Produced by the Deloitte Center for Health Solutions Global Survey of Health Care Consumers Behaviors, attitudes and unmet needs

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1 Produced by the Deloitte Center for Health Solutions 2010 Global Survey of Health Care Consumers Behaviors, attitudes and unmet needs

2 Contents Foreword 3 The conceptual framework: Six zones of health care consumerism 4 Survey highlights 7 Zone One: Wellness and healthy living 9 Zone Two: Information resources 12 Zone Three: Traditional health services 14 Zone Four: Alternative health services 16 Zone Five: Health insurance 17 Zone Six: Health policy 19 Major findings 20 Implications 22 Contacts 23 2

3 Foreword In most of the world s developed systems of health care, costs are increasing at alarming rates as the compound effects of aging, chronic disease prevalence and unhealthy lifestyles escalate demand for resources. And in every system citizens expect modern facilities and technologies, readily accessible physicians and assurance that their health care needs will be met. Most health care systems view citizens as patients individuals with occasional need for primary or acute care, directed by physicians to follow prescribed treatment plans, and immune to consequences for non-adherence. A system orientation toward citizens as consumers rather than patients is a fundamental shift: it presumes that consumers and their providers, when equipped with appropriate tools coupled with incentives to reward improved outcomes, have the potential to lower costs and improve satisfaction. The results of this Deloitte 2010 Global Survey of Health Care Consumers suggest that opportunities exist for leaders in developed systems to accelerate their efforts toward consumerism. The majority of consumers in each of the six surveyed countries, the United States,,, and the United Kingdom are somewhat satisfied with their system s performance, but disconnected from its costs and seemingly passive about the role they play. Engaging consumers in health care is essential to systemic reforms that reduce costs and improve population-based outcomes. Survey findings suggest that each of the six systems has opportunity to accelerate efforts toward consumerism. Paul H. Keckley, Ph.D. Executive Director Deloitte Center for Health Solutions Deloitte LLP Washington DC Dean Arnold Health Care Sector Leader Deloitte Touche Tohmatsu London As used in this document, Deloitte means Deloitte LLP. Please see for a detailed description of the legal structure of Deloitte LLP and its subsidiaries Global Survey of Health Care Consumers 3

4 The conceptual framework: Six zones of health care consumerism The Deloitte 2010 Global Survey of Health Care Consumers series provides insights about the behaviors, attitudes and unmet needs of consumers in,,, the United Kingdom, and the United States. The 2010 survey reflects a broad-based view of health care consumerism in six zones (Figure 1): Wellness and healthy living: What individuals are doing to care for themselves. Information resources: What sources of information are useful in informing their decisions. Traditional health services: How consumers assess the performance and value of physicians, hospitals, medical devices and prescription drugs accessible in their system of care. Alternative health services: In addition to traditional services, what other services consumers use to achieve their health goals or manage their conditions. Health insurance: How consumers manage the costs and risks associated with the services they use or foresee using. Health policy: How consumers assess the overall performance of the system. Figure 1: Zones of health care consumer activity 1. Wellness and healthy living 2. Information resources Health care consumerism 3. Traditional health services Methodology Deloitte surveyed health care consumers across, the United States,,, and the United Kingdom. To reduce response bias and enhance the predictive value of the survey results to actual utilization data, participants in each country were first asked about recent behaviors (past week/past month/past year), then about attitudes, within each topic area. Results were weighted to assure proportional representation to each country s census population with respect to age, gender, income and geography. A core set of common questions were asked in each country, supplemented by questions tailored to each unique health system. Across the four European countries, the response margin of error is +/- 3.1% at a.95 confidence level. In, the response margin of error is +/- 2% at a.95 confidence level. In the United States, the response margin of error is +/- 1.6% at the.95 confidence level. : A national sample of 1,000 French adults, aged 18 and older, was surveyed in July 2009, using a web-based questionnaire that consisted of 88 questions, with 49 potential follow-up questions. : A national sample of 1,000 German adults, aged 18 and older, was surveyed in July 2009, using a web-based questionnaire that consisted of 90 questions, with 46 potential follow-up questions. : A national sample of 1,000 Swiss adults, aged 18 and older, was surveyed in July 2009, using a web-based questionnaire that consisted of 97 questions, with 42 potential follow-up questions. 6. Health policy 4. Alternative health services 5. Health insurance 4

5 United Kingdom: A national sample of 1,000 British adults, aged 18 and older, was surveyed in July 2009, using a web-based questionnaire that consisted of 96 questions, with 49 potential follow-up questions. : A national sample of 2,304 Canadian adults, aged 18 and older, was surveyed in November 2008, using a web-based questionnaire that consisted of 74 questions, with 46 potential follow-up questions. United States: A nationally representative sample of 4,001 American adults, aged 18 and older, was surveyed in October 2008, using a web-based questionnaire that consisted of 95 questions, with 42 potential follow-up questions. Background: Health care systems across Europe, and the United States The six countries vary in the structures of their health care delivery systems, the role played by private insurance and provider organizations, and governance. Health care expenditures as a percentage of each country s gross domestic product (GDP) range from 8.4% in the United Kingdom to 16.2% in the United States (Figure 2). has a statutory national health insurance system with compulsory coverage of French residents through health insurance funds whose participants are determined primarily according to their occupation. The system is financed mainly through social security contributions by employers and employees, taxes on alcohol and tobacco, and out-of-pocket payments. In 2006, 99.9% of the French population had public coverage. Also, 88.4%, or 54 million, had voluntary private health insurance. Thirty chronic conditions, including diabetes, are fully covered. Physicians are organized into unions and the government pays on a fee-for-service basis, based on negotiated rates. Hospital rates are set by the government. has a statutory national health insurance system with compulsory coverage of all German residents through health insurance funds whose participants are determined primarily based on their occupation. Up to a certain income level, all employees are required to join one of about 250 statutory health insurance funds. Persons earning a higher gross income are allowed to join a private plan. In 2006, 89.5% of the German population had public coverage. Also, 26.1% of the German population in 2006 had private health insurance, primary and supplemental coverage. Figure 2: Country comparisons: Health care expenditures Country Health Care Expenditures as Percent of GDP Per-capita Spending $D Public Expenditure on Health, Percent of Total 10.1% $3, % 11.0% $3, % 10.4% $3, % 10.8% $4, % United Kingdom 8.4% $2, % United States 16.0% $7, % Source: OECD Health Data 2009, based on 2007 data 2010 Global Survey of Health Care Consumers 5

6 has a statutory national health insurance system with compulsory coverage of all Swiss residents through plans purchased by individuals from a selection of approximately 90 competing private health insurance funds. All residents and dependents are required to have coverage unless they have insurance in another EU member country. Approximately 99% of the 7.6 million Swiss residents are covered by compulsory insurance. The Swiss system is funded by premium payments, out-of-pocket payments by individuals and government funding. United Kingdom has a national health system wherein coverage is universal and managed by the government. Hospitals are owned by the government and physicians are paid a salary by the government and fees from private insurance. Financing comes from employment taxes and social security. Also, 10% of the population has private insurance. has a national health system, governed and delivered by each provincial jurisdiction, wherein coverage is universal, portable across provinces and publicly insured for medically necessary services. Hospitals and regional health systems are not-for-profit corporations funded primarily by provincial governments, and physicians are paid through a mix of fee-for-service and salary compensation. Financing for publicly funded services comes from provincial and federal taxes. The majority of Canadians also have supplemental private health insurance, and private health spending on insurance and out-of-pocket expenses amounts to 30% of total annual health spending across the country. United States has health care that is funded by private insurance, individuals and the government. There are multiple payers and no individual or employer mandate. Approximately 46 million (16%) of the population is uninsured. Almost all people over the age of 65 have insurance coverage, and approximately 80% of the under-65 population has coverage. 6

7 Survey highlights Perspectives on the overall performance of countries health care systems The majority of consumers do not understand the health care system in their country. 37% of French and Canadian adults believe that they have a complete understanding of their health care system. This compares with 28% of American, 27% of British, 23% of Swiss and 22% of German adults who report having a complete understanding of their health care system; in each of these countries the percent of respondents who report having limited or no understanding of their health care system is also higher (Figure 3). The French and Swiss grade their system s performance higher than others; Germans and Americans rate their system lowest. 55% of French and Swiss adults give their health care system a grade of A or B, while 44% of German adults and 35% of American adults give their system a failing grade of D/F (Figure 4). Males in all countries grade their health care system higher than females. 59% of French and Swiss males give their health care system an A/B compared with 51% of French females and 49% of Swiss females. 23% of German males and 11% of German females give their system an A/B grade. Figure 3: How well do you think you understand how your health care system works? 0% 6% 7% Understanding of health care system 10% 12% 15% 16% Completely (8, 9 or 10) Not at all (1, 2 or 3) 23% 22% 28% 27% 37% 37% 5% 10% 15% 20% 25% 30% 35% 40% Figure 4: Using a typical report card scale with grades A, B, C, D, and F, how would you grade the overall performance of your health care system? 12% Health care system grade 55% 14% 55% 15% 43% 20% 30% 21% 35% 17% 44% 0% 10% 20% 30% 40% 50% 60% Excellent- A/B Failing- D/F 2010 Global Survey of Health Care Consumers 7

8 Wastefulness in the health care system of each country is a concern: the respondents are more critical than citizens in other countries (Figure 5). Perceived wastefulness is lowest in, which is graded highest in overall performance compared to the other countries; however, this correlation is not consistent across countries: Although is also graded highest for overall performance, citizens perceive the system as having the second-highest level of wasted spending. Figure 5: In your opinion, what percentage of all health care dollars spent is wasted? Believe >50% percent of health care system spending is wasted 28% 17% 15% 14% 12% 10% 0% 5% 10% 15% 20% 25% 30% 8

9 Zone One: Wellness and healthy living Self-reported health status is highest in and the ; Germans and French report the lowest health status. 61% of Canadian and 60% of American adults rate their overall health as excellent or very good, while 23% of German adults rate their health as excellent or very good (Figure 6). A similar trend is observed across age cohorts; for example: 15% of Germans age consider themselves to be in excellent or very good health, while 56% of Canadians and 55% of adults in the same age group consider themselves to be in excellent or very good health. A greater percentage of European males rate their health status as excellent or very good compared with European females. 1 in 3 Germans and 1 in 4 French rates their health status as fair/poor. A majority of consumers in, and the United States report having one or more chronic conditions. 57% of adults in, and 52% of adults in both and the report being diagnosed with one or more chronic conditions (Figure 7). More than 64% of adults age 65+ report having one or more chronic conditions; in the United States, 81% of adults age 65+ report having one or more chronic conditions. In all countries except, a majority (>56%) of adults age report having one or more chronic conditions. In all countries surveyed, a trend exists across health status and chronic disease: Over 80% of consumers with one or more chronic diseases report fair or poor health status. Figure 6: How would you rate your overall health? 8% 9% 12% Excellent/very good 16% Failing/poor Physical health status 23% 25% 31% 0% 10% 20% 30% 40% 50% 60% 70% Figure 7: Have you been diagnosed by a doctor or other medical professional as having one or more chronic conditions? 37% 49% Percent diagnosed with one or more chronic diseases 51% 47% 61% 60% 52% 52% 57% 47% 39% 0% 10% 20% 30% 40% 50% 60% % with chronic disease 2010 Global Survey of Health Care Consumers 9

10 In general, consumers are not engaged in health and wellness programs: fewer than 1 in 5 say they participated in a healthy living program in the prior year. Figure 8: Have you participated in a healthy living/wellness program in the last 12 months? Participation in healthy living/wellness program consumers report higher levels of participation than others; French, Swiss and British participation is the lowest (Figure 8). Across all countries surveyed, presence of a chronic disease or self-reported lower health status does not appear to drive higher participation in wellness programs. 10% 14% 16% 20% Interest in participating in wellness programs is relatively modest: about half of survey respondents in each country say they would be highly likely to participate. Trends are observed between current participation in a wellness program and interest in participating in such programs going forward: 59% of American adults (highest) compared to 44% of French adults (lowest) report that they would be highly likely to participate in a wellness program if it was offered at no cost (Figure 9). Across all countries, females are more likely than males to be highly interested in participating in a wellness program if it was offered at no cost. 6% 0% 5% 10% 15% 20% Figure 9: If you were given the opportunity to participate in a wellness program for free, how likely is it that you would do so? 10% Likelihood of participation in wellness program 9% 59% 16% 57% 11% 56% 12% 55% 16% 47% 21% 44% 0% 10% 20% 30% 40% 50% 60% Highly likely (8, 9 or 10) Not at all likely (1, 2 or 3) 10

11 Among consumers with one or more chronic conditions, participation in disease management programs is highest in and ; it is lowest in the and. For consumers with one or more chronic diseases, approximately 7 of 10 in all countries adhere to their recommended treatment regimen (Figure 10). In all countries surveyed, except for the, participation by individuals with one or more chronic diseases in a specific disease management program appears to be higher than participation in broader health and wellness programs. Among most consumers, interest in remote monitoring tools to support improved health and wellness is strong. Consumers in all countries identify a high level of interest in remote or home monitoring devices as tools to help them self-manage their health; interest is higher in the,, and compared with, and (Figure 11). Interest in personal health coaching was expressed by 32% of Americans (highest) and 19% of French consumers (lowest). Across all countries surveyed, interest in care coordinators to help navigate the health care system, or less personalized aids such as participation in support groups with people who have similar health conditions, was lower. Figure 10: Do you currently participate in a disease management program and do you follow the treatment regimen for your chronic condition? 80% 70% 60% 50% 40% 30% 20% 10% 0% Compliance with treatment regimen and participation in disease management program 70% 70% United States 78% 74% 69% 72% Compliance with treatment regimen for chronic disease United Kingdom 33% 32% 28% 24% Participation in disease management program 14% 13% Figure 11: If you needed care or treatment, and these special services were available to you, how interested would you be in using them? Interest in tools and aids to support self-managed care 13% 26% 22% 20% 32% 29% 29% 24% 26% 22% 19% 20% 45% 49% 56% 55% 53% 49% 68% 64% 67% 63% 66% 64% 0% 10% 20% 30% 40% 50% 60% 70% 80% Remote monitoring devices Personal health coach In-home medical device Care coordinator 2010 Global Survey of Health Care Consumers 11

12 Zone Two: Information resources Most consumers do not compare hospitals or physicians before making a selection; and German consumers are consistently more likely to shop compared to others (Figure 12). In seeking information about the effectiveness and safety of treatment options, consumers in all countries consider academic medical centers and physicians as their most trusted sources. Consumers in all countries identify academic medical centers and medical societies/associations (physicians) as their most trusted sources of information on the effectiveness and safety of treatments (Figure 13). Other sources of information such as government, health insurers, pharmacies, life sciences companies, independent health websites and other hospitals are consistently rated lower across the countries surveyed. Figure 12: Have you compared physicians or hospitals before choosing one? 30% 25% 20% 15% 10% 5% 0% United States Percent who compare physicians and hospitals before making a selection 15% 13% 13% Percent who compare hospitals before making a selection 9% 9% 8% United Kingdom 30% 24% 13% 16% 15% 15% Percent who compare physicians before making a selection Figure 13: If you wanted information about the most effective and safe treatment(s) for a certain health condition, how much trust do you have for these third party sources to provide reliable information? Trusted sources for information on treatment effectiveness and safety 60% 53% 52% 51% 47% 53% 50% 54% 50% 40% 43% 37% 46% 30% 20% 10% 27% 23% 0% Academic medical centers Medical societies/associations United States United Kingdom 12

13 Consumers want access to online tools and services that help them to understand their health care information, navigate the health care system and connect to their health care providers. Of several tools considered, consumers in all countries consistently report the highest level of interest in access to a secure Internet site that allows them to schedule office visits, access medical records, view test results, order prescription refills, find information about treatment options, and check status of bills/payments (Figure 14); access to their doctor via is the second-highest rated online tool by consumers. On average, 35% are highly interested in using an online personal health record (PHR) connected to their doctor s office, to help them manage their health and interactions with the health care system (Figure 14); Americans and Canadians are most interested (>40%), and Germans and Swiss are least interested (<30%). Less than 10% of survey participants in all countries already maintain a personal health record. Security and privacy issues associated with personal health records and online tools are a concern to about half: Swiss, German and French consumers express more concern than others. Interest in PHRs and other online tools to support self-care, patient education and access is higher in, the and (Figure 14), while concern over privacy is lower ( 38%) (Figure 15). German, French and Swiss consumers have lower interest and higher concerns. 52% of German, 53% of Swiss, and 44% of French adults report that they would be highly concerned that their privacy may be at risk if they used a computer program that allowed them to share information with their physician (Figure 15). Figure 14: How interested would you be in using these online tools and services? Access to a secure Internet site Access to your doctor via Personal health record Interest in online tools and services 24% 28% 31% 40% 37% 38% 37% 38% 37% 40% 37% 42% 51% 49% 50% 48% 57% 54% 0% 10% 20% 30% 40% 50% 60% Figure 15: How concerned are you that your privacy may be at risk if you used a computer program that allowed you to share information with your doctor? Concern about privacy of health information stored online 15% 16% 19% 22% 24% 28% 34% 36% 38% 44% 53% 52% 0% 10% 20% 30% 40% 50% 60% Highly concerned Not at all concerned 2010 Global Survey of Health Care Consumers 13

14 Zone Three: Traditional health services The majority of consumers are satisfied with the hospitals and physicians they have used recently. Hospitals Figure 16: How satisfied are you with quality of care your received at the hospital recently? Satisfaction with quality of care at hospital Less than 30% of consumers surveyed had an overnight stay in hospital in the past 12 months; on average, over 60% are highly satisfied with the care they received. Consumers in (28%), (25%) and (24%) report a higher level of using a hospital for an overnight stay in the past 12 months, compared to less than 17% of consumers in the, or. In most countries, except, over 60% of consumers state high satisfaction with the quality of care received during their hospital stay (Figure 16). 62% 63% 65% 59% 64% 73% Physicians 0% 10% 20% 30% 40% 50% 60% 70% 80% The majority of consumers have a primary care physician relationship and are satisfied. 94% of French consumers report having a primary care provider (highest), compared with 70% of British consumers who report having a primary care provider (lowest). In all countries, over 65% of consumers rate high satisfaction with their primary care provider; satisfaction is highest in and (Figure 17). European males report higher satisfaction than European females with their primary care provider; 74% of French males, 76% of German males, 77% of Swiss males, and 67% of British males report being completely satisfied with their primary care physician. The percentage of adults reporting complete satisfaction with a primary care physician is highest among those over age 65, where results are over 81% in all countries except the (73%). Completely satisfied (8, 9 or 10) Figure 17: How satisfied are you with your primary care physician? Satisfaction with primary care provider 74% 74% 73% 71% 71% 65% 0% 10% 20% 30% 40% 50% 60% 70% 80% Completely satisfied (8, 9 or 10) 14

15 Consumers, especially in the, and, prefer primary care physicians who are prescriptive in their approaches. 38% of Swiss consumers report preferring a physician who acts as a health coach (highest), who provides guidance and information needed for consumers to make their own decisions, compared with 20% of consumers who prefer a health coaching model (lowest). British consumers state the highest preference for physicians who act as a medical authority (44%), who directs them to take what he/she believes is the best approach based on their own expertise, compared to 22% of Swiss and French consumers (lowest). Prescription medications Prescription drug utilization varies widely: it is highest in and the, and lowest in (Figure 19). The variation in prescription medication use is aligned to the variation of consumer-reported chronic disease prevalence across countries: has the lowest reported incidence of chronic disease and prescription drug use; is among the highest. Although over 80% of consumers in all countries report adhering to drug labels and to instructions provided by their doctors, less than 40% in each country report "always" taking their medication as directed. Figure 18: Do you generally prefer a doctor who acts as a health coach or a doctor who acts as a medical authority? I prefer a doctor who acts as a medical authority I prefer a doctor who acts as a health coach Preference of physician style 20% 20% 22% 22% 25% 27% 0% 10% 20% 30% 40% 50% 33% 33% 34% 36% Figure 19: Percent of consumers who use prescription medication Prescription drug usage 38% 44% 63% 57% 53% 47% 47% 33% 0% 10% 20% 30% 40% 50% 60% 70% 80% % who use prescription drugs 2010 Global Survey of Health Care Consumers 15

16 Zone Four: Alternative health services Use of alternative health services varies and is generally low; consumers are not inclined to substitute/augment traditional therapies with alternative methods of care. Figure 20: Have you treated a health problem with an alternative or natural therapy? Treatment of health problem with alternative or natural therapy Canadian (25%) and Swiss (22%) consumers are the highest users of alternative health services (e.g., acupuncture, naturopathy, chiropractic), while French consumers are the lowest (Figure 20). A large majority of consumers in all countries do not substitute a traditional health therapy (e.g., prescription medications) for alternative therapies. 16% 19% 22% 25% Consumers typically prefer physicians with a traditional vs. holistic medicine orientation; interest in physicians who integrate non-traditional methods of care into practice is strongest in the, and. 13% 15% 0% 5% 10% 15% 20% 25% 33% of American and 32% of British adults prefer a medical professional with an orientation toward traditional medicine, while 21% of German and Swiss adults prefer a medical professional with an orientation toward holistic or alternative treatments (Figure 21). Across all six countries, a greater percentage of males prefer a traditional approach versus a holistic orientation. Across all six countries, adults age 65+ prefer a professional with an orientation toward traditional medicine. % who treated health problem with alternative therapy Figure 21: Do you prefer a doctor or medical professional with an orientation toward holistic or alternative treatment or one with an orientation toward traditional medicine? Preference for physicians with a holistic vs. traditional medicine practice orientation 7% 9% 10% 13% 15% 19% 21% 21% 26% 27% 32% 33% 0% 5% 10% 15% 20% 25% 30% 35% Traditional medicine Holistic or alternative treatment 16

17 Zone Five: Health insurance Regardless of the system s financing or insurance structure, the majority of consumers believe they are not adequately insured. Coverage by public vs. private supplemental insurance varies across countries due to the nature of the health care system in each country; 86% of French consumers have supplemental insurance, compared with 17% of Swiss consumers. Although 2 of 3 consumers in most countries report being adequately insured, less than 30% report being well-insured; consumers report higher levels, with 39% identifying themselves as being well insured (Figure 22). Reported household spending for health care in the prior year increased in every country: consumers in and the report higher spending sensitivity; less in the and. The majority of consumers in all six countries report that health care spending has either increased or stayed the same in the past 12 months (Figure 23). 59% of Swiss adults, 47% of American adults, and 46% of French adults report that their health care spending has increased over the last 12 months; less than 7% in each country report that health spending has decreased. Figure 22: Thinking about the amount and types of health insurance coverage you have, both public and private, do you consider yourself to be adequately insured? % well-insured Adequacy of insurance 0% 5% 10% 15% 20% 25% 30% 35% 40% Figure 23: In the last 12 months, has your household spending on health care products and services increased, decreased or stayed about the same compared to the previous year? 20% 22% 25% 25% 29% 39% 5% 5% 7% 32% 42% 47% 46% 41% 59% 0% 44% 48% 3% 32% 59% 5% 23% 65% 5% 10% 20% 30% 40% 50% 60% 70% 80% Increased Stayed the same Decreased 2010 Global Survey of Health Care Consumers 17

18 Concerns about foreseeable health care costs are highest in the, and ; Canadian and Swiss consumers are less concerned. The majority of adults (>50%) across all six countries report that they are somewhat prepared to handle future health care costs, although less than 40% reporting being well prepared (Figure 24). 49% of American adults and 51% of Canadian adults age 65+ report that they are completely prepared to handle future health care costs, while 31-37% of Europeans in the same age group report being completely prepared. Figure 24: To what extent do you feel your household is financially prepared to handle future health care costs? Household ability to handle future health care costs 11% 16% 18% 17% 21% 22% 25% 27% 29% 29% 31% 39% 0% 5% 10% 15% 20% 25% 30% 35% 40% Completely (8, 9 or 10) Not at all (1, 2 or 3) 18

19 Zone Six: Health policy Consumers see areas for improvement in their system: increased access to primary care services from physicians and nurses, increased funding to accelerate use of electronic medical records, performance-based payments for providers are the highest priorities. Increasing the availability of primary care physicians is supported by a majority of consumers in all countries; consumer support is highest in, the and (Figure 25). Expanding funding to improve adoption of electronic health care records is also one of the top-supported health care system reform priorities; support is highest in and lowest in. An average of 40% of consumers in all countries support establishing pay-for-performance systems for doctors and hospitals; however, more than 1 in 5 consumers oppose this reform in each country, and in 46% of consumers are opposed. Figure 25: Top Health Policy Reforms Health Reform Expand teaching programs to increase the supply of primary care physicians Allow nurses to diagnose and treat uncomplicated conditions Increase government funding to support adoption of electronic health records Establish performance-based systems that pay doctors and hospitals based on clinical outcomes vs. service volumes 85% 56% 52% 55% 72% 74% 59% 45% 42% 39% 57% 47% 58% 49% 34% 41% 48% 40% 37% 41% 40% 39% 39% 40% 2010 Global Survey of Health Care Consumers 19

20 Major findings #1: Consumers opinions about their respective health care system vary widely based on their cultural predispositions and personal interactions with the system (Figure 26, next page). Overall, consumers in these systems are alike in many ways: Satisfaction with the hospitals and primary care physicians they use regularly is reasonably high. Proximity and reputation are the most important factors in choosing hospitals. Appreciation for the usefulness of online technologies and home monitoring is high, although almost 90% lack personal health records. The complexity of the health care system in each country is problematic: consumers admit to their lack of understanding and frame their opinions based on personal experiences. Significant numbers recognize the value of healthy lifestyles and appear receptive to voluntary participation in wellness programs; however, there is limited current uptake of these programs. The performance of the health care system in each country is a mix of positives and disappointments: access to services and technologies is thought to be strong but costs and wastefulness are considered problems. Wastefulness is a concern to many in each system: consumers are attentive to efficiency and quality. #2: Opinions diverge with respect to overall health care system performance, spending and the impact of cost on consumer behaviors. The French and Swiss grade their health care system higher than other countries. French and Canadian consumers report higher levels of understanding of their health care system. More Canadians and Americans rate their health as excellent or very good. Participation in wellness programs is below 20% in all countries except the United States. Americans are more likely to seek information on quality or services when choosing a hospital. The majority of adults in and are concerned about the privacy of health information stored online; consumers in other countries express less concern. More than 65% of all adults are satisfied with their primary care physician. More German and Swiss adults prefer a physician who integrates holistic approaches; however, the percentage is below 25% overall. Security about exposure to health care costs varies widely: French and Canadian consumers believe they are better prepared for future health care costs than others. 20

21 Figure 26: Health care survey results, by country Domains of health care consumer activity United Kingdom United States Percent who give the health care system a grade of A or B 43% 55% 17% 55% 30% 21% Overall health system Percent who feel they have a good understanding of how the health care system works Percent who believe that more than 50% of health care system spending is wasted 37% 37% 22% 23% 27% 28% 14% 17% 12% 10% 15% 28% Percent who rate their physical health care as excellent or very good 61% 31% 23% 51% 49% 60% Percent participating in wellness programs 16% 6% 14% 10% 10% 20% Wellness and healthy living Percent willing to participate in a wellness program at no cost 56% 44% 57% 47% 55% 59% Percent reporting one or more chronic diseases 47% 52% 57% 39% 47% 52% Percent who participate in a disease management program 33% 14% 24% 13% 28% 32% Percent interested in remote and/or home monitoring devices 64% 49% 49% 45% 64% 63% Percent who compare hospitals before making a selection 13% 8% 13% 9% 9% 15% Information resources Percent who compare doctors before making a selection 13% 15% 24% 16% 15% 30% Percent who maintain a Personal Health Record 6% 7% 6% 6% 4% 9% Percent highly concerned about privacy for health information stored online Percent who have stayed overnight in a hospital for surgical, non-surgical or emergency treatment 34% 44% 52% 53% 36% 38% 15% 28% 24% 25% 16% 17% Traditional health services Percent satisfied with recent hospital care 62% 64% 59% 65% 63% 73% Percent who have a doctor who functions as primary care provider 84% 94% 88% 76% 70% 80% Percent satisfied with their primary care physician 74% 71% 73% 74% 65% 71% Percent who use prescription medication 47% 63% 53% 33% 47% 57% Alternative health services Health insurance Percent who treated a health problem with alternative or natural therapies 25% 13% 15% 22% 16% 19% Prefer doctor with orientation toward holistic or alternative treatments 13% 11% 26% 24% 9% 12% Percent who feel financially well-prepared for future health care costs 39% 31% 25% 29% 29% 27% Percent who consider themselves to be well-insured 25% 25% 22% 29% 20% 39% 2010 Global Survey of Health Care Consumers 21

22 Implications The role consumers play in managing their care is key to reducing costs for health care systems. The majority of these of system costs are avoidable if consumers live healthier lives and adhere to treatment recommendations when diagnosed. To achieve optimal consumerism in a health care system, leaders must provide tools and incentives that reward appropriate behaviors by consumers working in tandem with their providers via a guided self-care management strategy. A health care system aligned with consumerism will likely see costs reduced and satisfaction improve if it transitions from a patientorientation to consumer model of care. The findings suggest that consumers who interact daily with health care systems share many concerns: costs are problematic, comparisons of hospital and physician quality is modest and disappointing, and understanding of respective health care systems is low. To engage consumers as active participants in their health and to align their spending with system goals of improved health status and lower costs, political leaders, hospitals and physicians, and policy makers will need to address three major challenges: Consumer awareness and understanding: The capture and dissemination of information about system performance quality, satisfaction, prices, provider adherence to evidence-based practices, and consumer adherence to personalized health plans is necessarily a high priority for each system. Useful report cards that gauge system performance must be developed and made accessible to providers and consumers. Regulators and health plans should align financial incentives with optimal performance in the key areas measured. This effort will require investments in information systems and operational procedures, as well as regulatory changes that support transparency, to evaluate the performance of each country s health care system. Self-care support and health coaching: Chronic illnesses are prevalent in all six countries. The majority of consumers say they need help in managing their diagnosis, but use of information technologies to deliver coaching and self-care support to consumers is lacking. These cost-effective tools are not perceived as being readily accessible to the population. As a result, avoidable costs are increasing. Social media, online tools, and emergent administrative and clinical information applications that eliminate paperwork, redundant testing and delayed access to diagnostic test results will be essential investments. Capitalizing on these efforts will be a key priority. Strategic investment: Political priorities often challenge investments in health care system transformation. However, the rate of system spending growth poses a fiscal challenge to these countries. The reality is that substantial investment is needed to reduce health care system costs while improving performance. These investments are front-end loaded but pay long-term dividends. A concerted campaign to transition from patient passivity to active engagement of consumers will require political leadership and vision. This report highlights consumer similarities and differences in health care systems that vary by design and cost. However, surveyed consumers in all systems experience pressure to pay for their portion of health care costs (even in systems that are fully funded by the government). They also see a common need for improved service and increased transparency in their systems. The opportunity exists to improve each of these health care systems. Engaging consumers as active participants in the process is a key component for success. 22

23 Contacts Authors We would like to recognize the individuals who contributed their insights and support to this research. Paul H. Keckley, PhD Executive Director Deloitte Center for Health Solutions Deloitte LLP Dean Arnold DTT Health Care Sector Leader Deloitte Touche Tohmatsu Thomas Northoff Partner, Life Sciences & Health Care Leader Deloitte Consulting GmbH Yves Jarlaud Partner, Life Sciences & Health Care Leader Deloitte Conseil Robert Reppas Partner Deloitte AG Mark Fam, CHE, MHA Senior Fellow Deloitte Center for Health Solutions Deloitte Consulting LLP Acknowledgements In addition to the authors above, we would like to thank Joyce Ehrlich, Jennifer Bohn, Patsy Bolduc, Helen Baxter, Erwan Lamour and Janett Reidel for their leadership, as well as Bianca Chung, Michael Curtis, Malay Gandhi, and My Di Le for their contributions Global Survey of Health Care Consumers 23

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