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Need for Health Care Reform Escalates; One in Four Americans Skip Care When Sick or Injured

Consumers Rate U.S. Health Care System Poorly, According to Deloitte Survey

WASHINGTON, March 17 /PRNewswire/ -- As health care reform heats up in the White House, nearly 40 percent of consumers have expressed discontent with the status quo, rating the U.S. health care system a D or an F. A quarter of consumers have skipped care when they were sick or injured; two in five of those consumers have done so because they simply could not afford it, were not covered by insurance or thought the costs were too high, according to the results of the 2009 Deloitte Survey of Health Care Consumers (


In addition to skipping or delaying care, the high cost of health care is prompting many consumers to switch their physicians, prescriptions or health plans to save money. Of the 16 percent who switched physicians in the last year, one in four switched due to costs. Three in 10 switched medications in the past year; 38 percent switched to save money. Seventeen percent of enrollees changed health plans in the past year; 29 percent were seeking a lower cost plan.

"The current economic climate is taking a toll on American consumers prompting them to increasingly make decisions about health care that are married to their pocketbooks," said Paul H. Keckley, Ph.D., executive director, Deloitte Center for Health Solutions. "Consumers want a bigger say in their health care decisions. More than half believe that 50 percent or more of the dollars spent on health care in the United States are wasted. The time for health care reform could not be more pressing."

More than 4,000 U.S. consumers 18 and over were surveyed as part of Deloitte's second annual study examining health care consumers' attitudes, behaviors and unmet needs conducted by the Deloitte Center for Health Solutions. The survey offers health care industry leaders and policymakers a timely look at how health care consumerism is evolving and provides a comprehensive perspective about how Americans approach their health, health care and health insurance. Based on a unique segmentation scheme that goes beyond the conventional boundaries of what health and health care are commonly thought to encompass, the survey provides a framework based on the expanding spectrum of treatment alternatives, delivery settings, information sources, technology innovations and programs.

"The results of our survey are conclusive -- consumers want better performance from their health system," said John T. Bigalke, vice chairman and U.S. Health Sciences & Government industry leader, Deloitte LLP. "They want better value for the dollars they spend and believe fundamental changes are necessary to achieve these goals."

As the new administration moves forward to tackle health care reform, it may not have to look too far to see what is currently working with the system. Fifty-three percent of insured consumers are satisfied with their plan, an increase from 44 percent from last year's survey. Surprisingly, those that are most satisfied include Medicare (70 percent) and military health (67 percent) enrollees, compared with only 45 percent of individual policy holders that are satisfied with their health plans.

The Deloitte survey also reveals many gaps between what consumers think about their health status and the effort they put into improving their health and adhering to medical treatment. While seven out of eight Americans believe they are healthy, the reality tells a different story. Chronic conditions are becoming more mainstream in America, with more than half (55 percent) of survey respondents reporting at least one or more chronic conditions. Additionally, 57 percent indicated that they take one or more medications; however, only four in 10 say they take their medications as directed. This is coupled with the fact that less than half of consumers surveyed say they act in ways to make themselves healthier: 44 percent are trying to reduce stress, 44 percent are focusing on eating a healthy diet, 39 percent are putting an effort into managing weight and only 35 percent are exercising.

Additionally, consumers are beginning to test alternative sources for care often driven by lower costs. For example, 13 percent of consumers surveyed have visited a retail clinic this year and 30 percent said they would do so if it cost 50 percent or less than seeing a doctor in a doctor's office. Eight percent of consumers have traveled for care outside of their local community as "medical tourists," and 43 percent said they would be likely to do so if it would cost 50 percent or less than staying in their local area. However, only 1 percent said they have traveled offshore to receive care; and one in 10 say they would consider doing so if they could save money. One in five consumers also used an alternative or natural therapy to treat a health problem in the past year.

The framework of the study reflects a broad-based view of consumerism in six zones: (1) wellness and healthy living, including self-care and health management, (2) information sources helpful in consumer decision-making, (3) traditional health services provided by medical professionals, hospitals and retail clinics, as well as prescription medications and medical devices, (4) alternative health services sometimes described as complementary medicine, (5) insurance coverage and other financial considerations and (6) opinions about health reform.

Data across these six zones uncovered a variety of trends that influence how consumers view the health care system and areas they are willing to consider for future changes:

  • Fifty-three percent would like employers to be required to provide health insurance for employees (17 percent oppose).
  • Thirty-seven percent favor a mandate requiring every American to obtain health insurance either through direct purchase or through an employer or government program.
  • Twenty-five percent favor increasing taxes to help cover the uninsured (43 percent oppose and 32 percent are lukewarm).
  • Cost concerns (52 percent) and loss or lack of employer sponsorship (52 percent) are major reasons for not having coverage among the uninsured.
  • Almost half (47 percent) of those who dropped their coverage in the last year did so because they couldn't afford or didn't want to pay the high cost of insurance; 33 percent did so because they switched jobs and 10 percent did so because their employer dropped their plan.
  • Most (94 percent) believe health care costs are a threat to their personal financial security --only 6 percent say their household is completely prepared financially to handle anticipated health care costs.
  • Eighty-four percent believe current economic conditions will make it harder for consumers to pay their medical bills; 28 percent had problems paying medical bills in the past year.
  • Seven in 10 say they would participate in a wellness program if they were given financial incentives, such as a reduced insurance premium or monetary reward.
  • Forty-two percent want access to an online personal health record connected to their doctor's office.
  • Fifty-five percent want to be able to communicate with their doctor via email to exchange health information and get answers to questions.
  • Sixty-eight percent of consumers are interested in home monitoring devices that enable them to check their condition and send the results to their doctor.
  • Privacy and security of personal health information is an issue: 38 percent are very concerned versus 24 percent who are not at all concerned.
  • Seventy-four percent of recent hospital users were satisfied with their most recent experience -- a significant increase from 60 percent who said they were satisfied in last year's survey.
  • Six in 10 prefer generic drugs over branded drugs to save money, unless they believe a specific brand is more effective.


A nationally representative sample of 4,001 American adults, ages 18 and older, was surveyed between October 2 and 10, 2008, using a web-based questionnaire. The results were weighted to assure proper proportional representation to the nation's population, as reflected in the U.S. Census, with respect to age, gender, income, race/ethnicity and geography. The margin of error around the U.S. point estimates is +/- 1.6 percent at the .95 confidence level.

Related Content:

Report: 2009 Survey for Health Care Consumers (

Overview: Deloitte Center for Health Solutions (

Profile: Paul Keckley, Ph.D (

Profile: John T. Bigalke (

About Deloitte

As used in this document, "Deloitte" means Deloitte LLP and Deloitte Services LP, a subsidiary of Deloitte LLP. Please see for a detailed description of the legal structure of Deloitte LLP and its subsidiaries.


    Marykate Reese
    Public Relations
    +1 203 257 0452

    Sean Leous
    Public Relations
    Hill & Knowlton
    +1 212 885 0549

SOURCE Deloitte
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