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Trends, Costs  in Healthcare

2009 Survey of Health Care Consumers: Key Findings, Strategic Implications

Deloitte Center for Health Solutions

2009 Deloitte Survey of Health Care Consumers - The 2009 Survey of Health Care Consumers, conducted by the Deloitte Center for Health Solutions, is Deloitte’s second annual study of health care consumers’ attitudes, behaviors and unmet needs. It offers health care industry leaders and policymakers a comprehensive and timely perspective about how Americans approach their health, health care and health insurance.

The study’s framework reflects a broad-based view of consumerism in six zones: (1) wellness and healthy living, including self-care and health management; (2) information sources helpful in consumer decision making; (3) traditional health services provided by medical professionals, hospitals and retail clinics, as well as prescription medications and medical devices; (4) alternative health services sometimes described as complementary medicine; (5) insurance coverage and other financial considerations; and (6) opinions about health care reform.


A nationally representative sample of 4,001 American adults, ages 18 and older, was surveyed between October 2 and 10, 2008, using a web-based questionnaire. The results were weighted to assure proper proportional representation to the nation’s population, as reflected in the U.S. Census, with respect to age, gender, income, race/ ethnicity and geography. The margin of error around the U.S. point estimates is +/- 1.6% at the .95 confidence level.

The transformation of the U.S. health care system requires a deep understanding of the role that consumers play – how they think and behave relative to the lifestyles they choose, the purchases they make and the assumptions they follow in preparing for future health problems and possible costs.

The survey’s key conclusions are the following:

·         Health care is a consumer market: consumers find ways to navigate the complexities of the U.S. system by comparing service, quality and costs

• Most (73%) are confused about how the U.S. health care system works.

• Most (94%) believe that health care costs are a threat to their personal financial security (regardless of the insurance they have/don’t have or their health status).

• Over half (52%) believe that 50% or more of the dollars spent on health care in the U.S. are wasted.

• Most believe that the system is performing poorly: 80% give it a grade of C (42%) or below (38% give it a D or F); only 20% give it an A or B.

·         The health care market is not homogenous: it is comprised of six unique segments

·         Health cost concerns are changing behaviors

·         Consumers want holistic care and resources to pursue wellness and healthy living

·         Consumers embrace innovations that enhance self-care, convenience, personalization and control of their personal health information

A sample of interesting findings include:

·         Nearly 40 percent of consumers have expressed discontent with the status quo, rating the U.S. health care system a D or an F

·         A quarter of consumers have skipped care when they were sick or injured; two in five of those consumers have done so because they simply could not afford it, were not covered by insurance or thought the costs were too high

·         Three in 10 switched medications in the past year; 38 percent switched to save money

·         53 percent of consumers would like employers to be required to provide health insurance for employees

·         37 percent favor a mandate requiring every American to obtain health insurance either through direct purchase or through an employer or government program

·         7 in 10 say they would participate in a wellness program if they were given financial incentives, such as a reduced insurance premium or monetary reward

·         13 percent of consumers have visited a retail clinic this year and 30 percent said they would do so if it cost 50 percent or less than seeing a doctor in a doctor’s office

·         42 percent want access to an online personal health record connected to their doctor’s office

·         65 percent of consumers are interested in home monitoring devices that enable them to check their condition and send the results to their doctor

Consumers navigate the U.S. health care system in very different ways.

• There are six unique consumer segments that differ in their approach in many ways, including care preferences, levels of satisfaction and adherence, use of information,

and openness to innovative, non-conventional and alternative options.

• In the past year, the most traditional segment (Content & Compliant), the most alternative-leaning segment

(Out & About), and the least engaged segment (Casual & Cautious) have declined slightly in size, giving way to small increases in the segments that are most active with respect to various reflections of consumerism (Sick & Savvy, Online & Onboard, Shop & Save).

Zone One: Wellness and Healthy Living Interest in personal wellness is high, but actual effort to improve and maintain health is mixed.

• 7 of 8 Americans believe themselves to be in good health.

• Over half (54%) are actively putting effort into learning more about their personal health risks, preventing health problems and feeling good emotionally and mentally.

• Smokers insist they are trying to quit: 2 in 3 say they tried to cut back in the past year.

• 2 in 5 alcohol users say they tried to reduce consumption.

• However, less than half say they act in ways to make themselves healthier: 44% are trying to reduce stress, 44% are focusing on eating a healthy diet, 39% are putting effort into managing weight and 35% are exercising.  Interest in programs, tools and resources to assist with health improvement is high.

• 19% say they participated in a healthy living/wellness program in the last 12 months (up from the 17% who in 2008 said they had participated in the previous 24 months); 7 in 10 say they would participate if they were given a financial incentive such as a reduced insurance premium or monetary reward.

• 64% say they would be interested in using an in-home medical device that could help them know what to do, and when, to improve their health or treat a health condition.

• 44% express interest in programs and tools such as classes, fitness memberships, and health diaries that could help them monitor and improve their health.

• 37% say they are interested in using online tools that could help them assess, monitor and manage their health.

• Developing a “healthy lifestyle roadmap” based on a risk profile identified through risk assessment tools, screening and genetic testing is of interest to 39%.

• 1 in 3 consumers indicate they would be interested in working with a personal health coach who could help them create and stick to a personal health plan.

• 68% are interested in home monitoring devices that enable them to check their condition and send the results to their doctor.  Consumers with chronic conditions want self-care resources and health coaching to manage their condition.

• 7 in 10 adults with one or more chronic conditions (55% of total) say they follow their treatment regimen(s) closely, but adherence varies by age and insurance status.

• 32% of those with a chronic condition currently participate in a health/disease management program.

• Reported adherence increases with age: 48% of Gen Y, 60% of Gen X, 76% of Boomers, and 88% of Seniors report following their treatment regimen(s) closely; adherence is high among Medicare enrollees (85%), but low among the uninsured (51%).

• 3 in 5 say financial penalties such as higher insurance costs would increase their adherence to their chronic treatment regimen(s); 76% of consumers say they would participate in a health/disease management program; and 78% say they would agree to see a doctor or registered nurse regularly if a financial incentive was offered.

Consumers want to control their health information and prefer providers who use Internet-based tools to augment care.

• 9% have a computerized personal health record (PHR), compared to 8% in 2008.

• 57% want a secure Internet site that would enable them to access their medical records, schedule office visits, refill prescriptions and pay medical bills.

• 42% want access to an online personal health record connected to their doctor’s office.

• 55% want to be able to communicate with their doctor via email to exchange health information and get answers to questions.

• Privacy and security of personal health information is an issue: 38% are very concerned vs. 24% who are not at all concerned.

• 60% believe that the government should set standards for how medical information is collected, stored, exchanged and protected, while others view this as a role for health plans (21%) and employers (5%); 14% say no entity should set standards.

Satisfaction with hospital care overall is high (74%), although ER satisfaction (68%) lags.

• Satisfaction rose from 60% of hospital users in 2008 to 74% of hospital users in 2009.

• Satisfaction varies widely by insurance source, ranging from a low of 57% among the uninsured to a high of 81% among Medicare enrollees and 82% among the military.

• Fewer ER users are satisfied (68%) compared to inpatient (74%) and outpatient (79%) users.

Differentiation of hospitals based on perceived quality is significant and increasing.

• Consumers (62%) believe that hospitals vary with respect to quality, an increase from 55% in 2008.

• Comparing hospital quality is higher for inpatient use (15%) compared to outpatient use (8%).

• Most rely on recommendations from medical professionals (67%), websites (57%), friends and relatives (48%) and health plans (42%) to learn about quality differences.

Medication adherence is low: Only 4 in 10 say they take meds as directed.

• 6 in 10 say they “almost always” fill their prescriptions.

• While 8 in 10 say they adhere to drug labels most of the time, only 4 in 10 say they “always” take their medications as directed. Adherence is highest among Medicare enrollees, lower among the uninsured, Gen Y and Medicaid enrollees. 

Government mandates that infringe on individual choices are a concern to consumers. Additional taxation to cover the uninsured is unpopular.