Us Chs Consumerism Global

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2010 Global Surveyo Health Care ConsumersBehaviors, attitudes and unmet needs

Produced by the Deloitte Center or Health Solutions


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Contents

Foreword 3

The conceptual ramework: Six zones o health care consumerism 4

Survey highlights 7

Zone One: Wellness and healthy living 9

Zone Two: Inormation resources 12

Zone Three: Traditional health services 14

Zone Four: Alternative health services 16

Zone Five: Health insurance 17

Zone Six: Health policy 19

Major fndings 20

Implications 22

Contacts 23


3/242010 Global Survey o Health Care Consumers 3

In most o the worlds developed systems o health care, costs are increasing at alarming

rates as the compound eects o aging, chronic disease prevalence and unhealthy

liestyles escalate demand or resources. And in every system citizens expect modern

acilities and technologies, readily accessible physicians and assurance that their healthcare needs will be met.

Most health care systems view citizens as patients individuals with occasional need

or primary or acute care, directed by physicians to ollow prescribed treatment plans, and

immune to consequences or non-adherence.

A system orientation toward citizens as consumers rather than patients is a undamental

shit: it presumes that consumers and their providers, when equipped with appropriate

tools coupled with incentives to reward improved outcomes, have the potential to lower

costs and improve satisaction.

The results o this Deloitte2010 Global Survey of Health Care Consumers suggest that

opportunities exist or leaders in developed systems to accelerate their eorts towardconsumerism. The majority o consumers in each o the six surveyed countries Canada,

the United States, Germany, France, Switzerland and the United Kingdom are somewhat

satised with their systems perormance, but disconnected rom its costs and seemingly

passive about the role they play.

Engaging consumers in health care is essential to systemic reorms that reduce costs and

improve population-based outcomes. Survey ndings suggest that each o the six systems

has opportunity to accelerate eorts toward consumerism.

Paul H. Keckley, Ph.D.Executive Director

Deloitte Center or Health Solutions

Deloitte LLP

Washington DC

Dean ArnoldHealth Care Sector Leader

Deloitte Touche Tohmatsu

London

Foreword

As used in this document, Deloitte means Deloitte LLP. Please see www.deloitte.com/us/about

or a detailed description o the legal structure o Deloitte LLP and its subsidiaries.


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The Deloitte2010 Global Survey of Health Care Consumers

series provides insights about the behaviors, attitudes and

unmet needs o consumers in France, Germany, Switzerland,

the United Kingdom, Canada and the United States.

The 2010 survey refects a broad-based view o health care

consumerism in six zones (Figure 1):

Wellness and healthy living: What individuals aredoing to care or themselves.

Inormation resources: What sources o

inormation are useul in inorming their decisions.

Traditional health services: How consumers assess

the perormance and value o physicians, hospitals,

medical devices and prescription drugs accessible in

their system o care.

Alternative health services: In addition to traditional

services, what other services consumers use to achieve

their health goals or manage their conditions.

Health insurance: How consumers manage the

costs and risks associated with the services they use

or oresee using. Health policy: How consumers assess the overall

perormance o the system.

Methodology

Deloitte surveyed health care consumers across Canada,

the United States, Germany, Switzerland, France and the

United Kingdom. To reduce response bias and enhance the

predictive value o the survey results to actual utilization

data, participants in each country were rst asked about

recent behaviors (past week/past month/past year), then

about attitudes, within each topic area. Results were

weighted to assure proportional representation to eachcountrys census population with respect to age, gender,

income and geography. A core set o common questions

were asked in each country, supplemented by questions

tailored to each unique health system.

Across the our European countries, the response margin

o error is +/- 3.1% at a .95 condence level. In Canada,

the response margin o error is +/- 2% at a .95 condence

level. In the United States, the response margin o error is

+/- 1.6% at the .95 condence level.

France: A national sample o 1,000 French adults,

aged 18 and older, was surveyed in July 2009, using a

web-based questionnaire that consisted o 88 questions,

with 49 potential ollow-up questions.

Germany: A national sample o 1,000 German adults,




Switzerland: A national sample o 1,000 Swiss adults,




The conceptual ramework:Six zones o health care

consumerism

2010 Deloitte Development LLC. All rights reserved.

Figure 1: Zones of health care consumer activity

Health care

consumerism

1. Wellness

and healthy

living

2. Informationresources

3. Traditionalhealth

services

4. Alternativehealth

services

5. Healthinsurance

6. Healthpolicy



United Kingdom: A national sample o 1,000 British

adults, aged 18 and older, was surveyed in July 2009, using

a web-based questionnaire that consisted o 96 questions,


Canada: A national sample o 2,304 Canadian adults,

aged 18 and older, was surveyed in November 2008, using

a web-based questionnaire that consisted o 74 questions,


United States: A nationally representative sample o 4,001

American adults, aged 18 and older, was surveyed in October

2008, using a web-based questionnaire that consisted o

95 questions, with 42 potential ollow-up questions.

Background: Health care systems across Europe,

Canada and the United States

The six countries vary in the structures o their health

care delivery systems, the role played by private insurance

and provider organizations, and governance. Health care

expenditures as a percentage o each countrys grossdomestic product (GDP) range rom 8.4% in the United

Kingdom to 16.2% in the United States (Figure 2).

France has a statutory national health insurance system

with compulsory coverage o French residents through

health insurance unds whose participants are determined

primarily according to their occupation. The system is

nanced mainly through social security contributions by

employers and employees, taxes on alcohol and tobacco,

and out-o-pocket payments. In 2006, 99.9% o the

French population had public coverage. Also, 88.4%, or

54 million, had voluntary private health insurance. Thirtychronic conditions, including diabetes, are ully covered.

Physicians are organized into unions and the government

pays on a ee-or-service basis, based on negotiated rates.

Hospital rates are set by the government.

Germany has a statutory national health insurance system

with compulsory coverage o all German residents through

health insurance unds whose participants are determined

primarily based on their occupation. Up to a certain income

level, all employees are required to join one o about 250

statutory health insurance unds. Persons earning a higher

gross income are allowed to join a private plan. In 2006,

89.5% o the German population had public coverage.Also, 26.1% o the German population in 2006 had private

health insurance, primary and supplemental coverage.

Figure 2: Country comparisons: Health care expenditures

Country

Health Care

Expenditures as

Percent o GDP

Per-capita

Spending

$USD

Public Expenditure

on Health,

Percent o Total

Canada 10.1% $3,895 70.0%

France 11.0% $3,601 79.0%

Germany 10.4% $3,588 76.9%

Switzerland 10.8% $4,417 59.3%

United Kingdom 8.4% $2,992 81.7%

United States 16.0% $7,290 45.4%

Source: OECD Health Data 2009, based on 2007 data



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Switzerland has a statutory national health insurance

system with compulsory coverage o all Swiss residents

through plans purchased by individuals rom a selection

o approximately 90 competing private health insurance

unds. All residents and dependents are required to have

coverage unless they have insurance in another EU member

country. Approximately 99% o the 7.6 million Swiss

residents are covered by compulsory insurance. The Swiss

system is unded by premium payments, out-o-pocketpayments by individuals and government unding.

United Kingdom has a national health system wherein

coverage is universal and managed by the government.

Hospitals are owned by the government and physicians

are paid a salary by the government and ees rom private

insurance. Financing comes rom employment taxes

and social security. Also, 10% o the UK population has

private insurance.

Canada has a national health system, governed and

delivered by each provincial jurisdiction, wherein coverage

is universal, portable across provinces and publicly insured

or medically necessary services. Hospitals and regional

health systems are not-or-prot corporations unded

primarily by provincial governments, and physicians

are paid through a mix o ee-or-service and salary

compensation. Financing or publicly unded services

comes rom provincial and ederal taxes. The majorityo Canadians also have supplemental private health

insurance, and private health spending on insurance and

out-o-pocket expenses amounts to 30% o total annual

health spending across the country.

United States has health care that is unded by private

insurance, individuals and the government. There are

multiple payers and no individual or employer mandate.

Approximately 46 million (16%) o the US population

is uninsured. Almost all people over the age o 65 have

insurance coverage, and approximately 80% o the

under-65 population has coverage.



Perspectives on the overall perormance o

countries health care systems

The majority o consumers do not understand

the health care system in their country.

37% o French and Canadian adults believe that

they have a complete understanding o their

health care system.

This compares with 28% o American, 27% o

British, 23% o Swiss and 22% o German adults

who report having a complete understanding o

their health care system; in each o these countries

the percent o respondents who report having

limited or no understanding o their health care

system is also higher (Figure 3).

The French and Swiss grade their systems

perormance higher than others; Germans and

Americans rate their system lowest.

55% o French and Swiss adults give their health care

system a grade o A or B, while 44% o German

adults and 35% o American adults give their systema ailing grade o D/F (Figure 4).

Males in all countries grade their health care system

higher than emales.

59% o French and Swiss males give their health

care system an A/B compared with 51% o French

emales and 49% o Swiss emales.

23% o German males and 11% o German emales

give their system an A/B grade.

Survey highlights

Understanding of health care system


Complete ly (8, 9 or 10) Not at all (1 , 2 or 3)

0%

37%

6%

37%

7%

28%15%

27%

10%

23%

12%

22%

16%

5% 10% 15% 20% 25% 30% 35% 40%

Canada

France

US

UK

Switzerland

Germany

Figure 3: How well do you think you understand how your health care system works?

Figure 4: Using a typical report card scale with grades A, B, C, D, and F, how would

you grade the overall performance of your health care system?

Health care system grade


Excellent-A/B Failing-D/F

55%

12%

55%

14%

43%

15%

30%

20%

21%

35%

17%

44%

France

Switzerland

Canada

UK

US

Germany

0% 10% 20% 30% 40% 50% 60%


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Wasteulness in the health care system o each

country is a concern: the US respondents are more

critical than citizens in other countries (Figure 5).

Perceived wasteulness is lowest in Switzerland, which is

graded highest in overall perormance compared to the

other countries; however, this correlation is not consistent

across countries: Although France is also graded highest

or overall perormance, citizens perceive the system as

having the second-highest level o wasted spending.

Figure 5: In your opinion, what percentage of all health care dollars spent is wasted?

Believe >50% percent of health care system spending is wasted


28%

17%

15%

14%

12%

10%

US

France

UK

Canada

Germany

Switzerland

0% 5% 10% 15% 20% 25% 30%



Sel-reported health status is highest in Canada

and the US; Germans and French report the lowest

health status.

61% o Canadian and 60% o American adults rate

their overall health as excellent or very good, while

23% o German adults rate their health as excellent

or very good (Figure 6).

A similar trend is observed across age cohorts; or

example: 15% o Germans age 45-64 considerthemselves to be in excellent or very good health,

while 56% o Canadians and 55% o US adults in

the same age group consider themselves to be in

excellent or very good health.

A greater percentage o European males rate

their health status as excellent or very good

compared with European emales.

1 in 3 Germans and 1 in 4 French rates their health

status as air/poor.

A majority o consumers in Germany, France and

the United States report having one or more

chronic conditions.

57% o adults in Germany, and 52% o adults in both

France and the US report being diagnosed with one or

more chronic conditions (Figure 7).

More than 64% o adults age 65+ report

having one or more chronic conditions; in the

United States, 81% o adults age 65+ report

having one or more chronic conditions.

In all countries except Switzerland, a majority

(>56%) o adults age 45-64 report having one

or more chronic conditions.

In all countries surveyed, a trend exists across health

status and chronic disease: Over 80% o consumerswith one or more chronic diseases report air or

poor health status.

Zone One:Wellness and healthy living

Figure 6: How would you rate your overall health?


Excellent/very good Failing/poor

Physical health status

61%

8%

60%

9%

51%12%

49%

16%

31%

25%

23%

37%

Canada

US

Switzerland

UK

France

Germany

0% 10% 20% 30% 40% 50% 60% 70%

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


0% 10% 20% 30% 40% 50% 60%

57%

52%

52%

47%

47%

39%

Germany

France

US

UK

Canada

Switzerland

% with chronic disease


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In general, consumers are not engaged in health

and wellness programs: ewer than 1 in 5 say they

participated in a healthy living program in the

prior year.

US consumers report higher levels o participation

than others; French, Swiss and British participation

is the lowest (Figure 8).

Across all countries surveyed, presence o

a chronic disease or sel-reported lowerhealth status does not appear to drive higher

participation in wellness programs.

Interest in participating in wellness programs is

relatively modest: about hal o survey respondents

in each country say they would be highly likely

to participate.

Trends are observed between current participation in a

wellness program and interest in participating in such

programs going orward: 59% o American adults

(highest) compared to 44% o French adults (lowest)

report that they would be highly likely to participate in awellness program i it was oered at no cost (Figure 9).

Across all countries, emales are more likely than males

to be highly interested in participating in a wellness

program i it was oered at no cost.

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% 10% 15% 20%

6%

10%

10%

14%

16%

20%

Figure 9: If you were given the opportunity to participate in a wellness program for

free, how likely is it that you would do so?

Likelihood of participation in wellness program


Highly l ikely (8, 9 or 10) Not at al l l ikely (1, 2 or 3)

Canada

US

Switzerland

UK

France

Germany

0% 10%

21%

44%

16%

47%

12%

55%

11%

57%

59%

9%

16%

56%

20% 30% 40% 50% 60%



Among consumers with one or more chronic

conditions, participation in disease management

programs is highest in Germany and France; it is

lowest in the UK and US.

For consumers with one or more chronic diseases,

approximately 7 o 10 in all countries adhere to their

recommended treatment regimen (Figure 10).

In all countries surveyed, except or the US,

participation by individuals with one or more chronicdiseases in a specic disease management program

appears to be higher than participation in broader

health and wellness programs.

Among most consumers, interest in remote

monitoring tools to support improved health

and wellness is strong.

Consumers in all countries identiy a high level o interest

in remote or home monitoring devices as tools to help

them sel-manage their health; interest is higher in the

UK, US, and Canada compared with Germany, France and

Switzerland (Figure 11). Interest in personal health coaching was expressed

by 32% o Americans (highest) and 19% o French

consumers (lowest).

Across all countries surveyed, interest in care

coordinators to help navigate the health care system,

or less personalized aids such as participation in

support groups with people who have similar health

conditions, was lower.

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

Compliance with treatment

regimen for chronic disease

Participation in disease

management program

0%

10%

20%

30%

40%

50%

60%

70%

80%70%

78%74%

69% 72%

33%32% 28% 24%

14% 13%

70%


Canada

United States

United Kingdom

Germany

France

Switzerland

Figure 11: If you needed care or treatment, and these special services were availableto you, how interested would you be in using them?


Remote monitoring devices

Personal health coach

In-home medical device

Care coordinator

Interest in tools and aids to support self-managed care

0% 10% 20% 30% 40% 50% 60% 70% 80%

68%64%

26%22%

67%63%

32%29%

66%64%

29%24%

56%45%

20%13%

55%49%

26%22%

53%49%

19%20%

UK

US

Canada

Switzerland

Germany

France


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Most consumers do not compare hospitals or

physicians beore making a selection; US and

German consumers are consistently more likely

to shop compared to others (Figure 12).

In seeking inormation about the eectiveness

and saety o treatment options, consumers in all

countries consider academic medical centers and

physicians as their most trusted sources. Consumers in all countries identiy academic medical

centers and medical societies/associations (physicians)

as their most trusted sources o inormation on the

eectiveness and saety o treatments (Figure 13).

Other sources o inormation such as government,

health insurers, pharmacies, lie sciences companies,

independent health websites and other hospitals are

consistently rated lower across the countries surveyed.

Zone Two:Inormation resources

Figure 12: Have you compared physicians or hospitals before choosing one?


United States

Germany

Canada

Switzerland

United Kingdom

France

Percent who compare physicians and hospitals before making a selection

Percent who compare hospitals

before making a selection

Percent who compare physicians

before making a selection

15%

13% 13%

9% 9%8%

30%

24%

13%

16%15% 15%

0%

5%

10%

15%

20%

25%

30%

Figure 13: If you wanted information about the most effective and safe treatment(s)

for a certain health condition, how much trust do you have for these third party

sources to provide reliable information?

Trusted sources for information on treatment effectiveness and safety


Canada

United States

France

United Kingdom

Switzerland

Germany

Academic medical centers Medical societies/associations

0%

10%

20%

30%

40%

50%

60%53% 52% 51%

47%43%

37%

53%50%

27%

54%

46%

23%



Consumers want access to online tools and services

that help them to understand their health care

inormation, navigate the health care system and

connect to their health care providers.

O several tools considered, consumers in all countries

consistently report the highest level o interest in access

to a secure Internet site that allows them to schedule

oce visits, access medical records, view test results,

order prescription rells, nd inormation about treatmentoptions, and check status o bills/payments (Figure 14);

access to their doctor via email is the second-highest

rated online tool by consumers.

On average, 35% are highly interested in using an

online personal health record (PHR) connected to their

doctors oce, to help them manage their health and

interactions with the health care system (Figure 14);

Americans and Canadians are most interested (>40%),

and Germans and Swiss are least interested (


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Consumers, especially in the US, Canada and

UK, preer primary care physicians who are

prescriptive in their approaches.

38% o Swiss consumers report preerring a physician

who acts as a health coach (highest), who provides

guidance and inormation needed or consumers to

make their own decisions, compared with 20% o US

consumers who preer a health coaching model (lowest).

British consumers state the highest preerence orphysicians who act as a medical authority (44%), who

directs them to take what he/she believes is the best

approach based on their own expertise, compared to

22% o 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).

The variation in prescription medication use is aligned

to the variation o consumer-reported chronic disease

prevalence across countries: Switzerland has thelowest reported incidence o chronic disease and

prescription drug use; France is among the highest.

Although over 80% o consumers in all countries

report adhering to drug labels and to instructions

provided by their doctors, less than 40% in each

country report "always" taking their medication

as directed.

Figure 18: Do you generally prefer a doctor who acts as a health coach or a doctor

who acts as a medical authority?


I prefer a doctor who acts as a medical authority

I prefer a doctor who acts as a health coach

Preference of physician style

0% 10% 20% 30% 40% 50%

UK

US

Canada

Germany

France

Switzerland

44%

20%

36%

20%

33%

25%

27%

33%

22%

34%

22%

38%


% who use prescription drugs

Figure 19: Percent of consumers who use prescription medication

Prescription drug usage

63%

57%

53%

47%

47%

33%

France

US

Germany

UK

Canada

Switzerland

0% 10% 20% 30% 40% 50% 60% 70% 80%


16/2416

Use o alternative health services varies and is

generally low; consumers are not inclined to

substitute/augment traditional therapies with

alternative methods o care.

Canadian (25%) and Swiss (22%) consumers are

the highest users o alternative health services

(e.g., acupuncture, naturopathy, chiropractic),

while French consumers are the lowest (Figure 20).

A large majority o consumers in all countries donot substitute a traditional health therapy (e.g.,

prescription medications) or alternative therapies.

Consumers typically preer physicians with a

traditional vs. holistic medicine orientation;

interest in physicians who integrate non-traditional

methods o care into practice is strongest in the US,

UK and Canada.

33% o American and 32% o British adults preer

a medical proessional with an orientation toward

traditional medicine, while 21% o German and

Swiss adults preer a medical proessional withan orientation toward holistic or alternative

treatments (Figure 21).

Across all six countries, a greater percentage

o males preer a traditional approach versus

a holistic orientation.

Across all six countries, adults age 65+ preer

a proessional with an orientation toward

traditional medicine.

Figure 20: Have you treated a health problem with an alternative or natural therapy?

Treatment of health problem with alternative or natural therapy

0% 5% 10% 15% 20% 25%


% who treated health problem with alternative therapy

25%

22%

19%

16%

15%

13%

Canada

Switzerland

US

UK

Germany

France

0% 5% 10% 15% 20% 25% 30% 35%

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. traditional medicine practice orientation


Traditional medicine Holistic or alternative treatment

US

UK

Canada

France

Switzerland

Germany

33%

10%

32%

7%

27%

15%

26%

9%

19%

21%

13%

21%

Zone Four:Alternative health services



Regardless o the systems fnancing or insurance

structure, the majority o consumers believe they

are not adequately insured.

Coverage by public vs. private supplemental

insurance varies across countries due to the nature

o the health care system in each country; 86% o

French consumers have supplemental insurance,

compared with 17% o Swiss consumers.

Although 2 o 3 consumers in most countries reportbeing adequately insured, less than 30% report

being well-insured; US consumers report higher

levels, with 39% identiying themselves as being

well insured (Figure 22).

Reported household spending or health care in the

prior year increased in every country: consumers

in Switzerland and the US report higher spending

sensitivity; less in the UK and Canada.

The majority o consumers in all six countries report

that health care spending has either increased or

stayed the same in the past 12 months (Figure 23). 59% o Swiss adults, 47% o American adults, and

46% o French adults report that their health care

spending has increased over the last 12 months;

less than 7% in each country report that health

spending has decreased.

Figure 22: Thinking about the amount and types of health insurance coverage you

have, both public and private, do you consider yourself to be adequately insured?

Adequacy of insurance


% well-insured

0% 5% 10% 15% 20% 25% 30% 35% 40%

39%

29%

25%

25%

22%

20%

US

Switzerland

France

Canada

Germany

UK

Figure 23: In the last 12 months, has your household spending on health care

products and services increased, decreased or stayed about the same compared

to the previous year?

0%

59%32%

5%

47%42%

7%

46%41%

5%

44%48%

3%32%

59%5%

23%65%

5%

10% 20% 30% 40% 50% 60% 70% 80%

Switzerland

US

France

Germany

Canada

UK


Increased Stayed the same Decreased

Zone Five:Health insurance


18/24



Consumers see areas or improvement in their

system: increased access to primary care services

rom physicians and nurses, increased unding

to accelerate use o electronic medical records,

perormance-based payments or providers are

the highest priorities.

Increasing the availability o primary care physicians is

supported by a majority o consumers in all countries;

consumer support is highest in Canada, the US andUK (Figure 25).

Expanding unding to improve adoption o electronic

health care records is also one o the top-supported

health care system reorm priorities; support is highest

in Canada and lowest in Germany.

An average o 40% o consumers in all countries

support establishing pay-or-perormance systems

or doctors and hospitals; however, more than 1 in 5

consumers oppose this reorm in each country, and in

Germany 46% o consumers are opposed.

Figure 25: Top Health Policy Reorms

Health Reorm Canada France Germany Switzerland UK US

Expand teaching programs to

increase the supply o primary

care physicians

85% 56% 52% 55% 72% 74%

Allow nurses to diagnose

and treat uncomplicated

conditions

59% 45% 42% 39% 57% 47%

Increase government unding

to support adoption o

electronic health records

58% 49% 34% 41% 48% 40%

Establish perormance-basedsystems that pay doctors and

hospitals based on clinical

outcomes vs. service volumes

37% 41% 40% 39% 39% 40%


Zone Six:Health policy


20/24



Figure 26: Health care survey results, by country

Domains o health care consumer activity Canada France Germany SwitzerlandUnited

KingdomUnitedStates

Overallhealth system

Percent who give the health care system a grade o A or B 43% 55% 17% 55% 30% 21%

Percent who eel they have a good understanding o how thehealth care system works

37% 37% 22% 23% 27% 28%

Percent who believe that more than 50% o health care systemspending is wasted

14% 17% 12% 10% 15% 28%

Wellness andhealthy living

Percent who rate their physical health care as excellent or very good 61% 31% 23% 51% 49% 60%

Percent participating in wellness programs 16% 6% 14% 10% 10% 20%

Percent willing to participate in a wellness program at no cost 56% 44% 57% 47% 55% 59%

Percent reporting one or more chronic diseases 47% 52% 57% 39% 47% 52%

Percent who participate in a disease management program 33% 14% 24% 13% 28% 32%

Percent interested in remote and/or home monitoring devices 64% 49% 49% 45% 64% 63%

Inormationresources

Percent who compare hospitals beore making a selection 13% 8% 13% 9% 9% 15%

Percent who compare doctors beore making a selection 13% 15% 24% 16% 15% 30%

Percent who maintain a Personal Health Record 6% 7% 6% 6% 4% 9%

Percent highly concerned about privacy or health inormationstored online

34% 44% 52% 53% 36% 38%

Traditionalhealthservices

Percent who have stayed overnight in a hospital or surgical,non-surgical or emergency treatment

15% 28% 24% 25% 16% 17%

Percent satised with recent hospital care 62% 64% 59% 65% 63% 73%

Percent who have a doctor who unctions as primary care provider 84% 94% 88% 76% 70% 80%

Percent satised with their primary care physician 74% 71% 73% 74% 65% 71%

Percent who use prescription medication 47% 63% 53% 33% 47% 57%

Alternativehealthservices

Percent who treated a health problem with alternativeor natural therapies

25% 13% 15% 22% 16% 19%

Preer doctor with orientation toward holistic or alternative treatments 13% 11% 26% 24% 9% 12%

Healthinsurance

Percent who eel nancially well-prepared or uture health care costs 39% 31% 25% 29% 29% 27%

Percent who consider themselves to be well-insured 25% 25% 22% 29% 20% 39%



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The role consumers play in managing their care is key

to reducing costs or health care systems. The majority

o these o system costs are avoidable i consumers live

healthier lives and adhere to treatment recommendations

when diagnosed. To achieve optimal consumerism in

a health care system, leaders must provide tools and

incentives that reward appropriate behaviors by consumers

working in tandem with their providers via a guided

sel-care management strategy. A health care systemaligned with consumerism will likely see costs reduced

and satisaction improve i it transitions rom a patient-

orientation to consumer model o care.

The ndings suggest that consumers who interact daily

with health care systems share many concerns: costs

are problematic, comparisons o hospital and physician

quality is modest and disappointing, and understanding o

respective health care systems is low.

To engage consumers as active participants in their

health and to align their spending with system goals

o improved health status and lower costs, politicalleaders, hospitals and physicians, and policy makers

will need to address three major challenges:

Consumer awareness and understanding: The

capture and dissemination o inormation about system

perormance quality, satisaction, prices, provider

adherence to evidence-based practices, and consumer

adherence to personalized health plans is necessarily

a high priority or each system. Useul report cards that

gauge system perormance must be developed and

made accessible to providers and consumers. Regulators

and health plans should align nancial incentives with

optimal perormance in the key areas measured. This

eort will require investments in inormation systems

and operational procedures, as well as regulatory

changes that support transparency, to evaluate the

perormance o each countrys health care system.

Sel-care support and health coaching: Chronic

illnesses are prevalent in all six countries. The majority

o consumers say they need help in managing their

diagnosis, but use o inormation technologies to

deliver coaching and sel-care support to consumers

is lacking. These cost-eective tools are not perceived

as being readily accessible to the population. As a

result, avoidable costs are increasing. Social media,

online tools, and emergent administrative and clinicalinormation applications that eliminate paperwork,

redundant testing and delayed access to diagnostic

test results will be essential investments. Capitalizing on

these eorts will be a key priority.

Strategic investment: Political priorities oten

challenge investments in health care system

transormation. However, the rate o system spend ing

growth poses a scal challenge to these countries.

The reality is that substantial investment is needed

to reduce health care system costs while improving

perormance. These investments are ront-end loaded

but pay long-term dividends. A concerted campaign totransition rom patient passivity to active engagement o

consumers will require political leadership and vision.

This report highlights consumer similarities and dierences in

health care systems that vary by design and cost. However,

surveyed consumers in all systems experience pressure to

pay or their portion o health care costs (even in systems

that are ully unded by the government). They also see

a common need or improved service and increased

transparency in their systems.

The opportunity exists to improve each o these health care

systems. Engaging consumers as active participants in the

process is a key component or success.

Implications



Authors

We would like to recognize the individuals who contributed their insights and support to this research.

Paul H. Keckley, PhD

Executive Director


Deloitte LLP

[email protected]

Dean Arnold

DTT Health Care Sector Leader

Deloitte Touche Tohmatsu

[email protected]

Thomas Northo

Partner, Lie Sciences & Health Care Leader

Deloitte Consulting GmbH

[email protected]

Yves Jarlaud

Partner, Lie Sciences & Health Care Leader

Deloitte Conseil

[email protected]

Robert Reppas

Partner

Deloitte AG

[email protected]

Mark Fam, CHE, MHA

Senior Fellow


Deloitte Consulting LLP

[email protected]

Acknowledgements

In addition to the authors above, we would like to thank Joyce Ehrlich, Jennier Bohn, Patsy Bolduc, Helen Baxter,

Erwan Lamour and Janett Reidel or their leadership, as well as Bianca Chung, Michael Curtis, Malay Gandhi, and My Di Le

or their contributions.

Contacts


24/24

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