Following widespread media coverage of health care reform, political debates and legislative initiatives over the past year, consumers still profess to know very little about the health care system in the United States, according to the 3rd Annual Deloitte Center for Health Solutions Survey of Health Care Consumers. (www.deloitte.com/us/2010Consumerismsurvey)
Less than a quarter (23 percent) of consumers surveyed say they understand how the health care system works, but 76 percent grade the system a "C" or below and nearly half (48 percent) believe that 50 percent or more of health care dollars are wasted.
"In a year marked by historic debate over the future of the health care system, our survey indicates that not much has changed from 2009 to 2010 in terms of consumers' understanding and perceptions of the system," said Paul H. Keckley, Ph.D., and executive director of the Deloitte Center for Health Solutions. (www.deloitte.com/centerforhealthsolutions)
More than half (57 percent) of consumers surveyed say they are satisfied with their health plan, yet less than half (46 percent) say they understand their health insurance coverage, and one in four does not know how much they are paying for health insurance.
"While consumers tend to rate the 'system' low, when it comes to their own personal experience with their health insurance plan, doctor or hospital, they are much more likely to say they are satisfied, even if they do not know how much they are paying," added Keckley. "It will be interesting to see how this might change in the years to come as systematic reforms are implemented."
The Deloitte Survey also identified a variety of contradictions concerning consumers' perceptions, attitudes and behaviors about their health care decisions and personal health status.
Consumers perceive themselves to be healthy; Suffer from chronic conditions
Seven out of eight (88 percent) consumers surveyed believe they are in "excellent," "very good," or "good," health, yet more than half (54 percent) have been diagnosed with one or more chronic conditions and, of the 56 percent who take prescription medications, almost half (47 percent) take three or more daily. In addition, only one in five surveyed say they participate in a wellness program.
"At a time when U.S. obesity rates are at an all time high and diabetes and other chronic conditions continue to soar, the fact that people still believe they are healthy when reality tells a different story is a serious problem that will continue to challenge the health care system," added Keckley.
Split on government's role in health care; Prefer private competition
Consumers also have mixed emotions over government's role in the health care system. More than 40 percent (42 percent) support government-mandated health insurance, compared to 38 percent who oppose it. However, more consumers (42 percent) would choose an employer-sponsored plan versus the government's (25 percent), all other factors being equal. Less than half (46 percent) believe the competition from the government would be fair to private insurance plans and one in three consumers believe that the market needs 10 or more insurance companies competing to ensure consumer choice.
Financially confident; Forego care due to cost
"Despite economic uncertainty and high unemployment rates, one in four (24 percent) respondents are confident about managing their future health care costs," said Keckley. "While one might think this may be a reflection of economic stabilization, consumers' actual behavior tells another story. Of the people who skipped care when sick or injured (19 percent), four out of ten did so due to cost."
Interested in health records; Slow to use them
One in five consumers rates their interest in accessing personal health records through a secure Internet connection as high, would switch physicians to obtain access, and would be very likely to use a mobile communication device to access them. However, only 10 percent currently report actually having a computerized personal health record.
"Consumers tend to be resigned to the system when it comes to technology and service, and have modest desires compared with other industries, such as retail, banking and travel," commented Keckley. "The American Recovery and Reinvestment Act of 2009, or the 'stimulus package,' provides $22 billion for the investment in health care information technology with $19.2 billion dedicated to increase the use of electronic health records (EHRs) by physicians and hospitals. This should help revolutionize the health care delivery system as reforms are implemented and the industry leverages stimulus funding to modernize health records."
Additional key survey findings include:
- Despite the increased popularity in social networking, such as Facebook and Twitter, only 5 percent use social networking sites to look for information about prescription drugs, and just 3 percent use social networking sites to communicate with their physician or health plan.
- Interest toward in-home monitoring devices has decreased, with all age groups showing decreased interest. While 64 percent of consumers expressed interest in an in-home monitoring device in 2009, significantly fewer (49 percent) express interest in 2010.
- Slightly fewer respondents (33 percent) are concerned about the security and protection of online personal health records compared to 2009 (38 percent).
- Compared with last year (47 percent), fewer respondents (43 percent) say that their health care costs increased and more (46 percent) say that costs stayed the same compared to 2009 (42 percent).
- Fifteen percent of consumers say they used a retail clinic in the past 12 months.
- More than a third (34 percent) of consumers say they are likely to use a retail clinic if it cost 50 percent or less than a doctor's appointment compared to 30 percent of consumers who indicated they would do likewise in 2009.
- Consumers are receptive to medical tourism, but only 7 percent say they sought health care services outside their local community in the last 12 months.
- Confidence in prescription medications remains high and unchanged from 2009 survey results – three in four are confident that the medications they take are effective.
- Sixty-seven percent of consumers indicate that they would choose a generic medicine over a brand name if given a choice, a slight decrease from 2009 (71 percent).
- Two in seven respondents asked their doctor to prescribe a generic therapy because of cost concerns.
- More consumers are seeking alternative or natural remedies before seeing a physician (17 percent in 2010 compared with 12 percent in 2009) and more consumers are supplementing their current regimes with alternative remedies (20 percent in 2010 compared with 16 percent in 2009).
- Fourteen percent said they delayed or forewent treatment recommended by a doctor or medical professional.
"Consumers are a powerful force in health care," concluded Keckley. "To discount their role, to understate their impact and to relegate them to passive participants is a mistake. Reinforcing old paradigms that assume consumers will 'go along' with the status quo is short-sighted. However, mapping innovations to close the value gap consumers see in the system is a strategic opportunity."
A nationally representative sample of 4,008 U.S. consumers 18 years old and over was surveyed between December 28, 2009 and January 5, 2010, using a web-based questionnaire. The results were weighted to assure proper proportional representation to the nation's population, as reflected in the 2006 U.S. Census, with respect to age, gender, income, race/ethnicity and geography. The margin of error is +/- 1.6% at the .95 confidence level.