2010 Global Survey of Health Care Consumers Behaviors, attitudes and unmet needs

Produced by the Deloitte Center for Health Solutions

Contents
Foreword The conceptual framework: Six zones of health care consumerism 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 Implications Contacts 3 4 7 9 12 14 16 17 19 20 22 23

2

have the potential to lower costs and improve satisfaction. Ph. costs are increasing at alarming rates as the compound effects of aging. France. Engaging consumers in health care is essential to systemic reforms that reduce costs and improve population-based outcomes. Switzerland 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.deloitte. Please see www.D. the United States. and immune to consequences for non-adherence.Foreword In most of the world’s developed systems of health care. The majority of consumers in each of the six surveyed countries – Canada. 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. Paul H. 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. 2010 Global Survey of Health Care Consumers 3 . chronic disease prevalence and unhealthy lifestyles escalate demand for resources. Germany. Keckley. directed by physicians to follow prescribed treatment plans. when equipped with appropriate tools coupled with incentives to reward improved outcomes. Most health care systems view citizens as “patients” – individuals with occasional need for primary or acute care. “Deloitte” means Deloitte LLP. Survey findings suggest that each of the six systems has opportunity to accelerate efforts toward consumerism. And in every system citizens expect modern facilities and technologies.com/us/about for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. readily accessible physicians and assurance that their health care needs will be met. A system orientation toward citizens as consumers rather than patients is a fundamental shift: it presumes that consumers and their providers.

the response margin of error is +/.2% at a . Across the four European countries. 4 . Information resources 1. aged 18 and older. what other services consumers use to achieve their health goals or manage their conditions. income and geography. • Health policy: How consumers assess the overall performance of the system. using a web-based questionnaire that consisted of 90 questions.000 German adults. Switzerland.6% at the . All rights reserved. the United Kingdom. Traditional health services Health care consumerism 6. France: A national sample of 1.000 French adults. • Alternative health services: In addition to traditional services. To reduce response bias and enhance the predictive value of the survey results to actual utilization data. A core set of common questions were asked in each country. using a web-based questionnaire that consisted of 88 questions.1.000 Swiss adults. Germany.95 confidence level. • Health insurance: How consumers manage the costs and risks associated with the services they use or foresee using. supplemented by questions tailored to each unique health system. Methodology Deloitte surveyed health care consumers across Canada. Switzerland. Switzerland: A national sample of 1. Health insurance 4. using a web-based questionnaire that consisted of 97 questions. within each topic area. with 49 potential follow-up questions. Alternative health services © 2010 Deloitte Development LLC. was surveyed in July 2009. aged 18 and older. Figure 1: Zones of health care consumer activity 2. In the United States. the United States. Wellness and healthy living 3. Results were weighted to assure proportional representation to each country’s census population with respect to age. attitudes and unmet needs of consumers in France.95 confidence level. Canada and the United States.95 confidence level. France and the United Kingdom. was surveyed in July 2009. the response margin of error is +/. aged 18 and older. gender. • Traditional health services: How consumers assess the performance and value of physicians. Germany: A national sample of 1.The conceptual framework: Six zones of health care consumerism The Deloitte 2010 Global Survey of Health Care Consumers series provides insights about the behaviors.3. with 46 potential follow-up questions. • Information resources: What sources of information are useful in informing their decisions. medical devices and prescription drugs accessible in their system of care. Health policy 5. Germany. 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. the response margin of error is +/. participants in each country were first asked about recent behaviors (past week/past month/past year). hospitals. In Canada. was surveyed in July 2009. then about attitudes.1% at a . with 42 potential follow-up questions.

In 2006. was surveyed in October 2008. with 49 potential follow-up questions.9% 59. 2010 Global Survey of Health Care Consumers 5 . Figure 2: Country comparisons: Health care expenditures Health Care Expenditures as Percent of GDP 10. Canada and the United States The six countries vary in the structures of their health care delivery systems. 89.001 American adults.0% 10. aged 18 and older. was surveyed in November 2008.3% 81. using a web-based questionnaire that consisted of 95 questions. based on negotiated rates. Physicians are organized into unions and the government pays on a fee-for-service basis.304 Canadian adults. all employees are required to join one of about 250 statutory health insurance funds. with 46 potential follow-up questions.4%.0% Per-capita Spending $USD $3. had voluntary private health insurance. France 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. In 2006. All rights reserved. or 54 million. using a web-based questionnaire that consisted of 74 questions.United Kingdom: A national sample of 1.9% of the French population had public coverage. including diabetes.1% 11.588 $4.4% Country Canada France Germany Switzerland United Kingdom United States Source: OECD Health Data 2009.7% 45. are fully covered. aged 18 and older. Also. Persons earning a higher gross income are allowed to join a private plan.992 $7.290 Public Expenditure on Health.4% 10. Canada: A national sample of 2.417 $2. Percent of Total 70.4% in the United Kingdom to 16. using a web-based questionnaire that consisted of 96 questions.1% of the German population in 2006 had private health insurance. and out-of-pocket payments. 88.0% 79. taxes on alcohol and tobacco. Hospital rates are set by the government. and governance. Also. Background: Health care systems across Europe.601 $3. Thirty chronic conditions.4% 16.8% 8.0% 76. aged 18 and older.895 $3. primary and supplemental coverage. Germany 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. with 42 potential follow-up questions. United States: A nationally representative sample of 4. was surveyed in July 2009. Health care expenditures as a percentage of each country’s gross domestic product (GDP) range from 8. 99. 26. Up to a certain income level. based on 2007 data © 2010 Deloitte Development LLC.5% of the German population had public coverage.2% in the United States (Figure 2). the role played by private insurance and provider organizations. The system is financed mainly through social security contributions by employers and employees.000 British adults.

Also. Financing comes from employment taxes and social security. United Kingdom has a national health system wherein coverage is universal and managed by the government. governed and delivered by each provincial jurisdiction. Financing for publicly funded services comes from provincial and federal taxes. 10% of the UK population has private insurance. 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. Hospitals are owned by the government and physicians are paid a salary by the government and fees from private insurance. individuals and the government. All residents and dependents are required to have coverage unless they have insurance in another EU member country. wherein coverage is universal. 6 . The majority of Canadians also have supplemental private health insurance. Approximately 99% of the 7. There are multiple payers and no individual or employer mandate. and private health spending on insurance and out-of-pocket expenses amounts to 30% of total annual health spending across the country. and approximately 80% of the under-65 population has coverage. and physicians are paid through a mix of fee-for-service and salary compensation. Approximately 46 million (16%) of the US population is uninsured. out-of-pocket payments by individuals and government funding.Switzerland 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. The Swiss system is funded by premium payments. Canada has a national health system.6 million Swiss residents are covered by compulsory insurance. United States has health care that is funded by private insurance. Almost all people over the age of 65 have insurance coverage.

• 23% of German males and 11% of German females give their system an “A/B” grade. D. All rights reserved. how would you grade the overall performance of your health care system? Health care system grade France Switzerland Canada UK US Germany 0% 10% Excellent-“A/B” 55% 12% 55% 14% 43% 15% 30% 20% 21% 35% 17% 44% 20% Failing-“D/F” 30% 40% 50% 60% © 2010 Deloitte Development LLC.” while 44% of German adults and 35% of American adults give their system a “failing” grade of “D/F” (Figure 4). • This compares with 28% of American. The French and Swiss grade their system’s performance higher than others. 2010 Global Survey of Health Care Consumers 7 . • 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. 9 or 10) Not at all (1. 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). • 55% of French and Swiss adults give their health care system a grade of “A” or “B. 27% of British.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. B. All rights reserved. • 37% of French and Canadian adults believe that they have a “complete” understanding of their health care system. Figure 3: How well do you think you understand how your health care system works? Understanding of health care system Canada France US UK Switzerland Germany 0% 5% 37% 6% 37% 7% 28% 15% 27% 10% 23% 12% 22% 16% 10% 15% 20% 25% 30% 35% 40% Completely (8. 23% of Swiss and 22% of German adults who report having a complete understanding of their health care system. and F. 2 or 3) © 2010 Deloitte Development LLC. • Males in all countries grade their health care system higher than females. C. Germans and Americans rate their system lowest. Figure 4: Using a typical report card scale with grades A.

citizens perceive the system as having the second-highest level of wasted spending. • Perceived wastefulness is lowest in Switzerland. 8 . however. what percentage of all health care dollars spent is wasted? Believe >50% percent of health care system spending is wasted US France UK Canada Germany Switzerland 0% 5% 10% 10% 15% 20% 25% 12% 15% 14% 17% 28% 30% © 2010 Deloitte Development LLC. All rights reserved. this correlation is not consistent across countries: Although France is also graded highest for overall performance.Wastefulness in the health care system of each country is a concern: the US respondents are more critical than citizens in other countries (Figure 5). Figure 5: In your opinion. which is graded highest in overall performance compared to the other countries.

• More than 64% of adults age 65+ report having one or more chronic conditions. in the United States. while 56% of Canadians and 55% of US adults in the same age group consider themselves to be in “excellent” or “very good” health. 81% of adults age 65+ report having one or more chronic conditions.Zone One: Wellness and healthy living Self-reported health status is highest in Canada and the US. • A similar trend is observed across age cohorts. All rights reserved. • In all countries except Switzerland. 2010 Global Survey of Health Care Consumers 9 . 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. • A greater percentage of European males rate their health status as “excellent” or “very good” compared with European females. a majority (>56%) of adults age 45-64 report having one or more chronic conditions. • In all countries surveyed. for example: 15% of Germans age 45-64 consider themselves to be in “excellent” or “very good” health.” while 23% of German adults rate their health as “excellent” or “very good” (Figure 6).” A majority of consumers in Germany. Figure 6: How would you rate your overall health? Physical health status Canada US Switzerland UK France Germany 0% 61% 8% 60% 9% 51% 12% 49% 16% 31% 25% 23% 37% 10% Excellent/very good 20% 30% Failing/poor 40% 50% 60% 70% © 2010 Deloitte Development LLC. All rights reserved. • 57% of adults in Germany. • 1 in 3 Germans and 1 in 4 French rates their health status as “fair/poor. France and the United States report having one or more chronic conditions. Figure 7: Have you been diagnosed by a doctor or other medical professional as having one or more chronic conditions? Percent diagnosed with one or more chronic diseases Germany France US UK Canada Switzerland 39% 47% 47% 52% 52% 57% 0% 10% % with chronic disease 20% 30% 40% 50% 60% © 2010 Deloitte Development LLC. and 52% of adults in both France and the US report being diagnosed with one or more chronic conditions (Figure 7). 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.

• 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). 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. • Across all countries surveyed. 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. Figure 9: If you were given the opportunity to participate in a wellness program for free. • US consumers report higher levels of participation than others. Figure 8: Have you participated in a healthy living/wellness program in the last 12 months? Participation in healthy living/wellness program US Canada Germany Switzerland UK France 0% 5% 6% 10% 15% 10% 10% 14% 16% 20% 20% © 2010 Deloitte Development LLC. All rights reserved. All rights reserved. females are more likely than males to be highly interested in participating in a wellness program if it was offered at no cost.In general. 2 or 3) © 2010 Deloitte Development LLC. 9 or 10) 20% 30% 40% 50% 60% Not at all likely (1. 10 . how likely is it that you would do so? Likelihood of participation in wellness program Canada US Switzerland UK France Germany 0% 59% 9% 57% 16% 56% 11% 55% 12% 47% 16% 44% 21% 10% Highly likely (8. Swiss and British participation is the lowest (Figure 8). • Across all countries. presence of a chronic disease or self-reported lower health status does not appear to drive higher participation in wellness programs. French.

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

pharmacies. All rights reserved. All rights reserved. In seeking information about the effectiveness and safety of treatment options. 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% 50% 40% 30% 20% 10% 0% Academic medical centers Canada United States France United Kingdom Switzerland Germany Medical societies/associations 53% 52% 54% 46% 51% 53% 47% 43% 37% 50% 27% 23% © 2010 Deloitte Development LLC. • Other sources of information such as government. • 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). 12 . consumers in all countries consider academic medical centers and physicians as their most trusted sources. US and German consumers are consistently more likely to “shop” compared to others (Figure 12). Figure 12: Have you compared physicians or hospitals before choosing one? Percent who compare physicians and hospitals before making a selection 30% 25% 20% 15% 10% 5% 0% Percent who compare hospitals before making a selection United States Germany Canada Switzerland Percent who compare physicians before making a selection United Kingdom France 15% 13% 13% 9% 9% 8% 13% 30% 24% 16% 15% 15% © 2010 Deloitte Development LLC. health insurers. life sciences companies. independent health websites and other hospitals are consistently rated lower across the countries surveyed. Figure 13: If you wanted information about the most effective and safe treatment(s) for a certain health condition.Zone Two: Information resources Most consumers do not compare hospitals or physicians before making a selection.

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

Zone Three: Traditional health services The majority of consumers are satisfied with the hospitals and physicians they have used recently. compared to less than 17% of consumers in the UK. 76% of German males. Figure 17: How satisfied are you with your primary care physician? Satisfaction with primary care provider Switzerland Canada Germany France US UK 0% 10% 20% 30% 40% 50% 60% 65% 70% 74% 74% 73% 71% 71% 80% Completely satisfied (8. Hospitals Less than 30% of consumers surveyed had an overnight stay in hospital in the past 12 months. except Germany. over 65% of consumers rate high satisfaction with their primary care provider. • In most countries. All rights reserved. Switzerland (25%) and Germany (24%) report a higher level of using a hospital for an overnight stay in the past 12 months. Figure 16: How satisfied are you with quality of care your received at the hospital recently? Satisfaction with quality of care at hospital US Canada UK Switzerland Germany France 0% 10% 20% 30% 40% 50% 60% 59% 64% 70% 62% 63% 65% 73% 80% Completely satisfied (8. over 60% of consumers state high satisfaction with the quality of care received during their hospital stay (Figure 16). over 60% are highly satisfied with the care they received. • Consumers in France (28%). • 94% of French consumers report having a primary care provider (highest). 74% of French males. • European males report higher satisfaction than European females with their primary care provider. on average. Physicians The majority of consumers have a primary care physician relationship and are satisfied. 77% of Swiss males. 9 or 10) © 2010 Deloitte Development LLC. • The percentage of adults reporting complete satisfaction with a primary care physician is highest among those over age 65. compared with 70% of British consumers who report having a primary care provider (lowest). satisfaction is highest in Canada and Switzerland (Figure 17). 9 or 10) © 2010 Deloitte Development LLC. All rights reserved. US or Canada. 14 . where results are over 81% in all countries except the UK (73%). • In all countries. and 67% of British males report being completely satisfied with their primary care physician.

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

adults age 65+ prefer a professional with an orientation toward traditional medicine. traditional medicine practice orientation 33% 10% 32% 7% 27% 15% 26% 9% 19% 21% 13% 21% US UK Canada France Switzerland Germany 0% 5% Traditional medicine 10% 15% 20% 25% 30% 35% Holistic or alternative treatment © 2010 Deloitte Development LLC.g. Figure 20: Have you treated a health problem with an alternative or natural therapy? Treatment of health problem with alternative or natural therapy Canada Switzerland US UK Germany France 13% 0% 5% 10% 15% 20% 16% 15% 19% 22% 25% 25% % who treated health problem with alternative therapy © 2010 Deloitte Development LLC. • Canadian (25%) and Swiss (22%) consumers are the highest users of alternative health services (e. 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. prescription medications) for alternative therapies. chiropractic). while 21% of German and Swiss adults prefer a medical professional with an orientation toward holistic or alternative treatments (Figure 21)... acupuncture. • Across all six countries. holistic medicine orientation. Consumers typically prefer physicians with a traditional vs. naturopathy. All rights reserved. • 33% of American and 32% of British adults prefer a medical professional with an orientation toward traditional medicine. • Across all six countries. while French consumers are the lowest (Figure 20). a greater percentage of males prefer a traditional approach versus a holistic orientation. 16 .g. UK and Canada. consumers are not inclined to substitute/augment traditional therapies with alternative methods of care.Zone Four: Alternative health services Use of alternative health services varies and is generally low. • A large majority of consumers in all countries do not substitute a traditional health therapy (e. interest in physicians who integrate non-traditional methods of care into practice is strongest in the US. All rights reserved.

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

Canadian and Swiss consumers are less concerned. 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 Canada France Switzerland UK US Germany 39% 11% 31% 18% 29% 16% 29% 17% 27% 21% 25% 22% 0% 5% 10% 15% 20% 25% 30% 35% 40% Completely (8. although less than 40% reporting being “well” prepared (Figure 24). 18 . • The majority of adults (>50%) across all six countries report that they are “somewhat” prepared to handle future health care costs.Concerns about foreseeable health care costs are highest in the US. • 49% of American adults and 51% of Canadian adults age 65+ report that they are completely prepared to handle future health care costs. Germany and France. while 31-37% of Europeans in the same age group report being completely prepared. All rights reserved. 9 or 10) Not at all (1. 2 or 3) © 2010 Deloitte Development LLC.

the US and UK (Figure 25). All rights reserved. • An average of 40% of consumers in all countries support establishing pay-for-performance systems for doctors and hospitals. 2010 Global Survey of Health Care Consumers 19 . service volumes Canada 85% France 56% Germany 52% Switzerland 55% UK 72% US 74% 59% 45% 42% 39% 57% 47% 58% 49% 34% 41% 48% 40% 37% 41% 40% 39% 39% 40% © 2010 Deloitte Development LLC. however. and in Germany 46% of consumers are opposed. support is highest in Canada and lowest in Germany. • Increasing the availability of primary care physicians is supported by a majority of consumers in all countries. • Expanding funding to improve adoption of electronic health care records is also one of the top-supported health care system reform priorities. more than 1 in 5 consumers oppose this reform in each country. increased funding to accelerate use of electronic medical records.Zone Six: Health policy Consumers see areas for improvement in their system: increased access to primary care services from physicians and nurses. 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. performance-based payments for providers are the highest priorities. consumer support is highest in Canada.

• Appreciation for the usefulness of online technologies and home monitoring is high. • Significant numbers recognize the value of healthy lifestyles and appear receptive to voluntary participation in wellness programs. next page). #2: Opinions diverge with respect to overall health care system performance. spending and the impact of cost on consumer behaviors. however. consumers in other countries express less concern. • More than 65% of all adults are satisfied with their primary care physician.” • Participation in wellness programs is below 20% in all countries except the United States. • More Canadians and Americans rate their health as “excellent” or “very good. 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. • The majority of adults in Germany and Switzerland are concerned about the privacy of health information stored online. there is limited current uptake of these programs.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. 20 . • Americans are more likely to seek information on quality or services when choosing a hospital. • More German and Swiss adults prefer a physician who integrates holistic approaches. • 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. Overall. • 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. • French and Canadian consumers report higher levels of understanding of their health care system. • The French and Swiss grade their health care system higher than other countries. • Wastefulness is a concern to many in each system: consumers are attentive to efficiency and quality. although almost 90% lack personal health records. Proximity and reputation are the most important factors in choosing hospitals. consumers in these systems are alike in many ways: • Satisfaction with the hospitals and primary care physicians they use regularly is reasonably high.

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

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

Contacts Authors We would like to recognize the individuals who contributed their insights and support to this research. Jennifer Bohn.de Yves Jarlaud Partner.co Thomas Northoff Partner. as well as Bianca Chung.com Dean Arnold DTT Health Care Sector Leader Deloitte Touche Tohmatsu deanarnold@deloitte. Life Sciences & Health Care Leader Deloitte Consulting GmbH tnorthoff@deloitte. Erwan Lamour and Janett Reidel for their leadership. Patsy Bolduc. Paul H. PhD Executive Director Deloitte Center for Health Solutions Deloitte LLP pkeckley@deloitte. Keckley. Life Sciences & Health Care Leader Deloitte Conseil yjarlaud@deloitte.uk.ca Acknowledgements In addition to the authors above. and My Di Le for their contributions. CHE.fr Robert Reppas Partner Deloitte AG rreppas@deloitte.ch Mark Fam. 2010 Global Survey of Health Care Consumers 23 . Michael Curtis. MHA Senior Fellow Deloitte Center for Health Solutions Deloitte Consulting LLP mfam@deloitte. Malay Gandhi. we would like to thank Joyce Ehrlich. Helen Baxter.

indirect. If any of the foregoing is not fully enforceable for any reason. Accordingly. title.com/about for a detailed description of the legal structure of Deloitte Touche Tohmatsu and its member firms. you should consult a qualified professional advisor. These materials and the information contained therein are provided as is. and Deloitte LLP makes no express or implied representations or warranties regarding these materials or the information contained therein. whether in an action of contract. Deloitte LLP expressly declaims all implied warranties. These materials and the information contained herein are provided by Deloitte LLP and are intended to provide general information on a particular subject or subjects and are not an exhaustive treatment of such subject(s). consulting or other professional advice or services. Without limiting the foregoing. negligence). investment. Member of Deloitte Touche Tohmatsu . tort (including. please visit www. roundtables and other forms of engagement. Please see www. the remainder shall nonetheless continue to apply. Before making any decision or taking any action that might affect your personal finances or business. To learn more about the Deloitte Center for Health Solutions. timely and reliable insights.deloitte. including. compatibility. Deloitte LLP will not be liable for any special.com/centerforhealthsolutions. a Swiss Verein. its research projects and events. and you assume full responsibility and risk of loss resulting from the use thereof. noninfringement. each of which is a legally separate and independent entity. or otherwise. legal. without limitation. fitness for a particular purpose. consequential.deloitte. Deloitte LLP does not warrant that the materials or information contained therein will be error-free or will meet any particular criteria of performance or quality. tax.deloitte. or punitive damages or any other damages whatsoever. warranties of merchantability. Through our research. relating to the use of these materials or the information contained therein. incidental. statute. we seek to be a trusted source for relevant. and its network of member firms.com/us/about for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. About Deloitte Deloitte refers to one or more of Deloitte Touche Tohmatsu. Our goal is to inform all stakeholders in the health care system about emerging trends. Copyright ©2010 Deloitte Development LLC. security and accuracy. without limitation.#1033 Center for Health Solutions About the Center The Deloitte Center for Health Solutions (DCHS) is the health services research arm of Deloitte LLP. Please see www. challenges and opportunities using rigorous research. the information in these materials is not intended to constitute accounting. Your use of these materials and information contained therein is at your own risk.