Development and testing of the Health Confidence Index

We propose development of an index for the U.S. health care system similar to an indicator of subjective evaluations of the U.S. economy, the Consumer Confidence Index. Interest in monitoring public confidence in the quality of the health system has grown particularly due to the recent patient-as-consumer orientation to health care. The Health Confidence Index is conceptualized to tap into confidence in both individuals (e.g., doctors) and groups (e.g., insurance companies) in the health system; and confidence formed both through more macro perceptions of the system and first-hand experiences in getting medical care.

Findings from three studies are reported. The first study offers strong support for the reliability and construct validity of an initial index of health confidence analyzing survey data collected in summer 2004 (N= 2,497). In the second study, we examined monthly national survey data from January 2005 to August 2006 (N= 2,993); modified the Health Confidence Index, obtained further support for its reliability and validity, and observed relatively stable monthly trends in the Index during the period. In our third study using two different panel data sets (Ns= 1,830 and 502), some evidence for the predictive validity of the Index was obtained, although health confidence had reciprocal relationships with its potential outcomes in several cases.

How the Health Confidence Index may contribute to public health practitioners and policy makers' being more responsive to public needs as well as engaging in policy development is discussed.