Deloitte’s Consumer Engagement Survey

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.

Interestingly –

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.

Comments (9)

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  1. JoeMac says:


    I assume you are referring to third party payment… right? If that is the case then why doesn’t any health insurance company offer plans for individuals or groups without third party payment. I consumers want them then shouldn’t they have created them by now? What is stopping them?

  2. H. James Prince says:

    I don’t see how more cost transparency in healthcare could ever possibly be a bad thing.

  3. Devon Herrick says:

    The health care “system” has long desired to keep consumers as passive recipients of services, but people are growing restless with this attitudeReady or not, Americans are rising up to take more control over their own care.

    Greg, I only partly agree with the above statement. Unfortunately, many workers are perfectly content to sit idly by, secure in the [erroneous] knowledge that their employers provide health coverage for free. Moreover, people erroneously assume the definition of good coverage is coverage where you never have to ask How much does that cost? or even reach for your wallet.

    It’s only because that type of system is unsustainable, and employers are increasingly refusing to provide workers with first-dollar coverage that people are beginning to consider the price of medical services when they consume them.

    Of course we’d all be much better off participating as active consumers rather than passive patients. But, patients won’t make this transition easily. To some degree it’s our job as policy analysts to harp on the issues until we convince employers, workers, reporters and policymakers that everyone would ultimately be better handling more of our own health care dollars.

  4. Mulligan says:

    Excellent post Greg.

  5. Greg Scandlen says:

    JoeMack —

    No, not just TPP, but the attitudes throughout the system where patients are simply the raw material for the medical industry. Atul Gawande’s kitchen would be an example. Most of the Dartmouth research is another example. I guess these attitudes happen because of TPP. You ask why we don’t have some other approach. The regulators forbid it. Pat Rooney tried and indemnity approach with Medical Savings Insurance. He wanted to pay a flat fee for hospital services, but the law suits drove him out of business. Other have tried with similar results. The one approach that is getting traction is HSAs.

  6. Frank Timmins says:

    Jo Mac, Insurance companies “are” third party payers. However, insurance companies can and are a party to HSAs (as the provider of the high deductible insurance), and HSAs are one of the answers to an alternative to the third party payer system. “What’s stopping them (or holding them up) are federal regulations inherent specifically in Obamacare.

    Regarding Devon Herrick’s comment, I think people are and will continue to become “restless” with the traditional delivery system (which Obamacare perpetuates) as the cost/benefit ratio becomes more and more obvious. It is certainly true that humans come from the factory with a built in tendency for inertia up to the point that it becomes uncomfortable to not do something about it.

    The prime example is the economic mutation caused by the employer’s subsidy of employee’s health insurance costs. I have noticed that the resistance to consumer directed healthcare such as HSA is vastly less from those who buy their own health policies vs. those who receive coverage through their employers. The one (gasp) good thing to come from the ACA is the increased focus on health insurance costs and how they are financed. It may take a while, but…..

  7. Jim Porterfield says:

    The 62% of the people are absolutely correct in thinking 50 percent of the money is wasted. Back in 2007 after studying Regina Herzlinger’s tome it was apparent we could easily cut health care costs by 50 percent by just doing everything we already knew how to do: on-line pharmacies, generic drugs, double strength pills+ a pill splitter, using on-line medical labs, medical tourism, doctors posting prices, using immediate care facilities rather than the emergency room and most importantly HSAs. Used properly, I calculated HSAs could have reduced Premium costs every year for 5 years (even with 3%/yr increases in CPI).

    So what happened. HSAs have been neutered. The pharmacies suddenly got religion and offered $4/month drug programs. Obamacare got steam rollered in, and my premiums have increased 31% in just the last two years alone. The number of infertility clinics has mushroomed along with autism, alzheimers, irratable bowel syndrome, and cancer in children, just to name a few.

    Worse, nearly every natural disease can be linked to a mineral deficiency in the food and I see no mention of that in Deloitte’s report. Glyphosate, and foreign proteins from GMOs infest nearly everything you find in the grocery store today. Anything that is not labeled “certified organic” will probably contain corn, soybean, canola, cottonseed oil and sugar all of which are suspect. Even much of the certified organic products are lower in minerals than they used to be. To paraphase a line from the movie Funny Girl–“Have we been duped by some dopes, or doped by some dupes?” In the case of our food and health, it might be both.

  8. Al says:

    Interesting. Where the consumer seems most satisfied (physicians, pharmaceuticals and insurers) the government seems to cast the most blame.

  9. Sebastian Alexander says:

    I am also a big fan of this survey, and congratulate Deliotte for conducting it. A firm like Deloitte takes a big risk if they put out a survey like this, because it has clients all over the space (including government), so anything other than banality is likely to offend a client. Mr. Keckley and colleagues are confident to take this risk.

    I’d point out a couple of things: The increasing satisfaction with primary-care providers needs to be understood in the context of figure 20 in the report, which shows that fewer people have access to primary-care providers. So, the increasing satisfaction is not purely positive.

    Nevertheless, the respondents are clear that their satisfaction with the supply-side of health care – be it service providers or medical-technology innovators – is high and increasing.

    On the other hand, they are increasingly dissatisfied with health insurers. Readers of this blog surely understand why: Health “insurers” are not insurers at all, but gatekeepers chosen by employers and government who impose huge friction on our ability to get medical care.

    They should have been declared obsolete years ago – but Obamacare locks them into place.