According to a new survey, the COVID-19 pandemic has changed Americans’ perceptions of health care, and not for the better.

According to the West Health-Gallup survey, released this week, nearly half of Americans believe the pandemic has worsened their perceptions of the U.S. health-care system, with many describing it as “broken” or “expensive.”

The high cost of health care was a major factor, with one-third of Americans purposefully delaying or declining medical care due to cost concerns.

In the midst of a pandemic, 14 percent of people with COVID-19 symptoms reported not seeking medical care because they were afraid they wouldn’t be able to afford it, according to an April 2020 Gallup poll. In the new survey, nearly all sectors of society, insured and uninsured, wealthy and poor, expressed deep concerns about the health-care system. The pandemic has also increased awareness of the disparities in the impact on Black, Hispanic, and other non-white populations.

According to the survey, nearly three out of every four Americans believe their household pays too much for the quality of health care they receive, and an estimated 58 million U.S. adults believe health care costs are a major financial burden for their families.

“It’s hard when you have three or four kids and you’re trying to juggle the cost, and you’re deciding whether I should go to the emergency clinic or can we wait another day,” one survey respondent, a white Republican woman in her 60s, told researchers.

Avoiding treatment due to rising costs is a problem that both rich and poor Americans face. Due to cost, approximately 34% of people with household incomes of less than $24,000 did not seek care in the previous three months. Twenty percent of people in high-income households (those earning more than $120,000 per year) said the same thing.

One in every five adults in the United States reported that they or a member of their household had a health problem worsen after delaying medical care due to cost concerns.

“Delaying care will only result in higher long-term costs,” said Dr. Blythe Adamson, founder of Infectious Economics LLC and an affiliate professor at the University of Washington. “If we detect cancer later, the patient will have poorer outcomes and require more expensive care.”

According to a West Health-Gallup poll, 60 percent of Americans are concerned about unequal access to quality health care services as a result of the pandemic. This fear was shared by three-fourths of Black Americans and two-thirds of Hispanic Americans, respectively.

“We, African Americans, get brushed aside a lot,” said one survey respondent, a Black, Democrat woman in her 40s. “Things we say, we feel get brushed off, they’re not really taking it seriously, like, oh, she’s just complaining again, or it’s not serious, that kind of thing.”

Essential workers, who earn less on average, continue to face higher COVID-19 risks than those who work in higher-paying, more Zoom-friendly jobs.

“We continue to see low-income workers who are exposed to high levels of COVID-19 at work but do not have insurance,” Adamson said. “These people are more likely to be hospitalized and bankrupt.”

While increased access to telemedicine has benefited some Americans, inequities persist. While other countries have government-backed health care, the United States still relies on a mix of public and private health insurers, which, according to Adamson, can lead to confusion and unequal pricing.

Furthermore, as Adamson pointed out, “many low-income people still do not have reliable internet, smartphones, or computers that they can use in a telemedicine visit.”

Overall, the survey results show that the pandemic appears to have harmed people’s perceptions of the United States’ health-care system.

“People’s perceptions of health-care value have shifted. Are we getting good value for every dollar we spend in this system on prevention, treatment, and hospitalization?” Adamson inquired.

Many of the existing health-care system’s shortcomings were highlighted by the COVID-19 pandemic.

“Our current system is unsustainable,” Adamson said, “especially for the poor.”