As Americans pay more and more for health care, their perceptionof the companies and people they depend on for treatment is notparticularly flattering.

Related: 10 potential changes to health care come January20th

While the United States is one of the only countries in theworld that allows pharmaceutical companies to advertise theirproducts, the billions of dollars drug-makers have spent on TV ads,billboards and the like has hardly bought them any trust from theAmerican public.

A new survey shows only 9 percent of Americans agree with thestatement that pharma and biotechnology firms “put patients overprofit.” Thirty-eight percent disagree, while 52 percent say theyare neutral.

Health insurers fare better, but only barely. Sixteen percentthink insurers are focused on patients, according to the survey of1,018 adults conducted by Harris Poll. Thirty-five percent say healthplans do not put patients over profit, while roughly half areunsure.

Related: 10 cities where you don't want to getsick

Perhaps most striking is how few Americans believe that doctors,nurses and hospitals’ top priority is patient well-being.

Only 36 percent say that health care professionals put patientsover profits, although only 10 percent assert that is not the case.Fifty-four percent are neutral on the question.

Similarly, only 23 percent say hospitals prioritize patientsover profits, while 19 percent disagree and 58 percent are neutral.The fact that a large swath of hospitals are nonprofit does notappear to have much of an effect on people’s perceptions of theirmotives.

Related: 20 conditions top U.S. health carespending

While few consumers believe the health care industry operatesout of altruism, far more believe the health care they receive ishigh quality. Roughly half believe that pharmacies, doctors andnurses providers offer high quality products and services.

However, pharmaceutical companies and insurers receive poorratings when it comes to quality. Only 31 percent say that pharmadelivers high quality products and only 26 percent say the sameabout insurers.

That so few actors in the health care sector elicit confidenceis indicative of a health care “maelstrom,” says Wendy Salomon,vice president of reputation management and public affairs atNielsen, the parent company of Harris Poll.

“While at times the pharmaceutical industry seems an easy targetfor criticism, it is stunning to see the little credit it receivesfor making a positive difference,” says Salomon. There are realopportunities for companies across the health care landscape toproactively share their stories and engage in reducing reputationalrisk.”