NEW YORK (NYTIMES) - Americans borrowed an estimated US$88 billion (S$120 billion) over the last year to pay for healthcare, according to a survey released on Tuesday (April 2) by Gallup and the non-profit West Health.

The survey also found that one in four Americans have skipped treatment because of the cost, and that nearly half fear bankruptcy in the event of a health emergency.

There was a partisan divide when respondents were asked whether they believed that the American healthcare system is among the best in the world: Among Republicans, 67 per cent of respondents said they believed so; that number was 38 per cent among Democrats.

But Democrats and Republicans had similar responses about putting off medical treatment. Asked if they had deferred treatment because of the cost, 27 per cent of Democrats said they had, compared with 21 per cent of Republicans and 30 per cent of independents.

Respondents from across the political spectrum also reported pessimism about their leaders' abilities to reduce healthcare costs.

About 70 per cent of respondents said they had no confidence in their elected officials to bring prices down. And 77 per cent said they were concerned that rising healthcare costs would damage the American economy.

"Our data shows an American public that's beaten down from this really serious issue," said Mr Dan Witters, a senior researcher at Gallup.

At the same time, 64 per cent of respondents said they were mostly satisfied with their experiences in the healthcare system. When asked if they were satisfied with how well the system was serving Americans generally, only 39 per cent said they were.

The survey's authors noted that Americans' feelings were complicated and at times conflicted. But one thing was clear: High healthcare costs had created significant anxiety.

Even among households earning US$180,000 or more a year, a third of respondents said they were concerned about the spectre of personal bankruptcy due to a health crisis. (There has been fierce debate among researchers about the extent to which healthcare costs can be blamed for bankruptcies.)

Many American families earning less than that, of course, feel the effects of high healthcare costs acutely. They are forced to cut back on other expenses to pay for healthcare, or skip appointments and prescription refills, creating health risks down the road.

Twelve per cent of respondents said they had borrowed money for care, including 11 per cent of those with health insurance, who may still face high deductibles and other out-of-pocket expenses.

Most survey respondents said they believed that Americans were paying too much for healthcare relative to what they receive.

Asked to choose between a hypothetical freeze in their healthcare costs or a 10 per cent increase in household income, 61 per cent of respondents chose the freeze. Those in low-income households were most likely to choose that option.

"When we're talking about healthcare and the debate right now, it usually bifurcates between the financial impact of healthcare or the health outcomes themselves," said Mr Tim Lash, chief strategy officer for West Health, a non-partisan non-profit that aims to lower healthcare prices.

"But those two things intersect at access", which can have dire health consequences, he said.

The organisation believes that Congress should allow Medicare to negotiate directly with drug companies; that there should be more transparency about the prices of medicines and procedures; and that the healthcare industry should shift toward "value-based care" - in which doctors are paid based on patient outcomes - rather than the current "fee-for-service" model.

Mr Lash noted that other wealthy countries spend much less on healthcare than the United States does, while achieving better outcomes in areas like life expectancy and infant mortality. Although about 87 per cent of Americans have health insurance, according to data from Gallup, an individual's plan may not cover all costs associated with treatment.

US President Donald Trump, who has sought to undo the Affordable Care Act, tweeted about high deductibles under the law on Monday morning, promising that "Good things are going to happen!" and tagging several Republican lawmakers.

The administration asked a federal appeals court to invalidate the law last week, while Democrats announced a healthcare Bill that builds on the Affordable Care Act and seeks to lower premiums, among other goals.

The partnership between West Health and Gallup, the analytics and consulting company, was a first. The survey results are based on phone interviews conducted in English and Spanish in early 2019 with a random sample of 3,500 adults across the country. Gallup and West Health said they will conduct similar surveys in the coming years.