2011 Survey of Health Care Consumers in Brazil Key Findings, Strategic Implications

Produced by the Deloitte Center for Health Solutions

Contents
Foreword Introduction Survey highlights Zone One: Wellness and healthy living Zone Two: Information resources Zone Three: Traditional health services Zone Four: Alternative health services Zone Five: Health insurance Zone Six: Health policy Major findings Stakeholder implications Closing thoughts Contacts 3 4 6 8 9 11 16 17 19 21 22 23 24

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Enrico De Vettori Partner Deloitte & Touche Sao Paulo In health care. This platform was developed to meet the industry’s needs across all of its segments: Pharmaceutical Industry. Hospitals. Deloitte conducted surveys in 11 other countries to compare consumer attitudes and behaviors in varied circumstances and systems of care. Animal Health. key issues include high cost of services. and an influx of imports. Home Care. and Public Health.Foreword This as an important time for Brazil to be part of the 2011 Survey of Health Care Consumers since Deloitte Brazil has just consolidated Brazil’s Life Sciences & Health Care platform within a team of specialists (physicians. and questions regarding old coverage contracts. veterinarians.C. The 2011 Survey of Health Care Consumers in Brazil. the role that individuals play in choosing doctors and hospitals. and anticipated limits on funding for health care systems. Laboratories. Pharmaceutical and biotech industries must deal with patent expirations. PhD Executive Director Deloitte Center for Health Solutions Washington. Dentistry. it is clear that engaging individuals to become more active increases the likelihood of better care and lower costs. Equipping consumers to be more active. will require new approaches to population health management. This survey of Brazilian health care consumers offers a glimpse of current opinions and activities as a baseline for future trend analysis. In many of the world’s health care systems. behaviors. that role to date has been minimal. pharmacists. It offers health care industry leaders and policy makers a timely look at how health care consumerism is evolving. physicians and hospitals have made most of the decisions on their behalf. 2011 Survey of Health Care Consumers: Brazil 3 . and economists. conducted by the Deloitte Center for Health Solutions. however. Medical Devices. as well as a comprehensive perspective on how Brazilians approach their health. and insurance coverage is becoming increasingly important. Image Services. has been designated the sixth-largest private health care market in the world by the World Health Organization (WHO). Brazil’s health care system comprises eight percent of the country’s gross domestic product (GDP). Looking forward. health care. studies for the first time Brazilian consumers’ attitudes. consumers’ role in managing their health has been secondary. threatened price controls by the government. Keckley. engaged. high levels of claim rates. and physicians are also facing challenges. The Brazilian health care market has been facing growing challenges for more than a decade. In most systems. treatment options. such as assisting patients under agreements that do not adequately cover their costs. though. Biotechnology Industry. which exposes these companies to USD exchange rate variations and the consequences of worldwide economic instability. Concurrently. Paul H. For example. the number of health plan operators has been decreasing year after year. and health insurance. and is responsible for two million direct jobs and five million indirect jobs. It is responsible for transactions totaling US$100 billion a year. Health Plan Payors. and accountable for their care and the associated costs may be an important new dimension for health care system improvement. D. and unmet needs. Hospitals. Health Care Supply Chain. it is apparent that the emergence of technologies that assist consumers in decision-making. among others). clinics. dentists.

economic. we offer a baseline analysis about health care consumerism in Brazil. and finance health care. Wellness and healthy living Health care consumerism 3. the Deloitte Center for Health Solutions surveyed adults in 12 countries to gauge opinions and expectations about their health care systems. consumers. service. a view that goes beyond the conventional boundaries of what health and health care are commonly thought to encompass. In addition to the traditional services that doctors and hospitals provide. Health policy 4. the 2011 survey continues to build on previous years’ surveys by exploring consumers’ behaviors. Information resources 1. however. In 2011. Now in its fourth year. and generational viewpoints. the study’s framework takes into account the expanding spectrum of treatment alternatives. Health care consumerism: Conceptual framework for this study Conducted annually since 2008. address health needs. Citizens in each of these countries differ widely in their social. information sources. attitudes.Introduction How do health care systems perform from the viewpoint of the citizens they serve? Do individuals understand their treatment options and respond accordingly? Are choices of physicians and hospitals made based on objective information about quality. 4 . Traditional health services 6. and cost? Are prescription drugs and alternative courses of care thoughtfully considered by consumers when recommended? Are mechanisms to mitigate financial risk via insurance or personal spending managed effectively. Across these countries there are many differences in health care systems’ structures and operations as well as in the political and economic thrusts of national health care reforms. and the first year for Brazil. they are all end users of health care and hold strong views on the performance of their respective systems and what they expect to receive from health care. and unmet needs in six areas (Figure 1): • Wellness and healthy living • Information resources • Traditional health services • Alternative health services • Health insurance • Health policy Figure 1: Zones of health care consumer activity 2. delivery settings. In this report. All rights reserved. and programs that are coming into existence to promote wellness and self-care. Alternative health services 5. Deloitte’s longitudinal study of heath care consumers seeks to provide a comprehensive view of health care consumerism. or are costs for health care forcing compromises for families? These questions are at the center of a global discussion about how health care systems – whether governmentrun or private – relate to their end users. Health insurance Copyright © 2011 Deloitte Development LLC. cultural.

hospitals are 41 percent public. Also.0% at the . Canada. China. The private system is financed by employers and/or individuals. All rights reserved. and 15. which contrasts findings from the 12 countries. Germany.This year. 2011 Survey of Health Care Consumers: Brazil 5 . was surveyed in April 2011 using a web-based questionnaire. Mexico China Brazil Belgium France Germany Luxembourg Portugal Switzerland UK Copyright © 2011 Deloitte Development LLC.3.S. The survey consisted of 56 questions. and the United States (Figure 2).com/us/2011consumerism. Deloitte surveyed health care consumers in Belgium. Background: Brazil’s health care system Brazil has a national health care system in which the government provides free services to all Brazilian citizens. Portugal. 34 percent private. aged 18 and older. Seventy-five percent of the population uses the public system exclusively to access health care. the United Kingdom. France.800 specialized diagnostic clinics. The sample was representative of the nation’s population with respect to age and gender.deloitte. The margin of error is +/. Switzerland. Survey methodology A nationally representative sample of 1.800 hospitals. 27. Figure 2: 2011 surveyed countries Canada Europe U. and 25 percent philanthropic owned. and separate country reports can be found at www.95 confidence level.800 diagnostic centers as well as many other types of health care organizations in Brazil. Mexico. Luxembourg. There are over 6. Brazil also has a private supplementary system comprised of health plans and insurance companies. Twenty-six percent of the population has private insurance coverage. with 29 potential follow-up questions. Brazil. It was administered in Portuguese.000 Brazilian adults. A global report. Funding is financed by public resources and contributions from beneficiaries. Participants were asked about behaviors before attitudes within each topic area to reduce response bias. Highlights of Brazil’s results are included in this summary.

• Consumers say they received good value for out-ofpocket spending in the past year on prescription drugs (50%). 9% feel that they do not. • 32% feel that they have a good understanding of how the Brazilian health care system works. how would you grade the overall performance of Brazil's health care system? 100% 80% 8% 60% 57% 40% 35% 26% 31% 20% 8% 0% 1% A Favorable grade B C D Unfavorable grade F Note: Bars may not sum precisely to the totals above due to rounding. 30% believe that the system is performing better now than five years prior. • Consumers are dissatisfied with wait times for services (81%). and insurance premiums (25%). and F. and a lack of focus on patient-centered care (57%). • 4 in 10 (40%) respondents are dissatisfied with the performance of the Brazilian health care system.Survey highlights Consumer perceptions of Brazilian health care system performance Brazilian consumers are dissatisfied and believe that the system is not performing well. over-the-counter products (41%). rehabilitation services (34%). • 43% of survey respondents report an increase in their health care spending in the last year. Figure 4: Health care system performance compared to previous years How do you think the public health care system in Brazil is performing now compared to what it was like five years ago? 100% 80% 60% 48% 40% 30% 20% 19% 4% 0% Better 2011 Brazil Copyright © 2011 Deloitte Development LLC. • Few (6%) consumers believe the Brazilian health care system works better than other comparable systems in the world – particularly with respect to quality of care (4%) and being technologically advanced (16%). with more Generation X (those born 1965 to 1981) (44%) and Boomers (those born 1946 to 1964) (42%) being dissatisfied than Generation Y (those born 1982 to 1993) (34%). C. B. 48% believe that it is performing similarly. Figure 3: Report card grades of overall health care system performance Using a typical report card scale with grades of A. In contrast. and 19% believe that it is worse (Figure 4). access to services (57%). • Slightly fewer than 1% of consumers give the Brazilian health care system’s performance a grade of “A” (excellent). physicians (47%). 26% give it a “D”) and 35% give it a “C” (Figure 3). All rights reserved. hospital care (39%). 57% give the system a grade of “D” or “F” (31% of consumers grade it as “F” or failing. • Of the 25% who delay or forgo treatment recommended by their doctor. D. All rights reserved. • Most consumers are aware of changes being made in the health care system (11% are “very aware” and 69% “somewhat aware”). 2011 Brazil Copyright © 2011 Deloitte Development LLC. 8% grade it “B” (very good). Much the same Worse I don’t know 6 . 27% do not go because the cost is too high and they cannot afford it.

paid for out-of-pocket (4%) or paid for by the government (1%). • Care is provided primarily by the recipient’s spouse (38%). 2011 Survey of Health Care Consumers: Brazil 7 . Of consumers who report caring for other individuals. and 22% care for individuals 65+. for one-quarter (25%). • 44% of consumers report providing care for another individual.Many Brazilians are responsible for the care of others. • Duration of care ranged from less than six months (24%). 23% are unsure of the duration of care. 17% care for individuals between ages 18 and 25. parent (26%). son or daughter (26%). • 88% of family caregivers report some impact on their income-generating capacity. this represents a major limitation on their ability to earn an income. and over two years (32%). between 12 and 24 months (12%). 32% care for individuals between ages 45 and 64. 35% care for individuals in more than one age group. 36% care for individuals under age 18. extended family members (8%). 28% care for individuals between ages 26 and 45. between six and 12 months (9%).

More women (70%) say they did so than men (63%). minerals. 13% have two. • In the past year. • Those with “excellent” or “very good” health (26%) are more likely to participate in a healthy living/wellness program than those with “fair” or “poor” health (13%). • 13% of consumers rate their physical health as “excellent” and 41% rate it as “very good” (Figure 5). Vitamins and food with health benefits are popular.” • Almost half (46%) of individuals report having a chronic condition (Figure 5).Zone One: Wellness and healthy living Most Brazilians report they are in good health. More men (57%) than women (49%) rate their physical health as “excellent” or “very good. One or more chronic conditions Figure 6: Wellness and preventive behaviors Which of the following have you done in the last 12 months? Visited a doctor for a routine check-up Had an imaging exam or test 67% 50% Took vitamins. minerals. Healthy living programs are used by 1 in 4 whereas few use personal trainers to improve health. • 2 in 3 (67%) consumers say they visited a doctor/ medical professional in the past year for a routine check-up (Figure 6). Those with supplemental health insurance (25%) are more likely than those without (16%) to participate. or herbal supplements Chose a food for its health benefit 49% 48% Participated in a healthy living/wellness program Consulted a personal trainer 0% 2011 Brazil 12% 20% 23% 40% 60% 80% 100% Copyright © 2011 Deloitte Development LLC. Almost half say they have at least one chronic condition. More men (34%) than women (24%) report taking vitamins or minerals. • To improve their health or to treat a health condition. All rights reserved. how would you rate your overall health? Have you been diagnosed by a doctor or other medical professional as having one or more chronic conditions? 100% 80% 60% 46% 41% 40% 35% 20% 13% 10% 2% 0% Excellent Very Good Good Fair Poor Self-reported health status 2011 Brazil Copyright © 2011 Deloitte Development LLC. and 5% have three or more chronic conditions. 31% use nutritional foods. 8 . • Half of consumers report they had an imaging exam or test (50%) and 40% of consumers say they had a flu shot in the past year (Figure 6). around half of consumers (49%) say they took vitamins. 28% have one chronic condition. • 12% of survey participants report they used personal trainers to improve their health (Figure 6). All rights reserved. and 15% take overthe-counter medications. Many have regular check-ups and screenings. or herbal supplements and half (48%) deliberately chose particular foods for their health benefits (Figure 6). 29% of Brazilian consumers take vitamins on a regular basis. • About 1 in 4 (23%) reports participating in a health living/wellness program in the past year (Figure 6). Got a flu shot 40% Figure 5: Self-reported health status and chronic conditions In general.

2011 Survey of Health Care Consumers: Brazil 9 . 9. Use of social networking sites for health care information. communicating with their insurance company (7%). Wikipedia) Pharmacies Pharmaceutical/biotech/ medical device manufacturers Independent health-related websites (e. Google. consumers trust medical associations/societies (47%) and academic medical centers/teaching hospitals (47%) (Figure 7). gave a rating of 8.. All rights reserved. • 70% respondents do not use social networking sites to learn more about prescription drugs. and communicating with their physician (5%). or comment about health experiences. and monitoring is low. management. how much trust would you have in the following “third-party“ sources to provide reliable information? Academic medical centers/teaching hospitals Medical associations/societies State Departments of Health and Human Services Ministry of Health Community hospitals Health insurance companies/health plans Internet search engines/sites (e. • Employers are the least-trusted source for quality/safety information (13%) (Figure 7) and for information on cost (19%).g. More Boomers (80%) than Generation Y (63%) and Generation X (70%) say they do not use social networking for the above healthrelated communications.Zone Two: Information resources Consumers trust medical providers for information about treatments.e. or 10 on a 10-point scale. communicate with their physician or insurance company. Trust in Internet sources and websites does not vary by generation. Web MD) Employers 0% 29% 25% 24% 23% 21% 18% 18% 17% 13% 20% 40% 60% 80% 100% 47% 47% Chart shows % who trust the source (i.. where 1 = no trust and 10 = complete trust) 2011 Brazil Copyright © 2011 Deloitte Development LLC. • One in five (20%) consumers reports using social networking sites to comment about their experiences using the health care system.g. More than 1 in 4 trusts the Internet (27%) and independent health-related websites (27%) for cost information. • For information on the most effective and safe treatments for a certain health condition. • 1 in 5 says they trust the Internet (21%) and independent health-related websites (17%) for treatment and safety information (Figure 7). and costs. Other uses include learning more about prescription drugs (16%). safety. Figure 7: Trust in information sources If you wanted information about the most effective and safe treatment(s) for a certain health condition..

Personal health records are not widely used by most Brazilians. • 1 in 3 consumers (33%) reports searching online for information about the quality of care provided by a specific physician or specialist. shopping. • Survey respondents report using the Internet to find information about the costs of physician services (31%) and for information on treatment options or a particular treatment (41%). 36% of individuals say they are very likely and 50% are somewhat likely to switch doctors if they could get access to their medical records through an Internet connection with the physician. • 16% currently maintain a PHR. how likely would you be to use your smart phone to monitor your health? 100% 80% 60% 43% 40% 20% 0% Interested in using a medical device that would enable you to check your condition and send information to your doctor electronically 2011 Brazil Copyright © 2011 Deloitte Development LLC. more 25-44 year-olds (25%) than 18-24 (21%). All rights reserved. More Boomers (78%) are interested than Generation Y (64%) and Generation X (69%) in remote monitoring tools. more women (38%) say they do this than men (28%). and 45% to make travel reservations. how interested would you be in using a self-monitoring device? If your medical records were available to you on your smart phone. • 4% of consumers say they switched physicians in the past 12 months because they wanted a doctor who used the Internet and electronic medical records.Brazilians are interested in self-monitoring technologies and smart phones for their health management. Boomers (18%) are more likely to say they are not interested than Generation X and Generation Y (11% each). Very likely Somewhat likely Not at all likely 13% 69% 44% Likelihood of using a smart phone (or PDA) to monitor health Use of online resources for health care is low compared to use for banking. and 45-64 year-olds (13%) use blogs. and you were able to download information about your medical condition and treatments. 4% of consumers do not show interest in using a medical device that would enable them to check a condition and send information to their doctor electronically through a computer or cell phone via the Internet. Figure 8: Interest in medical devices and cell phones for health-monitoring purposes If you have or were to develop a health condition that needs to be checked regularly. • In the past year. Utilization does not vary by health status or generation. • 4 in 10 (41%) respondents are concerned about privacy and security in maintaining a personal health record (PHR). 67% to conduct online banking. • Interest in using smart phones to monitor health and medical records is high: 43% say they are “very likely” and 44% are “somewhat likely” to use the technology if available (Figure 8). • 1 in 5 (21%) says they used a blog in the preceding year to share or comment on a health experience. • 69% of respondents say they are interested in remote monitoring tools (Figure 8). 10 . Fewer (41%) say they looked online for information about health care treatment options. 86% of consumers say they used the Internet to purchase merchandise. and travel.

• 49% have visited a doctor/medical professional for injury or illness in the past 12 months. Others report they did not seek care due to time pressures or inconvenient appointment times (38%). needing a different type of specialist (26%). 20% 29% 65% 38% 9% 8% 7% 20% 40% 60% 80% 100% 2011 Survey of Health Care Consumers: Brazil 11 . • Less than half (45%) of survey respondents have a primary care provider (PCP). This is due primarily to a belief that the problem would go away without medical attention (65%). • Of the 86% who report they paid out-of-pocket for physician services in the past 12 months. one quarter (26%) feel the opposite. • One in five (20%) individuals says they decided not to see a doctor when sick or injured. • Switching physicians is somewhat common: 33% of consumers report switching doctor/medical professionals in the past year. Figure 9: Reasons consumers did not see a doctor when they were sick or injured Why did you decide not to see a doctor/medical professional when you were sick or hurt? Thought the problem would go away Appointment times were inconvenient/I did not have time/took too long Wanted to use an alternative approach/natural therapy first or instead Cost was too high Insurance did not cover the service or treatment I needed Difficult to find a doctor who would accept a new patient Other 0% 2011 Brazil Copyright © 2011 Deloitte Development LLC. 25% delayed or decided not to seek treatment recommended by a medical professional. and a preference for doctors who charge a lower fee (8%). All rights reserved.Zone Three: Traditional health services Physicians Less than half of Brazilian consumers report having a primary care relationship. the doctor no longer accepting a particular type of insurance (15%). More women (38%) switch physicians than men (29%) do. • Of those who have a PCP. dissatisfaction with the service provided by the staff in the doctor’s office (26%). cost (20%). Reasons for switching physicians include dissatisfaction with the care received from their doctor (49%). nearly half (47%) feel that they received good value for their money. or lack of insurance coverage (9%) (Figure 9). most (76%) are satisfied with the quality of care received from their PCP (Figure 10). The main reason for delaying or forgoing treatment is concern over potential side effects (31%) and cost (27%). • In the past year.

Women (61%) are more satisfied than men (53%). ease of access. primarily for emergency room (ER) care (44%) and outpatient treatment (29%). All rights reserved. Younger individuals express more interest than older individuals: 18-24 (49%) vs. and reputation (60%). • Many are willing to use a walk-in retail clinic for a minor condition if it meant they would be seen immediately (43%). • Many consumers are willing to pay for care for a minor condition if it meant that they would receive care more quickly (41%). • 57% of consumers are satisfied with the quality of care received from the hospital they used most recently (Figure 10). • 1 in 5 (21%) says they used a walk-in clinic such as a pharmacy or grocery store in the past 12 months for a non-urgent health problem. 1 in 3 (32%) is willing to use a walk-in retail clinic for a minor condition if it cost 50% less than visiting a doctor in a doctor’s office. fast access (61%). • 61% of consumers say they used a hospital service in the previous 12 months. Retail medicine Brazilian consumers are receptive to retail/ ambulatory options for non-urgent care. and reputation are factors Brazilian consumers consider in differentiating hospitals. 12 . 45-64 (38%). All rights reserved. Medical school affiliation (21%) and religious affiliation (10%) are the least important factors (Figure 11). specialization (61%). • Consumers base hospital selection primarily on insurance coverage (61%).Hospitals Perceived specialization. Figure 11: Factors important to hospital choice How important were the following factors to you in choosing the hospital you used most recently? Fast access/no waiting times Insurance coverage Specialization Reputation Quality/satisfaction ratings or consumer reports Doctor recommendation/referral Amenities Distance from home Close to public transportation Cost of services Affiliation with a medical school Affiliation with a religious organization 0% 10% 20% 40% 60% 80% 100% 21% 41% 41% 53% 53% 51% 50% 61% 61% 61% 60% Chart shows % who gave the factor a rating of 8. how satisfied are you with the quality of care you receive from your primary care provider/received from the hospital you used most recently? 100% 80% 60% 1%/6% 76%/57% 40% 23% 21% 23% 18% 32% 20% 0% 4% 1% 0% 2 Not satisfied 0% 2% 3 1% 4% 4 5% 7% 5 9% 3% 6 17% 13% 16% 0% 1 7 8 9 Satisfied 10 Primary care provider Hospital care Copyright © 2011 Deloitte Development LLC. 9. or 10 on a 10-point scale (1 = not at all important and 10 = extremely important) among consumers who used hospital services in the last 12 months 2011 Brazil Copyright © 2011 Deloitte Development LLC. 14% report they stayed overnight. Figure 10: Satisfaction with primary care providers and hospitals Overall.

up-to-date technologies and facilities (67%). and lack of waiting times (59%). All rights reserved. • Many consumers say they would consider traveling outside Brazil if they needed a necessary hospital procedure like joint replacement or heart surgery (18% “definitely” and 41% “maybe”) or chose to undertake an elective procedure (13% “definitely” and 34% “maybe”) (Figure 12). • If elective procedures (such as cosmetic surgery or dental treatments) was available faster or of a better quality. then consumers would: • Seek care at a hospital not the nearest to their home (56% “definitely” and 36% “maybe”). and no waiting times (61%).Traveling for care Traveling for care outside Brazil is not common. an expectation of superior quality medical care and treatment (72%). • Seek care in a hospital located in a town or nearby city (37% “definitely” and 48% “maybe”) (Figure 12). however. cost (61%). • The decision to travel outside Brazil for elective procedures is based on criteria such as superior quality of medical care and treatment (70%). Figure 12: Willingness to travel for hospital care How likely would you be to travel for necessary or elective hospital care? Necessary 100% 6% 28% 36% 60% 37% 48% Elective 7% Necessary 9% Elective 16% 41% 53% Necessary Elective 80% 40% 66% 20% 56% 53% 37% 41% 34% 18% 0% Go to a hospital that is not the one nearest to your home because it offers better care or faster access to services Highly unlikely Maybe Definitely Travel to a hospital outside your town or city (e. in a major or different city) which is known to provide better care or faster access to services 13% Travel outside Brazil to have the procedure Copyright © 2011 Deloitte Development LLC. • Many are open to travelling outside their local area for treatment if recommended to do so by their physician (49%). • Seek care in a hospital located in a town or nearby city (53% “definitely” and 37% “maybe”) (Figure 12). • 15% of consumers report they traveled outside their local area in the preceding year. more up-to-date technologies and facilities (70%). • If necessary care (such as joint replacement or heart surgery) was available faster or of a better quality. to consult with a doctor. or receive treatment. • Consumers say they would be willing to travel outside Brazil for necessary care based on the following: availability of the specific treatment needed (75%).g. undergo a medical test or procedure. then consumers would: • Seek care at a hospital not the nearest to their home (66% “definitely” and 28% “maybe”). availability of specific treatments (66%). 2011 Survey of Health Care Consumers: Brazil 13 . many are willing to consider that option if it is recommended by their doctor. and 2% traveled outside Brazil.

3 in 4 (76%) are highly confident in the effectiveness of their prescription medications. 14 . All rights reserved. • Of the 6% of consumers who say they switched prescription medications in the past 12 months. • 6% of those who are taking one or more prescription medications switched medications in the past year (Figure 13). • 19% of those who are taking one or more prescription medications discontinued taking it before the supply was finished. • Prescription medication users looked online for information about treatment options (46%). medication not working (28%). and 1 in 10 (14%) modified the dosage or frequency of prescribed medication without asking their doctor (Figure 13). most switched to a generic brand to save money (59%). and sought advice at the pharmacy about a prescription medication prescribed by a doctor (24%) (Figure 13). side-effects (22%). Figure 13: Seeking and using information about treatment options Which of the following have you done in the last 12 months? Looked online for information about treatment options Asked a pharmacist’s opinion about a medication that was prescribed by a doctor Compared available treatment options for a particular health condition/problem Discontinued taking a prescribed medication before it was finished Modified the dosage or frequency of prescribed medication without asking or telling your doctor Asked doctor to prescribe particular drug by name or brand or asked whether it would be a better choice Switched prescription medications 6% 46% 24% 24% 19% 14% 13% 0% Chart shows % of prescription medication users 2011 Brazil 20% 40% 60% 80% 100% Copyright © 2011 Deloitte Development LLC. 15% take over-the-counter medications on a regular basis. 27% take two daily. preference for an easier to take medication (24%). • Of those who take prescriptions regularly. and switching to another brand because their insurance did not pay for the one prescribed (7%). Other reasons included the particular medication being no longer being available (30%). compared treatment options for a particular health condition (24%). • 40% say they take prescription medications on a regular basis. and 20% take three or more daily.Prescription medication use 4 in 10 (40%) take prescription medications and 15% use over-the-counter therapies. half (51%) take one daily.

1 in 3 (30%) says they purchased an over-the-counter product instead of filling a prescription (Figure 14). All rights reserved. • Of the consumers who take one or more prescription medications. using genetic testing to develop a specialized medication that specifically targets the individual with a particular disease). which is described as a medicine that is tailored to an individual’s needs and condition (e.g.. • Consumers who are taking one or more prescription medications are willing to use non-traditional methods of acquiring those medications: 21% say they purchased prescription medications via mail order or online and 3% purchased prescriptions outside Brazil (Figure 14). • 15% of consumers report they were treated.• Of those taking one or more prescription medications. Figure 14: Which of the following have you done in the last 12 months? Which of the following have you done in the last 12 months? Asked doctor to prescribe a generic drug rather than the brand drug due to cost Purchased a generic drug instead of a prescription drug because of price or advice received at the pharmacy counter Purchased an over-the-counter product from a store instead of filling a prescription Purchased prescription medications from a mail order or online pharmacy Asked doctor to prescribe a generic or different drug because prescribed drug was not in insurance plan formulary Purchased a drug using a coupon provided by the pharmaceutical company Purchased prescription medications from a source outside the country 0% Chart shows % of prescription medication users 2011 Brazil Copyright © 2011 Deloitte Development LLC. in the last year with a personalized medication. or are aware of someone who was treated. 44% 42% 30% 21% 14% 12% 3% 20% 40% 60% 80% 100% 2011 Survey of Health Care Consumers: Brazil 15 . 44% of consumers report they asked their doctor to prescribe a generic drug due to cost considerations (Figure 14).

11% switched to a health care practitioner who offered alternative/natural therapies. • 11% of respondents say they consulted an herbalist. of those who delayed or decided not to follow physician recommendations. 17% say they did so because they wished to use an alternative treatment or natural therapy first or instead. • Of those who decided in the past year not to see a doctor when they were sick or hurt. homeopath. or other alternative health care practitioner or advisor 15% 11% 0% 2011 Brazil Copyright © 2011 Deloitte Development LLC. chiropractor. All rights reserved. Figure 15: Use of alternative treatment approaches and natural therapies Which of the following have you done in the last 12 months? Used an alternative approach/ natural therapy in addition to a prescribed medication (% of medication users) 25% Treated a health problem with an alternative approach/natural therapy 23% Substituted an alternative approach/natural therapy for a prescribed medication (% of prescription medication users) Consulted an herbalist. 29% say they did so as they preferred to try an alternative treatment approach first or instead. and 23% treated a health problem with alternative/natural therapies (Figure 15). 20% 40% 60% 16 . or other alternative health care practitioner or advisor in the past year. chiropractor. • Of the 33% who report switching doctors in the preceding year. • Individuals who are taking one or more prescription medications report using an alternative treatment approach or natural therapy in addition (25%) to a prescribed medication and as a substitution (15%) to an alternative treatment for a prescribed medication. homeopath. More women (28%) than men (19%) utilized alternative and natural treatments.Zone Four: Alternative health services 11% of Brazilian respondents use alternative/ natural therapies.

having lost supplemental insurance after changing employment (20%). most say they wanted to get better coverage (46%) and pay less (39%). how adequately insured do you consider yourself to be? 100% 80% 61% 60% 40% 23% 20% 15% 1% 0% Well-insured Adequately insured Under-insured Not sure 2011 Brazil (n = 750 who said they have supplemental insurance) Copyright © 2011 Deloitte Development LLC. Few people have PBM (Pharmacy Benefit Management or Programa de Benefício de Medicamentos) (2%) and about 1 in 3 (36%) has dental. All rights reserved. Figure 16: Adequacy of insurance coverage Thinking about the amount and types of health insurance coverage you have. health plan. Of those who switched. • Of those who have supplemental insurance. 12% are insured through other sources. • Health insurance is obtained primarily through employers (52%). 38% of consumers say they purchased insurance directly. 2011 Survey of Health Care Consumers: Brazil 17 . 61% feel that they are “adequately insured. • Switching insurance plans is not common. 4% of consumers report they switched to a different health plan offered by the same insurance company and 5% switched to a different health plan offered by a different insurance company. and other reasons (9%). or health care program. 6 in 10 (60%) believe they are adequately insured. • 75% of all respondents are covered by some kind of supplemental health insurance. the types of insurance held include: • Insurance (51%) • Cooperative (29%) • Group medicine (22%) • Self-managed (10%) • Philanthropy (2%) • Reasons for not having supplemental health insurance include too expensive (58%).” and 15% feel they are “under-insured” (Figure 16). believing it was not necessary due to good health status (7%). • 23% feel “well-insured” across their public and private plans.Zone Five: Health insurance 3 in 4 (75%) consumers who responded have supplemental insurance. preferring to pay out-of-pocket (6%).

• Interest does not vary by chronic condition prevalence. fuel. or generation. Those who feel adequately insured feel better prepared to deal with future health care obligations. 2011 Brazil Copyright © 2011 Deloitte Development LLC. and adequately insured (22%). • 83% of survey participants are limited in their ability to spend money on essential household items (housing.Brazilians with insurance value benefits that enhance care coordination and active health management. All rights reserved. Wellinsured (42%) consumers are more financially prepared for future health care costs than under-insured (11%). 8 in 10 consumers say they limit spending for household essentials because of health care expenses. 18 . • Most consumers say they would be very (40%) or somewhat (56%) interested in a plan that offered an incentive to PCPs to coordinate care and manage health. More men (25%) than women (18%) feel secure. health status. and education) due to monthly health care expenses. 1 in 4 (24%) is not financially prepared (Figure 17). Figure 17: Financial preparation for future health care costs To what extent do you feel your household is financially prepared to handle future health care costs? 100% 80% 60% 24% 22% 40% 20% 9% 0% 1 2 Not prepared 3 7% 9% 16% 11% 13% 13% 13% 5% 4% 10 4 5 6 7 8 9 Prepared Note: Bars may not sum precisely to the totals above due to rounding. groceries. • 1 in 5 (22%) consumers reports being financially prepared to handle future health care costs.

The government does a good job balancing priorities in our system. Few are positive about the system (e. or 3 on a 10-point scale Generation X (1965-1981) Agree 6% 4% 15% 4% 25% 55% Disagree 62% 76% 42% 71% 26% 9% Agree 7% 5% 15% 4% 19% 51% Disagree 56% 68% 39% 61% 32% 10% 2011 Survey of Health Care Consumers: Brazil 19 .” • Consumers are optimistic (56% agree) about the possibility of improving quality and reducing costs simultaneously in the current system of care. • Opinions vary concerning privatization. is of high quality [4%]. The quality of care in our system is comparable to the best in the world. • Consumers are critical of the health care system. 2. and is technologically advanced [16%]). It is possible to improve quality and reduce costs simultaneously in our current system of care. with around 1 in 5 (22%) believing that privatization would improve performance. Increased privatization in our system would improve its performance. 4% of consumers agree with the statement that “the government does a good job balancing priorities in the system. and one-third (30%) not believing. Figure 18: Consumer insights about the Brazilian health care system by generation Boomers (1946-1964) and Seniors (1900-1945) Agree 5% 3% 22% 5% 23% 65% Disagree 64% 71% 38% 65% 32% 5% Generation Y (1982-1993) System Insights Our system works better than most systems in the world. Physicians and hospitals in our system have access to latest technologies and treatments. believing that it is better than many other comparable systems [6%].Zone Six: Health policy Consumers are critical of Brazil’s health care system and desire improvements.. or 10 on a 10-point scale Disagree = ratings of 1.g. Agree = ratings of 8. • Opinions held by generations about the performance of the Brazilian health care system are remarkably consistent (Figure 18). 9.

More women (38%) than men (31%) grade their system well for medical innovation. D. C. F)? Medical innovation (new treatments or services) 34% 29% 28% 35% 18% 46% 13% 51% 13% 57% 13% 57% 7% 81% 0% Favorable grade (“A” or “B”) 20% 40% 60% 80% 100% Up-to-date technology Up-to-date buildings and equipment Focus on wellness rather than illness Patient-/consumer-centered Access to services (availability and convenience) Wait times for service Unfavorable grade (“D” or “F”) Copyright © 2011 Deloitte Development LLC. Figure 19: Report card grades for specific elements of the health care system How would you grade the public health system in Brazil on the following dimensions (using a typical report card scale of A. All rights reserved. 20 . B.• Components of the Brazilian health care system that consumers feel favorably about include medical innovation (34%) and up-to-date technology (28%) (Figure 19).

and improved quality of care. improved service. • Half of consumers use vitamins and nutritional foods as a preventive measure.Major findings #1: Consumers say the Brazilian health care system performs poorly and does not compare well with other systems around the world. and the majority is dissatisfied with aspects of the system. less than half (41%) say they are concerned. much can be done that focuses on improving care systems. • 83% of consumers say health care costs have limited their spending on other essential household items. #3: Use of health care information technologies for self-monitoring and care management and use of online resources are low. but satisfaction for those with access is high. #4: Brazilian consumers are concerned about health costs and see the role insurance programs play in assuring financial security. #2: Access to primary care is relatively low. technology. Few believe that the system works better than other comparable systems in the world. 26% indicated that they are in “excellent” or “very good” health whereas 13% are in “fair” or “poor” health. • 1 in 4 consumers does not feel financially prepared to handle future health care costs. many consumers seek care for routine and sick visits along with preventive measures such as imaging exams and flu immunizations. • 90% of Brazilian respondents believe that their health care system performs sub-optimally and 4 in 10 are dissatisfied with how the system functions. • From a consumer perspective. The majority of Brazilian consumers do not participate in formal health lifestyle programs. • Of the 23% participating in health lifestyle programs. and developing a stronger consumer focus. • Brazilians want their health care system to improve and are highly receptive to innovation in the sector. reducing wait times. 2011 Survey of Health Care Consumers: Brazil 21 . and most consumers feel either adequately insured (61%) or well-insured (23%) by all types of coverage. #5: Policy changes that support improved access to primary health care services. Although less than half have a PCP. • Over half of Brazilians are optimistic about the possibility of improving quality and reducing costs simultaneously. better technology. • Satisfaction with care is high among consumers who have a PCP. vitamins and nutritional foods are commonly used to improve health. • 3 in 4 consumers have supplemental insurance. • 96% of survey participants are interested in insurance plans offering an incentive to PCPs to coordinate care and actively manage health. • Privacy and security of personal information in PHRs is an issue but not one of overwhelming concern to consumers. • Major areas for improvement are enhanced access to services. and innovation that reduces costs are popular among Brazilians. • 87% of consumers are interested in medical record access via smart phones and 50% indicate willingness to switch doctors to gain access to their medical records via an Internet connection. Increasing participation by those in fair or poor health is an opportunity for improvement. however. Many consumers are dissatisfied with performance but recognize opportunities for improvement. shorter wait times.

How will policy directions translate into a transparent health care system offering quality service and a full range of diagnostic. with new national health care policies emerging that have the potential to stimulate the production of higheradded-value products. evidence-based care. and over-the-counter solutions best reach consumers? How can consumers be engaged in understanding the impact and implications of emerging regulatory requirements such as policies to track and trace pharmaceuticals? Science presents a multitude of opportunities for consumers as well as limitations and challenges in achieving the optimal solution for their needs. and medical devices for monitoring health. and improve international partnerships. • This is an important moment for health care in Brazil. and attention to quality and service are all critical at a time when there is considerable market activity via acquisition and investment and a growing demand for hospitals in Brazil to become internationally accredited. analytic. including collaboration with private sponsors.Stakeholder implications Stakeholders in the Brazilian health care system should consider these questions and issues: • How should providers – doctors and hospitals – improve their value proposition to consumers to achieve seamless continuity of care. as can clinical information systems and integrated systems for consolidating personal health care information. Efforts to upgrade the quality of Brazilian hospitals. reduce consumer out-of-pocket costs. smart phones. social media. There is opportunity for stakeholders to take advantage of the growing amount of information available to consumers through online sources. and diagnostics? Value. pharmaceuticals. Consumers are increasingly “wired” and information systems that educate and equip individuals to act accountably and appropriately can have great impact. • Consumers are clearly interested in technology. Explicit efforts to educate Brazilians about the efficacy of prescription drugs and policy initiatives to improve oversight of the therapeutics industry are widely viewed as improvements. enhance access and service delivery. are appropriate given the public’s appetite for innovative technologies and specialization. surgery. thus. spur a generation of technical innovation. the spending associated with that care? 22 . and therapeutic products to the consumer? • Finally. • How can companies that manufacture medical devices. what levers are necessary to engage consumers more meaningfully in decisions that affect their health care and. and reduce non-evidence-based tests. health information technology.

however. they have told us that high-quality. 2011 Survey of Health Care Consumers: Brazil 23 . Consumers participating in this survey have shared their thoughts and feelings. This ongoing study by Deloitte is a major milestone in capturing what consumers want from their respective health care systems and provides valuable guidance to stakeholders planning the industry’s future. readily accessible and understandable health care is incredibly important to them. We agree.Closing thoughts There are no easy answers to the challenges that face Brazil’s health care system. this study offers insights to guide development of possible solutions.

Deloitte Center for Health Solutions 555 12th Street N. Anna Brewster.W. its projects and events. analysis. We would also like to thank Jennifer Bohn. and reporting stages of the project. and Kerry Iseman in the Deloitte Center for Health Solutions as well as Patsy Bolduc and Terry Koch from Deloitte Global Life Sciences and Health Care for their contributions.Contacts Authors Paul H. MHA Head of Research Deloitte Center for Health Solutions Deloitte LLP scoughlin@deloitte.com Leslie Korenda. Contact information To learn more about the Deloitte Center for Health Solutions. please visit: www. PhD Executive Director Deloitte Center for Health Solutions Deloitte LLP pkeckley@deloitte.com/centerforhealthsolutions 24 .com Aline Silva Ranieri Senior Consultant Deloitte & Touche aranieri@deloitte.deloitte. MPH Research Manager Deloitte Center for Health Solutions Deloitte LLP lkorenda@deloitte.deloitte. Washington. PhD.com Verena Pinto Consultant Deloitte & Touche vepinto@deloitte.com Web http://www.com/centerforhealthsolutions.com Acknowledgements We wish to thank Laura Eselius and all those who contributed their ideas and insights during the design.com Enrico De Vettori Partner Deloitte & Touche enricovettori@deloitte. Keckley.com Sheryl Coughlin. DC 20004 Phone 202-220-2177 Fax 202-220-2178 Toll free 888-233-6169 Email healthsolutions@deloitte.

2011 Survey of Health Care Consumers: Brazil 25 .

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