California s Chronically Ill: 2005
Introduction As health plan coverage continues to move towards member cost sharing, particular concern has been raised about the impact of these changes on those with chronic conditions. The same incentives intended to decrease over- or inappropriate use of health services might similarly affect those for whom appropriate use of health care costs may improve health quality and save overall costs. An online survey of Californians with chronic conditions was recently conducted by Harris Interactive. This survey was conducted simultaneously with employers and consumers to assess trends and impacts in the health insurance marketplace. This chart pack summarizes the survey findings. CONTENTS Methodology..................... 2 Profile of Survey Respondents...... 3 Changes in Premiums/Contributions, by Coverage Source............ 4 Changes in Physician Visit and Prescription Drug Copayments... 5 Changes in Prescription Drug Copayments................... 6 Mean Annual Out-of-Pocket Expenses for Health Care........ 7 Share of Those Unable to Pay Outstanding Medical Bills....... 8 Consumers Efforts to Control Costs. 9 Consumer Response to Increases in Physician Copayments....... 10 Consumer Response to Increases in Prescription Drug Copayments.................. 11 Consumers Knowledge About the Restrictions of their Health Plan. 12 Consumers Who Receive Services to Manage their Chronic Condition............. 13 Consumers Enrolled in a Patient Education Program, by Source.. 14 Consumers Enrolled in a Patient Education Program, by Condition. 15 Impact of Quality Ratings on Chronically Ill................. 16 About the Foundation and Harris Interactive............. 17 2005 CALIFORNIA HEALTHCARE FOUNDATION 1
Methodology On-line survey of chronically ill adults in California conducted by Harris Interactive between July 6 and July 27, 2004. Sample of 3,255 adults drawn from the Harris Poll Online panel and diagnosed with a chronic health condition. Data are weighted to reflect the overall California population, based on demographic profile of adults with chronic conditions from 2002 Harris Interactive telephone survey of California adults and for respondents likelihood to be online. Chronically ill* screened based on reporting a health condition that has lasted (or is expected to last) at least 12 months, and: Needing a physician-prescribed medication; Reporting using more health care services than peers; Reporting limitations in ability to perform activities compared to peers; Needing or receiving special therapy, e.g., physical, occupational, or speech; or Reporting a mental or emotional problem that requires treatment or counseling. *Definition of chronic illness adapted from criteria developed by the Foundation for Accountability (FACCT). 2005 CALIFORNIA HEALTHCARE FOUNDATION 2
Profile of Survey Respondents with Chronic Illnesses Physician info: 90% have a primary-care provider Number of physicians: 2.0 mean and median Number of physician visits in the past year: 6.1 mean / 4.0 median Number of prescription medications taken: 94% take at least one 3.7 mean / 3.0 median The chronically ill take at least one medication and have a range of medical conditions. Most common chronic conditions: 39% have allergies 36% have hypertension (high blood pressure) 28% have high cholesterol 24% have arthritis 18% have depression 17% have diabetes 22% have been hospitalized in the past two years 2005 CALIFORNIA HEALTHCARE FOUNDATION 3
Changes in Premiums/Contributions, by Coverage Source A majority of 36% 37% Employer-sponsored Self-purchased chronically ill Californians with 30% private coverage have experienced premium increases 22% 21% in the past year. 14% 11% 12% 3% N/A Increased a Lot Increased a Little Stayed the Same Decreased No Contribution Required Base: Covered by employer-sponsored plan; Q544 Base: Covered by self-purchased plan 2005 CALIFORNIA HEALTHCARE FOUNDATION 4
Changes in Physician Visit and Prescription Drug Copayments In the past year, 37% of chronically Physician Visits Prescription Drugs 51% ill Californians have experienced 43% increases in copayments for physician visits 20% 26% 28% and 48% have seen copayments rise for prescription drugs. 11% 5% 3% Increased a Lot Increased a Little Stayed the Same Decreased Base: All respondents 2005 CALIFORNIA HEALTHCARE FOUNDATION 5
Changes in Prescription Drug Copayments Total Tiered Non-Tiered 43% 57% Chronically ill Californians with tiered drug benefits were more likely to report increases 34% 33% in copayments for prescription drugs 28% 28% in the past year. 20% 20% 9% 3% 4% 3% Increased a Lot Increased a Little Stayed the Same Decreased Base: All respondents 2005 CALIFORNIA HEALTHCARE FOUNDATION 6
Mean Annual Out-of-Pocket Expenses for Health Care Services Chronically ill with $1,836 Coverage Source Health Status employer-sponsored coverage have significant out-ofpocket health care $1,259 $1,188 $1,151 $1,218 $1,287 $1,253 expenses; those with Medi-Cal are more protected. $340 All Employersponsored Selfpurchased Medicare Medi-Cal Excellent/ Very Good Good Fair/Poor Base: Currently insured Figures based on single coverage. 2005 CALIFORNIA HEALTHCARE FOUNDATION 7
Consumers Unable to Pay Medical Bills, by Health Status and Income Those in poor or 29% Health Status Annual Income fair health were twice as likely to 25% have problems 21% paying their medical bills 18% in the past 14% 14% 12 months as those in good or excellent health. Chronically Ill Poor/Fair Good/Very Good/ Excellent < $25K $25 50K > $50K Base: All respondents 2005 CALIFORNIA HEALTHCARE FOUNDATION 8
Consumers Efforts to Control Costs In the past month, the share of consumers that, because of cost 23% 28% 31% 18% 22% 26% 19% 24% 27% Total Income < $50k Fair/Poor Health 18% Chronically ill consumers with lower incomes or poor health are far more likely to forgo necessary medical treatment because of cost concerns. 9% 12% Had Specific Medical Problem, but Didn t Visit Doctor Didn t Receive Recommended Test, Treatment, or Procedure Didn t Get Annual Physical or Check-up Didn t Use Recommended Medical Device/Equipment Base: All respondents 2005 CALIFORNIA HEALTHCARE FOUNDATION 9
Consumer Response to Increases in Physician Copayments Chronically Ill Public* 2002 2004 2002 2004 Postponed or delayed a visit to the doctor 24% 32% 11% 29% Skipped a visit to the doctor 17% 20% 7% 27% Used the Internet for health information instead of a doctor 10% 10% 8% 18% Switched to a different doctor 3% 3% 6% 19% Switched to a nurse practitioner 3% 2% 1% 6% None of these 69% 61% 66% 48% Californians with chronic illnesses have responded less dramatically to rising physician copayments than the state s population as a whole, although both groups were more likely to delay or skip a doctor s appointment in 2004 than in 2002. *Data for the California public are from a Harris survey conducted for the California HealthCare Foundation, 2004. Base: All respondents with recent increases in physician copayments 2005 CALIFORNIA HEALTHCARE FOUNDATION 10
Consumer Response to Increases in Prescription Drug Copayments Chronically ill 41% 36% Total Tiered Non-Tiered Californians with tiered pharmacy benefits are more likely to look for 29% 25% 26% 20% 26% 29% 18% 19% 22% 18% 21% ways to cut costs including forgoing needed prescriptions or skipping doses 11% 9% 10% 11% 7% than are those in non-tiered plans. 4% 5% 3% Asked for Generic Rx Asked for Less Expensive Rx Used Mail-order Didn t Get a Prescription Filled Skipped Doses or Split Pills Used an Online Pharmacy Got Medications in Another Country Base: All respondents with recent increases in drug cost-sharing 2005 CALIFORNIA HEALTHCARE FOUNDATION 11
Consumers Knowledge About the Restrictions of their Health Plan Great Deal Fair Amount Very Little Nothing at All All 18% 49% 28% 5% Health Status Fair/Poor 16% 47% 30% 6% Good/Very Good/Excellent 18% 50% 28% 5% Income Level < $50k 17% 48% 29% 7% $50k + 19% 50% 27% 4% Many of the chronically ill, regardless of their health status or income, know very little about their health plan s restrictions. Base: Currently insured 2005 CALIFORNIA HEALTHCARE FOUNDATION 12
Consumers Who Receive Services to Manage their Chronic Conditions Californians with Emails/Calls to Remind Me of Doctors Appointments 39% chronic illnesses receive a range Educational Materials 28% of services to Emails/Calls to Remind Me of Diagnostic Appointments Advice on How to Better Manage My Condition Feedback on How I Am Managing My Condtion 11% 16% 19% help manage their conditions, appointment reminder calls or emails are most Questionnaires on How I Am Managing My Condition 8% widely used. Periodic Phone Calls from a Health Professional Phone Calls to Remind Me to Take My Medications 4% 6% Base: All respondents 2005 CALIFORNIA HEALTHCARE FOUNDATION 13
Consumers Enrolled in a Patient Education Program, by Source Enrollment in patient education 11% 64% 63% Health Insurance Company programs among Californians with chronic illnesses has not grown 8% significantly over the past two years. 23% 19% Physician 11% 7% Pharmaceutical Company 7% 6% Employer 4% 5% Medical Device Manufacturer 2002 2004 2002 2004 Base: All respondents Note: Numbers may add to more than 100% as multiple responses were allowed. Base: Those enrolled in patient education programs 2005 CALIFORNIA HEALTHCARE FOUNDATION 14
Consumers Enrolled in a Patient Education Program, by Condition All Chronically Ill 11% Diabetes Obesity 16% Heart/Circulatory Disease 16% Skin Conditions 16% Asthma 15% Depression 13% 26% Enrollment in patient education programs among those with chronic conditions is modest, one out of four individuals with diabetes are enrolled. Digestive Disorder Anxiety Allergies Thyroid 12% 11% 10% 9% Base: All respondents 2005 CALIFORNIA HEALTHCARE FOUNDATION 15
Impact of Quality Ratings on Chronically Ill Saw Rating Considered Change Actually Quality Rating Information Based on Rating Made Change Hospitals All Chronically Ill 19% 5% 4% Hospitalized in Last 2 Years 25% 3% 2% Health Plans All Chronically Ill 22% 4% 1% In Fair/Poor Health 19% 0% 0% Few chronically ill Californians have seen quality ratings; a very small percent use this information to make health care decisions. Physicians All Chronically Ill 10% 1% 0.5% In Fair/Poor Health 7% 1% 0.5% Base: All respondents 2005 CALIFORNIA HEALTHCARE FOUNDATION 16
About the Foundation The California HealthCare Foundation, based in Oakland, is an independent philanthropy committed to improving California s health care delivery and financing systems. Formed in 1996, our goal is to ensure that all Californians have access to affordable, quality health care. For more information about CHCF, visit us online at www.chcf.org. About Harris Interactive Harris Interactive Inc. is a Rochester, New Yorkbased global research company that blends strategic consulting with innovative and efficient methods of investigation, analysis, and application. Known for The Harris Poll and for Internet-based research methods, Harris Interactive conducts proprietary and public research for its clients. For more information, visit www.harrisinteractive.com. 2005 CALIFORNIA HEALTHCARE FOUNDATION 17