Americans' confidence in their ability to access and pay for healthcare declined in July after two straight months of improvement, according to a consumer sentiment index produced by Thomson Reuters.

The Thomson ReutersConsumer Healthcare Sentiment Indexdropped from 99 in June to 96 in July, surrendering gains made since hitting a low of 95 in April.

U.S. healthcare consumers polled in July predicted they will be more likely to delay, postpone or cancel office visits, elective surgeries, and therapies in the next three months. They also said they have had, and expect to continue having, difficulty paying for healthcare services and insurance. This is a significant reversal from June, when consumers generally expressed optimism for the future.

"The index hit historic lows in April, rebounded in May and June, and recorded across-the-board declines in July," saidGary Pickens, chief research officer at the Thomson Reuters Center for Healthcare Analytics. "It is clear that consumer attitudes remain extremely volatile."

The index, which is based on the Thomson Reuters PULSE Healthcare Survey, has two parts:

• A retrospective component gauges respondents' experiences during the past three months. It tracks whether they postponed, delayed or cancelled healthcare services and whether they had difficulty paying for medical care or health insurance. In July, retrospective consumer sentiment dropped from 98 to 96.
• A prospective component gauges respondents' expectations for the next three months. In July, prospective consumer sentiment fell from 100 to 97.