Health Care Reform: Consumer Pulse Survey Deloitte Center for Health Solutions DOWNLOAD

The Deloitte Center for Health Solutions (DCHS), part of Deloitte LLP, conducted a survey of consumers September 29 through October 4, 2010, to assess their awareness and expectations about health reform, more than six months after the Patient Protection and Affordable Care Act (PPACA) was signed into law. According to the survey, consumers express mixed views about health reform, with younger consumers having a more positive outlook. Consumers remain mixed in their assessment of the system's performance, concerned about costs and supportive of changes that improve its value.

General Perceptions

• Overall, 32 percent of U.S. adults surveyed gave the U.S. health care system a grade of A or B, compared with 27 percent who gave it a D or F.
  • Those who said they are financially prepared to handle future health care costs (40 percent) gave the system a grade of A or B more than those not financially prepared (23 percent).
  • Males age 65 and above (26 percent) gave the system a grade of A, which is statistically different from males 18-44 (5 percent), males 45-64 (10 percent), females 18-44 (7 percent), females 45-64 (4 percent) and females 65 and above (12 percent).
  • Those who said they were knowledgeable about the components of PPACA gave the system a better grade - 48 percent of “very knowledgeable” gave it an A or B, which is statistically different from “somewhat knowledgeable” (32 percent) and “not at all knowledgeable” (27 percent).
• Sixty-one percent of adults said they were knowledgeable about PPACA and 38 percent said they were “not at all knowledgeable.”
  • Sixty-seven percent of those with employer-provided coverage and 61 percent of Medicare respondents said they were knowledgeable about PPACA, compared to 30 percent of those with Military coverage.
  • Seventy percent of those with Military coverage said they were “not at all knowledgeable” about PPACA, which is statistically different from those with employer-provided coverage (33 percent), Medicare (39 percent) and individually insured (35 percent).
  • Sixty-nine percent of those who said they are financially prepared to handle future health care costs said they are knowledgeable about PPACA, which is statistically different from those who are not financially prepared (38 percent).

Expected Impacts of PPACA

• Fifty-nine percent of adults surveyed said they think PPACA will have a positive impact on increasing access to affordable insurance for the uninsured.
  • Seventy-one percent of men age 18-44 expect PPACA to have a positive impact on increasing access to affordable care for the uninsured, more than any other age-gender group.
  • Men age 65 and above (35 percent) expect PPACA to have a negative impact on increasing access to affordable care for the uninsured, which is higher than any other age-gender group.
• Nearly half (49 percent) of adults surveyed said they think PPACA will have a positive impact on encouraging consumers to live healthier lives.
• Opinions about positive impact of PPACA on other areas of the health care system are mixed:
  • Forty-five percent expect a positive impact on extending the life of Medicare, reducing costs of prescription drugs and reducing costs of health insurance.
    • Sixty-nine percent of respondents age 18-24 expect a reduction in health insurance costs
    • Almost two-thirds (64 percent) of respondents age 18-24 expect a reduction in prescription costs, compared to 42 percent of people 65 and above.
  • Forty-three percent expect a positive impact on reducing costs of health care in hospitals and doctors, changing the way health insurance plans are regulated and eliminating waste, fraud and abuse.
    • Men age 18-44 were most likely to anticipate positive impacts on eliminating fraud and abuse (53 percent).
  • Forty-one percent expect PPACA to have a positive impact on helping achieve economic recovery, while 25 percent expect PPACA to have a negative impact.
    • More than three-quarters (79 percent) of respondents age 18-24 expect PPACA will help achieve economic recovery, which is statistically different from all other age groups.

Financial Preparedness and Use of Substitutionary Care

• Thirty-six percent of adults surveyed said they are financially prepared to handle future health care costs, compared with 17 percent who said they are not prepared.
  • Eighty-nine percent of those with Military coverage said they are financially prepared to handle future health care costs, which is statistically different from those with employer-provided coverage (40 percent), Medicare (35 percent), Medicaid (36 percent), individually insured (33 percent) and uninsured (9 percent).
  • Sixty percent of those who said they are “very knowledgeable” about PPACA said they are financially prepared to handle future health care costs, which is statistically different from those who said they are “somewhat knowledgeable” (36 percent) and “not at all knowledgeable” (29 percent).
  • Of all employment statuses, retirees (45 percent) said they feel most financially prepared for future health care costs.
• Forty-eight percent of adults surveyed said they used an over-the-counter product instead of seeing a doctor for a problem
• Nearly one-quarter of respondents use other forms of substitutionary care:
  • Twenty-three percent used a walk-in clinic or other retail clinic located in a pharmacy, grocery store or other retail setting to get non-emergency care (instead of going to a hospital or doctor for care)
  • Twenty-one percent consulted an herbalist, homeopath, chiropractor or other alternative health care practitioner to treat a medical problem (instead of a traditional physician).

Health Care System Cost and Cost Drivers

• A substantial majority of adults surveyed believe insurance company costs (70 percent), hospital costs (69 percent) and fraud in the system (67 percent) are major drivers of overall health care system cost.
• More than half of adults surveyed believe the following are major drivers of overall health care system cost: Consumer behavior (65 percent), prescription drugs (61 percent), government regulation (58 percent), new technologies and equipment (55 percent), defensive medicine (52 percent) and overutilization of diagnostic testing like MRIs and CT scans (51 percent).
• Thirty-seven percent of adults surveyed said more than 20 percent of total premiums is reasonable for covering insurance plan overhead.
  • Forty-seven percent of those with household incomes of $25-50K and 44 percent of those with incomes of $25K or less said more than 20 percent of total premiums is reasonable for covering insurance plan overheads, which is statistically different from those with incomes of $100K or more (27 percent).
  • Eighteen percent of those that said they are “very knowledgeable” about PPACA and 14 percent of those that said they are “somewhat knowledgeable” said 15-20 percent of total premiums is reasonable for covering insurance plan overheads, which is statistically different from those that said they are “not at all knowledgeable” about PPACA (7 percent).

Health Insurance Coverage

• Breakdown of insurance coverage
  • Fifty-three percent of adults surveyed had insurance from a private source (47 percent through employer provided and 6 percent are individually insured).
  • Twenty-six percent had insurance from a public source (18 percent through Medicare, 4 percent through Medicaid and 4 percent through Military coverage).
  • Twelve percent had no health insurance coverage.
    * Note: Percentages may not add up to 100 percent due to “don't know” and rounding.
• Thirty-one percent of those with incomes of $25K or less do not currently have health insurance, which is statistically different from $25-50K (16 percent), $50-75K (3 percent), $75-100K (4 percent) and $100K or more (1 percent).

Survey Methodology

DCHS commissioned Harris Interactive to conduct, via its Harris Poll National Quorum®, a telephone survey of 1,008 U.S. adults 18 years and older September 29 - October 4, 2010 to assess consumer awareness and expectations about health reform more than six months after PPACA was signed into law. Data were weighted to be representative of the total U.S. adult population on the basis of age, sex, race/ethnicity, education, region, number of adults in the household, and number of phone lines in the household where necessary to align them with their actual proportions in the population. The survey results have a sampling error of +/- 3 percentage points at the 95 percent confidence level.

For more information and additional reports, please visit Deloitte Center for Health Solutions.