs. Drug companies were most frequently cited (72%), followed by health insurance companies (68%) and hospitals (56%), placing hospitals among the institutions commonly associated with rising health care expenses.

Support for Solutions to Address Hospital Costs and Transparency

Survey respondents expressed broad support for government actions aimed at addressing health care affordability, including strategies that relate specifically to hospital costs and transparency. Across political affiliations, respondents reported that it is important for the state to play a role in protecting consumers from high and unexpected medical costs and in improving access to information needed to navigate care (Table 2).

Virginia respondents supported a range of policy approaches relevant to hospital care, including limiting  excessive hospital prices, addressing billing practices that increase costs without improving care, and strengthening oversight of health system consolidation that may contribute to higher prices. Support for these strategies was observed among Republicans, Democrats, and Independents, suggesting shared concern about the impact of hospital costs on patients and families.

Together, these findings indicate that concerns about hospital affordability and transparency are accompanied by broad public support for government efforts to improve how hospital prices are set, communicated, and regulated.

Table 2. Percent Who Agreed or Strongly Agreed that the Government Should Employ Select Strategies, by Political Affiliation

Source: 2026 Survey of Virginia Adults, Ages 18+, Altarum Healthcare Value Hub’s Consumer Healthcare Experience State Survey

Conclusion

Findings from the Virginia Consumer Healthcare Experience State Survey show that hospital care is a significant source of financial concern for many respondents. Widespread worry about affording hospital services is accompanied by challenges finding and understanding hospital cost, billing, and quality information before care is received.

These findings show how difficulty anticipating hospital costs and assessing quality may increase the risk of unexpected medical bills and financial strain. At the same time, respondents across political affiliations express support for government efforts to improve hospital cost transparency and accountability, underscoring shared concern about the impact of hospital costs on patients and families.

Notes

1. 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-health-insurance-methodology/ (Accessed December 5, 2024).