For the past five years Deloitte has been conducting an annual survey of consumer “opinions and expectations about our health care system.” I love this survey because it treats health care consumers with the respect they (we) deserve. Deloitte contrasts its attitude with that of other players –
In the health care industry, physicians call consumers “patients,” health plans call them “enrollees” or “members,” and bio-pharma companies refer to them as “users” or sometimes “subjects,” if they are involved in a clinical trial. Many of the designations in health care infer that individuals play a primarily passive or reactionary role.
Deloitte reports –
Based on the results of our survey, among consumers, there is a widening gap between their unmet needs and the system’s performance.
Consumers see the current health care system as complicated and wasteful, failing to deliver value for the money spent. But they also see areas of strength –
Consumers see system strengths in medical technology, innovative treatments and services (61 percent) and meeting the needs of the insured (54 percent), whereas the system is considered to fail (rating performance as a “D” or “F”) those without insurance (53 percent) and to offer poor value for money spent on health care (44 percent).
Increasing perceptions of waste and lack of value may be contributing to dissatisfaction with the system; in 2012, 62 percent believe that 50 percent or more of the dollars spent on health care are wasted – up from 51% in 2009; 49% in 2010; and 51% in 2011. In 2012, only 25 percent feel that the best value is obtained for the money spent.
Satisfaction with primary care providers is high and growing, with 76% expressing satisfaction in 2012, compared to only 66% in 2008. But satisfaction is even higher with prescription drugs, with 88% of those using prescriptions saying they understand how their medications work, 87% understand the risks and side effects, and 86% believing their drugs are effective.
Most also are satisfied with their insurance, though that has been dropping over time, with 84% feeling “well” or “adequately” insured in 2012, down from 90% on 2009.
Three in five consumers (57 percent) would like to customize their own health plan by being able to select features (knowing that the cost would reflect the benefits and features chosen) rather than having pre-defined options.
This is at the top of a list of innovations consumers say they would be interested in, followed by –
Close to half (47 percent) of consumers say they are willing to seek care from a nurse practitioner or physician assistant and 25 percent will consider visiting a retail clinic if a physician is not available.
Support for ObamaCare is slipping in this survey. In 2011, 49% said “the health reform law is a good start,” while 21% said “it is a step in the wrong direction.” A year later (2012) only 38% said it was a good start and 34% said it was a step in the wrong direction.
A small plurality believe the law will increase access to coverage (27% to 20%), and increase the use of information technology (21% to 20%), but on other measures, pluralities feel it will fail to –
- Improve quality (20% to 26%)
- Motivate people to improve their health (20% to 24%)
- Get providers to work together to better manage patient care (20% to 22%)
- Ensure access to new technology (18% to 22%)
- Lower health care costs (16% to 32%)
Deloitte sums up its findings –
Understandable skepticism about “health care consumerism” is widespread: physicians believe most consumers are disinterested or not inclined to study treatment options and share decision-making about their care. Health economists consider the gap between costs and pricing in health care, and its lack of price transparency problematic. Health insurance plans and employers consider unhealthy lifestyles and non-compliance by consumers to evidence-based recommendations a major hurdle. Medical device and bio-pharma depend on business models that assume physicians are the decision- makers, not consumers. Most consider consumerism inevitable, but the path to a consumer-centric health system in the U.S. is wrought with regulatory and practical issues. And for policymakers seeking to “reform the system,” the issues are compounded by the public’s lack of understanding of the policies and structural framework of the U.S. health system. Instead, consumers frame their views about what they see in their communities, what they hear from the doctors, pharmacists and health care workers they know, and their periodic interaction with their insurance company – sometimes involving a dispute, sometimes enrollment, or sometimes a denial.
This disconnect between the people providing the care and the people receiving it is not healthy.
Consumers wish to engage the health system directly and purchase health services with the same energy and rationality they use when selecting cars and homes. But they are resigned to believe it is too complicated to act accordingly.
The health care “system” has long desired to keep consumers as passive recipients of services, but people are growing restless with this attitude. This arrangement has resulted in a system that is too expensive, too inefficient, too bureaucratic, unaccountable, and wasteful. Ready or not, Americans are rising up to take more control over their own care.