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

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

Germany. what other services consumers use to achieve their health goals or manage their conditions. with 46 potential follow-up questions.3. aged 18 and older. was surveyed in July 2009. supplemented by questions tailored to each unique health system. Switzerland: A national sample of 1. the response margin of error is +/. Germany: A national sample of 1. using a web-based questionnaire that consisted of 88 questions.95 confidence level. Switzerland. was surveyed in July 2009. • Health insurance: How consumers manage the costs and risks associated with the services they use or foresee using. A core set of common questions were asked in each country. the response margin of error is +/. 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 conceptual framework: Six zones of health care consumerism The Deloitte 2010 Global Survey of Health Care Consumers series provides insights about the behaviors. gender. participants in each country were first asked about recent behaviors (past week/past month/past year). the United Kingdom. Wellness and healthy living 3. aged 18 and older. • Alternative health services: In addition to traditional services.95 confidence level. hospitals.000 French adults. with 49 potential follow-up questions. • Health policy: How consumers assess the overall performance of the system.2% at a . France: A national sample of 1. with 42 potential follow-up questions. Health policy 5. Results were weighted to assure proportional representation to each country’s census population with respect to age.000 Swiss adults. To reduce response bias and enhance the predictive value of the survey results to actual utilization data. France and the United Kingdom. attitudes and unmet needs of consumers in France. Methodology Deloitte surveyed health care consumers across Canada. 4 . • Traditional health services: How consumers assess the performance and value of physicians.95 confidence level. income and geography. was surveyed in July 2009. In Canada. Health insurance 4. Switzerland. aged 18 and older. All rights reserved.1% at a . Traditional health services Health care consumerism 6.6% at the . Across the four European countries.1. the response margin of error is +/. Canada and the United States. within each topic area. Information resources 1. Alternative health services © 2010 Deloitte Development LLC. Germany. Figure 1: Zones of health care consumer activity 2. using a web-based questionnaire that consisted of 90 questions. then about attitudes. medical devices and prescription drugs accessible in their system of care.000 German adults. the United States. In the United States. • Information resources: What sources of information are useful in informing their decisions. using a web-based questionnaire that consisted of 97 questions.

the role played by private insurance and provider organizations.8% 8. 88. Canada: A national sample of 2. was surveyed in July 2009. 89. primary and supplemental coverage. In 2006. all employees are required to join one of about 250 statutory health insurance funds.001 American adults.0% Per-capita Spending $USD $3. taxes on alcohol and tobacco. Also. was surveyed in October 2008.304 Canadian adults. In 2006. based on 2007 data © 2010 Deloitte Development LLC. Canada and the United States The six countries vary in the structures of their health care delivery systems.1% 11. The system is financed mainly through social security contributions by employers and employees. United States: A nationally representative sample of 4. 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. 26. had voluntary private health insurance.4% 16.United Kingdom: A national sample of 1. including diabetes.5% of the German population had public coverage. using a web-based questionnaire that consisted of 96 questions. Hospital rates are set by the government.0% 79.601 $3. Persons earning a higher gross income are allowed to join a private plan. Up to a certain income level. based on negotiated rates. are fully covered. 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.2% in the United States (Figure 2). with 49 potential follow-up questions.3% 81.992 $7.417 $2. aged 18 and older.4% in the United Kingdom to 16. or 54 million.1% of the German population in 2006 had private health insurance.9% 59.7% 45. with 46 potential follow-up questions. Health care expenditures as a percentage of each country’s gross domestic product (GDP) range from 8. using a web-based questionnaire that consisted of 74 questions. Percent of Total 70. and out-of-pocket payments.0% 76.4%.000 British adults. Figure 2: Country comparisons: Health care expenditures Health Care Expenditures as Percent of GDP 10. All rights reserved. with 42 potential follow-up questions.290 Public Expenditure on Health. Thirty chronic conditions.9% of the French population had public coverage. Background: Health care systems across Europe. using a web-based questionnaire that consisted of 95 questions. 99.4% 10. aged 18 and older. Physicians are organized into unions and the government pays on a fee-for-service basis. 2010 Global Survey of Health Care Consumers 5 .588 $4. Also. aged 18 and older. and governance.0% 10.4% Country Canada France Germany Switzerland United Kingdom United States Source: OECD Health Data 2009.895 $3. was surveyed in November 2008.

wherein coverage is universal. Also. Almost all people over the age of 65 have insurance coverage. individuals and the government. and physicians are paid through a mix of fee-for-service and salary compensation. The Swiss system is funded by premium payments. There are multiple payers and no individual or employer mandate. Financing for publicly funded services comes from provincial and federal taxes. United States has health care that is funded by private insurance. 6 .6 million Swiss residents are covered by compulsory insurance. governed and delivered by each provincial jurisdiction. Canada has a national health system. The majority of Canadians also have supplemental private health insurance. Financing comes from employment taxes and social security. Hospitals and regional health systems are not-for-profit corporations funded primarily by provincial governments. 10% of the UK population has private insurance. and private health spending on insurance and out-of-pocket expenses amounts to 30% of total annual health spending across the country. All residents and dependents are required to have coverage unless they have insurance in another EU member country. 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. portable across provinces and publicly insured for medically necessary services. and approximately 80% of the under-65 population has coverage. Approximately 46 million (16%) of the US population is uninsured. Approximately 99% of the 7. Hospitals are owned by the government and physicians are paid a salary by the government and fees from private insurance. United Kingdom has a national health system wherein coverage is universal and managed by the government.

2 or 3) © 2010 Deloitte Development LLC. All rights reserved. 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. C. • This compares with 28% of American. • 23% of German males and 11% of German females give their system an “A/B” grade. • 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. • 55% of French and Swiss adults give their health care system a grade of “A” or “B. • Males in all countries grade their health care system higher than females. Figure 4: Using a typical report card scale with grades A. The French and Swiss grade their system’s performance higher than others. • 37% of French and Canadian adults believe that they have a “complete” understanding of their health care system. Germans and Americans rate their system lowest. and F.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. 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). D. All rights reserved. 27% of British. 2010 Global Survey of Health Care Consumers 7 .” while 44% of German adults and 35% of American adults give their system a “failing” grade of “D/F” (Figure 4). 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. B.

however. All rights reserved. 8 . citizens perceive the system as having the second-highest level of wasted spending. which is graded highest in overall performance compared to the other countries.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). 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. • Perceived wastefulness is lowest in Switzerland. this correlation is not consistent across countries: Although France is also graded highest for overall performance. Figure 5: In your opinion.

All rights reserved.Zone One: Wellness and healthy living Self-reported health status is highest in Canada and the US. 2010 Global Survey of Health Care Consumers 9 . while 56% of Canadians and 55% of US adults in the same age group consider themselves to be in “excellent” or “very good” health. • In all countries surveyed. • 57% of adults in Germany.” A majority of consumers in Germany. • In all countries except Switzerland. • A greater percentage of European males rate their health status as “excellent” or “very good” compared with European females. 81% of adults age 65+ report having one or more chronic conditions. and 52% of adults in both France and the US report being diagnosed with one or more chronic conditions (Figure 7). for example: 15% of Germans age 45-64 consider themselves to be in “excellent” or “very good” health. • A similar trend is observed across age cohorts.” while 23% of German adults rate their health as “excellent” or “very good” (Figure 6). • 61% of Canadian and 60% of American adults rate their overall health as “excellent” or “very good. France and the United States report having one or more chronic conditions. Germans and French report the lowest health status. • More than 64% of adults age 65+ report having one or more chronic conditions. in the United States. 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. 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. a majority (>56%) of adults age 45-64 report having one or more chronic conditions. • 1 in 3 Germans and 1 in 4 French rates their health status as “fair/poor. 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.

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. 9 or 10) 20% 30% 40% 50% 60% Not at all likely (1. French. Figure 9: If you were given the opportunity to participate in a wellness program for free. All rights reserved. • US consumers report higher levels of participation than others. 2 or 3) © 2010 Deloitte Development LLC. 10 . Swiss and British participation is the lowest (Figure 8). • Across all countries surveyed.In general. females are more likely than males to be highly interested in participating in a wellness program if it was offered at no cost. • Across all countries. • 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). presence of a chronic disease or self-reported lower health status does not appear to drive higher participation in wellness programs. 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. 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. consumers are not engaged in health and wellness programs: fewer than 1 in 5 say they participated in a healthy living program in the prior year.

Figure 11: If you needed care or treatment. and these special services were available to you. except for the US. was lower. • In all countries surveyed. participation in disease management programs is highest in Germany and France. • Interest in personal health coaching was expressed by 32% of Americans (highest) and 19% of French consumers (lowest). and Canada compared with Germany. Among most consumers. US. approximately 7 of 10 in all countries adhere to their recommended treatment regimen (Figure 10). France and Switzerland (Figure 11). • For consumers with one or more chronic diseases. interest in remote monitoring tools to support improved health and wellness is strong. 2010 Global Survey of Health Care Consumers 11 .Among consumers with one or more chronic conditions. 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. • 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. 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. interest in care coordinators to help navigate the health care system. interest is higher in the UK. All rights reserved. or less personalized aids such as participation in support groups with people who have similar health conditions. • Across 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. it is lowest in the UK and US.

pharmacies. Figure 13: If you wanted information about the most effective and safe treatment(s) for a certain health condition. life sciences companies. health insurers. 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). • 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). independent health websites and other hospitals are consistently rated lower across the countries surveyed. All rights reserved. In seeking information about the effectiveness and safety of treatment options. All rights reserved. • Other sources of information such as government.Zone Two: Information resources Most consumers do not compare hospitals or physicians before making a selection. 12 . 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. 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.

order prescription refills. find information about treatment options. 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. and check status of bills/payments (Figure 14). • German. • Of several tools considered. German and French consumers express more concern than others. • 52% of German. All rights reserved. French and Swiss consumers have lower interest and higher concerns. patient education and access is higher in Canada. navigate the health care system and connect to their health care providers. Less than 10% of survey participants in all countries already maintain a personal health record. Americans and Canadians are most interested (>40%). • Interest in PHRs and other online tools to support self-care. and Germans and Swiss are least interested (<30%). to help them manage their health and interactions with the health care system (Figure 14).Consumers want access to online tools and services that help them to understand their health care information. • On average. 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. Security and privacy issues associated with personal health records and online tools are a concern to about half: Swiss. 35% are highly interested in using an online personal health record (PHR) connected to their doctor’s office. access medical records. 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). All rights reserved. the US and UK (Figure 14). 2010 Global Survey of Health Care Consumers 13 . 53% of Swiss. while concern over privacy is lower (≤38%) (Figure 15). access to their doctor via email is the second-highest rated online tool by consumers. 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. view test results.

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

• 38% of Swiss consumers report preferring a physician who acts as a health coach (highest). 2010 Global Survey of Health Care Consumers 15 . compared with 20% of US consumers who prefer a health coaching model (lowest). less than 40% in each country report "always" taking their medication as directed. • 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. Canada and UK. • British consumers state the highest preference for physicians who act as a medical authority (44%). 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. All rights reserved. compared to 22% of Swiss and French consumers (lowest). Prescription medications Prescription drug utilization varies widely: it is highest in France and the US. and lowest in Switzerland (Figure 19). especially in the US. All rights reserved. France is among the highest. 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. • Although over 80% of consumers in all countries report adhering to drug labels and to instructions provided by their doctors. who directs them to take what he/she believes is the best approach based on their own expertise. who provides guidance and information needed for consumers to make their own decisions.Consumers.

All rights reserved. naturopathy.g. UK and Canada. Consumers typically prefer physicians with a traditional vs. • 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. while French consumers are the lowest (Figure 20). a greater percentage of males prefer a traditional approach versus a holistic orientation. • Across all six countries. 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. • 33% of American and 32% of British adults prefer a medical professional with an orientation toward traditional medicine. All rights reserved. while 21% of German and Swiss adults prefer a medical professional with an orientation toward holistic or alternative treatments (Figure 21). chiropractic).g. 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. consumers are not inclined to substitute/augment traditional therapies with alternative methods of care. prescription medications) for alternative therapies. 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...Zone Four: Alternative health services Use of alternative health services varies and is generally low. 16 . • Canadian (25%) and Swiss (22%) consumers are the highest users of alternative health services (e. acupuncture. • Across all six countries. adults age 65+ prefer a professional with an orientation toward traditional medicine. holistic medicine orientation.

Figure 22: Thinking about the amount and types of health insurance coverage you have. 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). less than 30% report being well-insured. 2010 Global Survey of Health Care Consumers 17 . • Coverage by public vs. All rights reserved. less than 7% in each country report that health spending has decreased.Zone Five: Health insurance Regardless of the system’s financing or insurance structure. US consumers report higher levels. less in the UK and Canada. 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. compared with 17% of Swiss consumers. All rights reserved. and 46% of French adults report that their health care spending has increased over the last 12 months. private supplemental insurance varies across countries due to the nature of the health care system in each country. both public and private. the majority of consumers believe they are not adequately insured. 47% of American adults. 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. 10% 15% 22% 20% 20% 25% 30% 35% 40% 25% 25% 29% 39% Figure 23: In the last 12 months. • 59% of Swiss adults. 86% of French consumers have supplemental insurance. with 39% identifying themselves as being well insured (Figure 22). • Although 2 of 3 consumers in most countries report being adequately insured. has your household spending on health care products and services increased.

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

the US and UK (Figure 25). more than 1 in 5 consumers oppose this reform in each country. • Expanding funding to improve adoption of electronic health care records is also one of the top-supported health care system reform priorities. consumer support is highest in Canada. support is highest in Canada and lowest in Germany. increased funding to accelerate use of electronic medical records. All rights reserved. • Increasing the availability of primary care physicians is supported by a majority of consumers in all countries.Zone Six: Health policy Consumers see areas for improvement in their system: increased access to primary care services from physicians and nurses. • 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 . 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. and in Germany 46% of consumers are opposed. however. 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.

• Significant numbers recognize the value of healthy lifestyles and appear receptive to voluntary participation in wellness programs. • More than 65% of all adults are satisfied with their primary care physician. • More Canadians and Americans rate their health as “excellent” or “very good. Proximity and reputation are the most important factors in choosing hospitals. however. Overall. consumers in other countries express less concern. • The majority of adults in Germany and Switzerland are concerned about the privacy of health information stored online.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. spending and the impact of cost on consumer behaviors. • 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. #2: Opinions diverge with respect to overall health care system performance. • French and Canadian consumers report higher levels of understanding of their health care system. consumers in these systems are alike in many ways: • Satisfaction with the hospitals and primary care physicians they use regularly is reasonably high. • Appreciation for the usefulness of online technologies and home monitoring is high. 20 . • The French and Swiss grade their health care system higher than other countries. there is limited current uptake of these programs.” • Participation in wellness programs is below 20% in all countries except the United States. • Americans are more likely to seek information on quality or services when choosing a hospital. • Wastefulness is a concern to many in each system: consumers are attentive to efficiency and quality. the percentage is below 25% overall. however. • 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. • 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. although almost 90% lack personal health records. next page). • More German and Swiss adults prefer a physician who integrates holistic approaches.

All rights reserved. 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. 2010 Global Survey of Health Care Consumers 21 .Figure 26: Health care survey results. 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.

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

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

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