Australian consumers are no longer passive participants in their health care

By Rohan Hammett, Asia Pacific Health Care Leader, Deloitte

The Deloitte Global survey on Health care Consumers has shown that Australian consumers are demanding greater transparency, convenience and access to health services and that they are using technology more than ever to manage their own health and wellbeing.

In its 2020 Global Consumer survey, Deloitte surveyed consumers from seven countries (Australia, Canada, Denmark, Netherlands, UK , Germany and Singapore). In 2019, Deloitte surveyed the US population with the same questions. More than 4,000 Australian health care consumers participated in the survey which provides valuable information for governments, health care providers, medical device companies and other stakeholders about satisfaction and unmet needs within our health system.

Like consumers in most countries, Australians are generally willing to share their health care data with their doctor, though they have some reservations about sharing it with health insurers or government. They are most willing to share their data for analysis that will impact their own health, or for the development of medications to treat patients that have the same conditions as they do.

In all countries, health care consumers were comfortable sharing information in their medical records for specific purposes that would benefit the health of themselves, or others with similar conditions. But there were varying levels of trust in who should be able to access personal health data, with governments and insurers the least trusted.

Perhaps reflecting the impact of the rollout of the MyHealth record, Australians felt more strongly than any of the other countries that consumers themselves should be the owners of their medical records and health data.

Increasingly, Australian consumers are using the power of technology to take charge of their own health, and proactively maintain their own wellbeing. They are no longer just waiting for health professionals to provide them with information about their health, they are finding that information on websites and apps and using it as an alternative to, or as a supplement to, advice from health professionals.

One in five Australian consumers are currently using their smartphones and other technologies to monitor serious conditions such as diabetes, hypertension, depression and cardiac arrhythmias. Forty percent of Australians are using technology to monitor their fitness and wellbeing goals, however only one-third of these consumers share the information they are gathering with their treating doctor.

Interestingly, the survey showed that more than 90% of Australian consumers are prepared to tell their doctor when they disagree with the recommendations for care they have received. Long gone are the days of “doctor knows best”, as consumers access health information from many sources and take on responsibility for their own health decisions. Almost forty percent of Australian consumers would like to access information that compares the price, quality and customer feedback reviews on their doctors, noting that this is not as readily available for health care as for many other aspects of their lives.

One in five Australian consumers would like to have access to virtual health consultations, and 18 percent of consumers have previously had a virtual consultation and do so for a number of reasons including: shorter wait times, convenience, shorter travel times and, for 17 percent of respondents, because they prefer not seeing the doctor face to face. More than 80 percent of Australian consumers who used virtual consultations were satisfied with the experience.

Further evidence of the shift to a consumer empowered health system is that one in three feels comfortable using at-home diagnostic tests. In addition, 91 percent of Australians said they would change their doctor if they weren’t satisfied with them.

There is no doubt that the empowered consumer is fast becoming a reality in the Australian health care system.

Doctors are still the most trusted participant in a consumer’s health and consumers feel more comfortable sharing their health data with their doctor than any other player in the health system. Australian consumers also rate their health care system very highly, with almost 80 percent of consumers rating it as “good, very good or excellent”. This was the second highest rating amongst the seven countries in the survey, with only Singapore showing a higher level of satisfaction with their health system.

Australians have the highest rating of any country regarding the degree to which health care is arranged around the needs of the consumer. We also had the lowest levels of dissatisfaction with waiting times for access to treatment amongst the seven countries. We rank second in perceived access to modern technology to support care with Singapore again leading the rankings.

Australians consumers, more than in any other surveyed country, feel that our health system focuses more on prevention than just illness, perhaps reflecting the success of public health campaigns on smoking, immunization and road safety.

There is little doubt that Australians rate our health system very highly, and it is exciting to see the rate at which consumers are embracing new technologies and access to information to proactively manage their own health and wellbeing. Australians are already beginning to feel “The Future of Health.” This future is expected to give consumers access to highly personalized information that will likely empower them to remain well; rather than just seeking treatment when they are ill. And our health system will be all the better for it.

How to build a smart health community?

Survey gives insights on how Canada can improve health outcomes for citizens

By Lisa Purdy, Life Sciences & Health Care leader, Deloitte Canada

The old adage that an ounce of prevention is worth a pound a cure makes perfect sense, but achieving such a state on a national scale has proven elusive. Until, perhaps, now.

Health-system stakeholders in Canada and around the world are currently working toward a future in which the focus shifts away from a system of caring for the ill to one of taking care of the well-being of the healthy. In one emerging approach, stakeholders are collaborating with non-traditional players in sectors such as employment, housing, education, transportation, and technology to establish smart health communities. The purpose of these is to help improve the health and well-being of their members on a sustainable basis by innovating, increasing access and affordability, improving quality, and lowering costs through more efficient delivery models.

Smart health communities can be physical or virtual, by population segment (e.g., children, adults, seniors), self-identified social group (e.g., opioid addicts, mental-health sufferers, weight management candidates), or natural (e.g., schools, workplaces). They focus on the needs of the individuals in the community and, therefore, are citizen-driven, meeting a need that’s not addressed by the traditional health system.

The basics of smart health communities have been around for many years—think of diabetes prevention and smoking cessation programs, delivered by a facilitator to a group in a meeting space, that use communities to encourage individuals to manage their weight, exercise, and behaviours. Now, digital technologies, coupled with the insights gleaned from expanding sources of data, have the potential to increase the impact of these communities, helping them make timely and informed health-related decisions.

Canadians already use digital technologies in ways that may help build the smart health communities ecosystem, according to results from Deloitte’s 2019 Global Survey of Health Care Consumers :

• 57 percent of Canadians who report having a chronic disease use smartphones heavily, and 42 percent of the total respondents use technology to measure fitness and health-improvement goals
• 38 percent of Canadians are very or extremely comfortable using an app to track changes in heart rate, blood pressure, and/or heart activity (ECG) to determine if they might be at risk of a heart attack or arrhythmia, and 37 percent use an at-home blood test that connects with an app
• 30 to 40 percent of Canadians are very or extremely willing to: 
  • wear a sensor the size of a paper clip in an artery that would warn of the risk of a heart attack or a stroke (39 percent)
  • use voice assistants to offer medication reminders (37 percent)
  • use a service where a drone (unmanned aerial vehicle) delivers prescription medication from the pharmacy to the home (37 percent)
  • have a surgeon be assisted by a surgical robot in the operating room (34 percent)
  • use robots to help monitor an older adult or close relative who was having difficulty staying at home because of a health condition (34 percent)
  • use facial recognition on a smartphone or tablet to help track medication adherence (32 percent).
  • use a home-based virtual nurse assistant who uses artificial intelligence to diagnose illness type and suggest a treatment or a doctor's visit (30 percent)

If 57 percent of Canadians who report having a chronic disease already heavily use smartphones, and a third of respondents have already expressed an interest in using certain technologies to improve their health care experience, isn’t the pathway paved for health systems to offer them other digital innovations, such as moving from in-patient, in-person health care delivery to virtual care?

Exploring the survey results

Among surveyed Canadians, 44 percent were either very or extremely satisfied with the care they received on their virtual visit, and 65 percent would make another. These numbers are encouraging but they also suggest the process is about more than just adding technology. We need to rethink how we support people in their health management and how we provide the care, both physically and virtually.

The survey data also gives us a glimpse into the changes we need to make to encourage people to make a second virtual visit. Seniors reported the highest rate of virtual consultations in Canada in the last 12 months, for example, yet more than half (57 percent) of them said they would not do so again. Millennials posted the second-highest rate of virtual consultations—and nearly three-quarters of the respondents in this age group said they would repeat the experience.

What accounts for the drop-off in interest among the older population? What aspects of virtual care that appeal to millennials might be tweaked to give a better experience to seniors in their first virtual visit? Could a smart health community address an unmet need for seniors—for example, provide training on the online platform—to increase their comfort with virtual care? How about combining virtual and personal follow-ups in community settings that seniors frequent rather than at a hospital or medical clinic? What can health systems learn from other industries about improving citizens’ online/virtual interactions? The issue should not be whether a visit should be virtual or in-person; it should be how we can improve the overall experience and what tools health-care system providers and communities can use to do that.

Health-care stakeholders can apply the results from this consumer survey and other insights from citizens to guide the development of smart health communities and other future-focused care delivery systems by first shifting their thinking from illness care to health and well-being. This will open the door to better capitalizing on data-enabled insights, expanding the roles of partners in the ecosystem, and using innovative technologies for better health, social, and economic outcomes.

About the Deloitte surveys of US and global consumers

The Deloitte US Center for Health Solutions conducted a global, online survey in 2019 to understand what citizens value in the health-care system, how receptive they are to digital innovations, and their willingness to share their personal data. The survey was fielded in seven countries: Australia (N=4,079), Canada (4,039), Denmark (2,023), Germany (3,625), Germany (2,014), Singapore (2,014), and the United Kingdom (4,165). Questions were matched to those in the US consumer survey conducted in 2018.

For each country, the survey team analyzed the data and drew insights across five main themes:

• Technology and virtual care
• Virtual visits
• Trust and data-sharing
• Tools for engagement
• Care-seeking and general sentiment

Every third Dane is willing to share health data - but that is far from enough

By Sten Peters, health care leader, Deloitte Denmark

Many Danes are ready to share their health information for better treatment, a study by Deloitte shows - but we need even more if health care transformation is to succeed.

One does not have to open many newspapers these days to find that the Danish health service is under pressure. When I, as a consultant in the industry, visit the country's hospitals and general practiticioners (GPs), I clearly feel a certain burnout among these health care professionals. They inreasingly need to optimise – and to think of new strategies to address today’s current challenges.

Fortunately, in recent years, both health care professionals have been experimenting with new technologies such as artificial intelligence (AI) and virtual consultations - and they have been met with great success. I have no doubt that digital transformation across the entire health care system is the way forward. But that requires us to start using patient data more wisely and on a larger scale.

In a recent global study by Deloitte, we asked more than 26,000 patients across eight countries (Australia, Canada, the United States, Singapore, the United Kingdom, the Netherlands, Germany and Denmark) what private health information they collect on a daily basis and whether they are willing to share this data with the health care ecosystem in return for faster, better and more personalised care. The results show that between one-third and one-fifth of respondents measure their fitness level, weight, caloric intake and sleep via digital devices daily, and between 28 and 53 percent share this data with their GPs.

Every third Dane is ready

If we look more closely at the Danish results, we can see that around every third Dane is willing to share their data with the health system, especially if the information is used to provide better medical treatment. 39 percent say they are ready to share their health information with their health care practitioner to better enable them to provide the best and most effective treatment possible. In the case of emergencies, such as heart attacks, 32 percent of Danish respondents are ready to share the data with emergency departments, while only 19 percent would share the information with developers of the digital measuring devices.

It is positive that we have now reached a level in Denmark where every third Dane is ready to share his daily health and fitness data. But, we need to reach a higher number in Denmark in order to fully transform the health care sector and to provide personalized health care. The transformation will likely only be achieved if more people are willing to share a greater amount of health data with the health care sector in the future.

Huge digital potential

From the data, we can see that many doubt that general practitioners have any use for fitness data, nutrition data and sleep information. We can also see that the willingness of Danes to share health information is limited to the level of fitness, sleep, diet and the like. Presumably, because they don't track more data about themselves.

It's a shame - the possibilities are endless! Take, for example, a device like 'Kardia', the real-time handheld health sensor that measures electrocardiogram (ECG) and connects to a mobile phone. This solution does not yet exist in Denmark, but is used in many other countries, such as the United States, where the model is approved by the US Food & Drug Administration (FDA).

The day it becomes a reality to easily record valid data such as ECG measurements in Denmark, I believe that many Danes will be willing to use them and to share their data. Imagine being able to send accurate heart rhythm data to your GP instead of calling and saying, "Something feels wrong." Who would rather not provide the evidence to assist with their care?

By enabling Danes to share better data with the health care system, we can also help the individual far more accurately and effectively based on their patient data. Our study shows that a third though is ready to take that step. Denmark needs to start data collection with those Danes willing share now so that we do not lose valuable research and development results and hinder momentum when it comes to developing the health sector of the future with the efficiency gains and better treatment it may bring.

Of course, in order to reach the goal, we also need to get the last two-thirds of Danes involved. But to achieve that, a more nuanced picture of sharing data with the health care ecosysem is needed - and it's up to the sector to show us the way.

Do you want to know more? Download Deloitte's analysis here.

Try it, you’ll like it: Survey shows German consumers favor using technology to improve health care

By Ibo Teuber, Director, health care, Deloitte Germany

“I tried it, I like it, and I’m willing to use it again,” appears to be the general opinion of German consumers who have applied digital technology to their priorities and friction points in the health care system.

Results from Deloitte’s 2019 Global Survey of Health Care Consumers show that German consumers are curious and positive about using digital technologies to improve health care, despite limited availability to date of health-related consumer touchpoints. For example, although just 13% of surveyed millennials said they attended a virtual visit with a doctor, nurse, or health care professional in the last 12 months, 79% of that group said they would do so again. In fact, more than half of the participants from all segments except for seniors reported that they would have another virtual visit/consultation.

When asked about using other health technologies, 27% of consumers said they are very or extremely comfortable with using a software app to track changes in heart rate, blood pressure, and/or heart rhythm (ECG) to determine whether they might be at risk for a heart attack or arrhythmia, and (30%) with using an at-home blood test that connects with an app. Consumers also said they are very or extremely willing to try the following technologies:

• Use a service where a drone delivers prescription medication from a pharmacy to the home (40%)
• Wear a sensor the size of a paper clip in an artery that would warn of the risk of a heart attack or a stroke (34%)
• Use a surgeon who is assisted by a surgical robot in the operating room (33%)
• Use robots to help monitor an older adult or close relative who was having difficulty staying at home because of a health condition; use voice assistants to offer medication reminders (32%)
• Use facial recognition on a smartphone or tablet to help track medication adherence (23%).
• Use a home-based, virtual nurse assistant that employs artificial intelligence (AI) to diagnose illness type and suggest what treatment or doctor's visit should be next (22%)

These are all promising indicators that using technology for health care purposes is poised for growth, but work remains to convince segments of the German population to broaden their regular daily technology use to include health care. According to the survey, 52 percent of Germans who report having a chronic disease heavily use smartphones but do not widely use technology for common health purposes. And less than a third of respondents say they have used any technologies (e.g., websites, smartphone/tablet apps, digital assistants, personal medical devices or fitness monitors) for health purposes in the last 12 months.

How can stakeholders in Germany’s health care system help increase technology use? Recent legislation should support technology innovation and expansion in Germany’s health care system. For example, the Digital Provision Act (Digitale-Versorgungs-Gesetz ) becomes effective 1 January 2020. Among its focus areas are digital health apps reimbursement; virtual care support and reimbursement; digital transmission of doctor’s letters, including patients’ medical reports; and patients’ access to their health record (from 2021 on). In addition, the EU-wide General Data Protection Regulation (Datenschutzgrundverordnung ) has established stronger rules around data protection, giving people more control over their personal data and leveling the playing field for businesses.

Accelerating digital innovation is another important step forward. As mentioned earlier, only a few health-related consumer touchpoints are currently available, suggesting that the right digital tools may not have been built yet. Fortunately, market dynamics favor the rapid development of digital health offerings in the coming months and years. Some of these solutions may be German innovations that are being commercialized for the first time; some may be adaptations of other countries’ product and service offerings. As these technologies proliferate, health systems will need to consider how best to integrate them with existing electronic health records, which standards to adhere to, and which consumer interfaces to use.

Health systems also should prioritize efforts to increase data security and privacy to alleviate consumers’ concerns about sharing personal data. While a sizable proportion of surveyed respondents are willing to share personal data with their doctors to improve care (36% are somewhat willing, 20% are very willing, and 15% extremely willing), more than a quarter of respondents (28%) are unwilling to share blinded/anonymous data with developers to improve applications. Also, 17% of respondents do not access their personal health records online because they do not trust the security of the website.

Importantly, stakeholders should continue to tout the positives of digital technology use with current and prospective users; for example, how virtual visits can reduce the time and cost involved of an in-person physician appointment. Also, if consumers are already using one type of health care technology—about a third of survey respondents said they use technology to measure fitness and health improvement goals and/or monitor health issues—encourage/provide incentives for them to try other applications. Finally, encourage consumers to join digital communities (patient forums, blogs, websites) that address specific health topics, enable them to connect with people with similar health issues, and encourage discussion. Information and connection help build trust, the cornerstone of high-quality health care.

About the Deloitte surveys of US and global consumers

The Deloitte US Center for Health Solutions conducted a global, online survey in 2019 to understand what consumers value in the health care system, how receptive they are to digital innovations, and their willingness to share their personal data. The survey was fielded in seven countries: Australia (N=4,079), Canada (4,039), Denmark (2,023), Germany (3,625), Germany (2,014), Singapore (2,014), and the UK (4,165). Questions were matched to those in the US consumer survey conducted in 2018. For each country, the survey team analysed the data and drew insights across five main themes:

• Technology & virtual care
• Virtual visits
• Trust and data sharing
• Tools for engagement
• Care seeking & general sentiment

Dutch health care consumers cautious with sharing data

By Mathieu Van Bergen, Health Care Leader, Deloitte Netherlands and
Lucien Engelen, Health Care advisor, Deloitte Netherlands

The Deloitte Global Survey of Health Care Consumers 2019

Research has shown that Dutch health care consumers are more cautious about sharing personal health data than people in other countries. Across the board, the Dutch are also relatively reserved about health care innovations.
These findings about Dutch health care consumers can be found in Deloitte’s recently launched Global Survey of Health Care Consumers 2019. In the report, Deloitte compared the views of health care consumers from seven countries: Australia, Canada, Denmark, Germany, the Netherlands, Singapore, and the United Kingdom. The results of a similar survey conducted in the United States in 2018 were also included. More than 2,000 Dutch respondents took part in the survey.

Data sharing

For better care, the Dutch are most likely to share with their physicians personal data on their health that they track via apps or smart watches: 39% of the respondents said they were willing to do this. Only 35% of the respondents were willing to share information with family members or first aid providers in emergencies, such as in the case of cardiac arrest. These rates were considerably higher in the United States, at 60% and 53%, respectively.

The Dutch are also more reserved about sharing this personal information with third parties. Only 17% said they would be willing to share anonymised health data with device developers and 19% were willing to provide anonymised data for health research. With the exception of Germany, these percentages are higher in all other countries, with the United States as high as 40% and 39%, respectively.

With regard to anonymised data from their own medical files, 37% of Dutch respondents said they would certainly share the data for a personal analysis for the purpose of suitable treatment. The number dropped to 35% when it came to those willing to share the anonymised data for the development of new medicines for patients with the same disorder.
Of the Dutch respondents who did not want to share any data from their medical files, 48% said their reason for this was not knowing precisely what the data would be used for. Other reasons included being afraid the information would not remain private, at 45%, and concern that third parties would use the data for financial gain, at 31%.

“In general, the Dutch are less open about their lives than Americans,” says Lucien Engelen, who is affiliated with Deloitte’s Center for the Edge as a Global Strategist in Digital Health. “But I expect enthusiasm to grow as more useful applications are developed and sharing health data leads to concrete benefits.”

The willingness to share data is an important condition for the development of data platforms that can lead to new innovations and discoveries. Data sharing can also be used for a pro-active and preventive approach to health care.

Read our full report on Global Survey of Health Care Consumers 2019.

Monitoring health

When it comes to monitoring health, 37% of Dutch respondents said that they had used digital tools in the past year to monitor fitness and health indicators, such as the number of steps taken, their weight, and their sleeping patterns. The percentage of health tracking devices in other countries is slightly higher, averaging around 40%, with an outlier of 53% in Singapore. Of the Dutch respondents, 36% with a health tracking device said that they did not use it or did so irregularly. The most common reason given was that goals had been attained.

Among the Dutch respondents who monitor health and fitness with digital tools, 41% said they had shared the data with a physician. The majority of those who had not done so said that they did not think their physician would be interested, which may represent an opportunity for health care providers.

Emerging technologies

The survey shows that the Dutch are still not particularly enthusiastic about technological health care innovations. The greatest enthusiasm was shown for the use of robots in surgical interventions: 38% of the respondents were open to this. But the use of a virtual assistant such as Siri to detect potential illness or as a reminder to take medication had a less enthusiastic response (25% and 31%, respectively).

The Dutch also prove to be less interested in conducting genetic tests and blood tests at home, with the results at 24% and 31%, respectively, compared with 44% and 45% in the United States. Engelen expects the Dutch to be more amenable to emerging technologies as soon as more supply is available and the benefits for users are clear. “I don’t think that the Dutch are resistant to technological innovations in health care,” Engelen says. “It’s more an attitude of, ‘I’ll believe it when I see it.’”

E-health initiatives in the Netherlands

Although the Dutch are somewhat cautious, a great deal is happening here in the field of e-health. A good example is NAAST, a health care institution that has implemented e-health on a wide scale. Other interesting developments are the e-health expertise center Nictiz (aimed primarily at standardisation) and the formation of the national e-health laboratory NeLL (aimed primarily at scientific validation of digital health care).

Technology offers great opportunities to improve health care and make it more efficient. “In the future, we will be able to use apps, sensors, wearables, robots, and video communications to track our health more effectively” Engelen says. “Consumers will have access to their own health care data and, on that basis, can make decisions to improve or maintain their health.

“Research shows that Dutch consumers are still somewhat cautious about this,” he continues. “It is important that health care providers continue to bear in mind the value for consumers as well as consumer perceptions and to include them in this process.”

Engelen predicts that non-conventional parties will also play a role in the future of health care. “Think of banks, for instance, that can contribute to health with debt assistance programmes, mobility companies that can make visits to health care institutions more accessible, or retail companies that, on the basis of data, can offer shopping that matches the personal health situation of consumers,” he says. “There is a great deal about to happen.”

For more information, please contact Lucien Engelen or Mathieu van Bergen.

Singapore consumers favor technology to improve health care value

By Dr Hishamuddin Badaruddin, Director, Deloitte Southeast Asia

Singapore’s consumers know a good value when they see (or taste) it. That’s why the hours-long line of hungry customers at Hong Kong Soya Sauce Chicken Rice and Noodle often stretches across Chinatown Complex, Singapore’s largest hawker center (open-air food court). The stall’s signature chicken rice dish costs less than $2—oh, and did I mention that in July 2016, it became one of the first street food stands in the world to be awarded a coveted Michelin star? A high-quality product at a low price—that’s worth waiting for.

Singaporeans do not appear similarly willing to queue up at a doctor’s office—in-person medical care can be expensive and time-consuming—which may be among the reasons they favorably view digital technology as a way to reduce cost, increase efficiency, and derive more value from their health care system interactions.

Singaporeans use technology in myriad ways to simplify and improve their daily lives; applying it to health care should be a natural progression of what has been going on for years. According to Deloitte’s 2019 Global Survey of Health Care Consumers, 74% of Singaporean respondents who report having a chronic disease heavily use smartphones. In addition, 55% said that, in the last 12 months, they used technology to measure fitness and health improvement goals; 47% used it to monitor health issues (e.g., blood sugar, blood pressure, breathing fluctuation); and 37% used it to book a doctor or nurse appointment at their home.

These technology-assisted, at-home medical appointments—generally referred to as virtual care—are proving particularly popular with consumers. Of those who have been using virtual health services over the past year, 80% of respondents overall are at least somewhat satisfied with care received via virtual visit/consultation, and 65% said they would have a virtual visit/consultation again—100% of seniors reported they would do so. The top reasons for utilising virtual visits rather than seeing a health care professional in-person speak to Singaporeans’ quest for convenience and affordability: Survey respondents said they did not want to queue at the doctor's office (33%); the wait time to get a virtual appointment was shorter than with regular doctor/general practitioner; virtual visits had more convenient hours than a doctor's office (29%); and it is less costly than visiting the doctor's office.

Consumers also expressed interest in other health-related technologies.

• 34% are somewhat comfortable or very comfortable with using an app to track changes in heart rate, blood pressure, and/or heart rhythm (ECG) to determine whether they might be at risk for a heart attack or arrhythmia, and 34% with using an at-home blood test that connects with an app,.
• On average, 31% of consumers are willing to try the following technologies: 
• Use a service where a drone delivers prescription medication from a pharmacy to the home (33%)
• Use a home-based, virtual nurse assistant that employs artificial intelligence (AI) to diagnose illness type and suggest what treatment or doctor's visit should be next (32%)
• Use robots to help monitor an older adult or close relative who was having difficulty staying at home because of a health condition; use voice assistants to offer medication reminders (32%)
• Use facial recognition on a smartphone or tablet to help you track that you took your medication as prescribed (32%)
• Wear a sensor the size of a paper clip in an artery that would warn of the risk of a heart attack or a stroke (30%)
• Use a surgeon who is assisted by a surgical robot in the operating room (29%).

Looking to the future, a majority of Singaporeans are either somewhat interested or very interested in using technologies (including websites, smartphone/tablet apps, digital assistants, personal medical devices or fitness monitors) for health purposes including monitoring health issues (86%); measuring fitness and health improvement goals (85%); check on the costs of care using an online cost-tracking tool (80%); and receiving alerts or reminders to take medications (71%). Interestingly, of the respondents that said they are not interested in using health care technology, most prefer not to because they do not have health issues or take medication—not because of the technology itself.

Singapore’s Smart Nation and Digital Government Office (SNDGO), under the Prime Minister’s Office (PMO), together with the Ministry of Health (MOH) and its public health agencies, is a strong advocate of using technology to guide people to take pre-emptive steps to keep themselves healthy or better manage their well-being. Among Smart Nation initiatives are:

• HealthHub, A one-stop digital healthcare portal for Singaporeans to access medical records and useful health information;
• Assistive robotics and data analytics in health care to enhance overall well-being, especially for the elderly and those with disabilities; increase productivity; and improve patient care.
• TeleHealth that brings integrated and seamless care into the home, including care team video consultations and TeleRehab, to enhance patient access and improve productivity in the health care system.
• National Steps Challenge & The Healthy 365 App, a nationwide physical activity program that incorporates daily walking and wearable technology in the form of a step-tracker app.

As Singapore continues on its well-planned path to health care digitalisation, it is important that stakeholders remember the importance of striving for care ubiquity—to use technology to reach pockets of people who may be left behind and making sure there are alternatives to traditional venues where they can access care.

About the Deloitte surveys of US and global consumers

The Deloitte US Center for Health Solutions conducted a global, online survey in 2019 to understand what consumers value in the health care system, how receptive they are to digital innovations, and their willingness to share their personal data. The survey was fielded in seven countries: Australia (N=4,079), Canada (4,039), Denmark (2,023), Germany (3,625), Germany (2,014), Singapore (2,014), and the UK (4,165). Questions were matched to those in the US consumer survey conducted in 2018. For each country, the survey team analyzed the data and drew insights across five main themes:

• Technology & virtual care
• Virtual visits
• Trust and data sharing
• Tools for engagement
• Care seeking & general sentiment

2019 Global Survey of health care consumers: United Kingdom cut

By Karen Taylor - Director, UK Centre for Health Solutions and
Krissie Ferris - Research Analyst, Centre for Health Solutions

Since 2008, the Deloitte US Center for Health Solutions has polled a nationally representative sample of US adults (18 and older) about their experiences and attitudes related to their health, health insurance, and health care.1 Earlier this year we helped the US Center design a global survey to help understand what consumers value most about healthcare, and their appetite for digital innovations, including their willingness to share their personal health data. The US Center collected primary data through an online survey, fielded between May and June 2019, in seven countries (Australia, Canada, Denmark, Germany, Netherlands Singapore and the UK). It then compared their responses to responses from the US consumer survey conducted in 2018. The US Center launched their report on the survey last week.2 This week’s blog is our take on the key findings for the UK.

The results of the 2019 consumer survey offer a unique insight to consumer behaviour that can help providers and commissioners to understand the progress and gaps in adoption of digital innovation and where actions is needed to help the UK embrace the ‘Future of Health’.3 Globally, many countries are encouraging the use of digital and other technologies to help consumers take more control of their health. In the UK, although lagging somewhat behind the more consumer–led health care systems, such as the US, the idea of choice and alternative ways of accessing services has become more prevalent. As a result, UK citizens are beginning to display a number of traits relating to consumerism.

UK survey results - using technologies to engage consumers in their own health

Of the 4,165 UK survey respondents, 88% owned a smartphone, 53% of whom said they used it heavily (many times a day) – see Figure 1. Prevalence of ownership and extent of use decreased by age group (98% of 25-34 year olds owned a smartphone and 81% used it heavily, compared to 77% of respondents aged 65+ who owned a smartphone but only 28% used it heavily – many time a day). Interestingly, ownership of tablets (e.g. iPads/Kindles etc.) was similar across the age groups but their use was more frequent in the 55-64 and 65+ age groups (while 14% of 25-34 year olds used tablets heavily, 21% of 55-64 year olds and 20% of people aged 65+ used tablets heavily).

We examined the different responses from the different age groups about their ownership of health technologies (e.g. websites, apps, fitness monitors), the 25-34 year olds were more likely to own one (51% compared to less than 21% of 55-64 year olds and 16% of those aged 65+); younger age groups also reported higher frequency of use. We then asked about specific use over the past year:

• 32% of 25-34 year olds (highest) down to 15% of 55-64 year olds and 17% aged 65+ had used technology to monitor health issues (such as blood sugar, blood pressure)
• around 35% of 18-24 year olds, reducing to 6% of 55-64 year olds (8% aged 65+) received reminders to take medications
• 24% of 25-34 year olds (highest) to 5% and 6% respectively of 55-64 and 65+ measure, record and send data about medications they take
• 38% of both 25-34 and 55-64 year olds and 49% of 65+ had used technology to order repeat prescriptions.

Few UK consumers have had a virtual consultation

Across all age groups, a low percentage of UK respondents had engaged with the health system virtually, such as attending a virtual consultation with a health professional (17%) or checking their health records on-line (20%). Again, this varied by generation bands - see Figure 2.

While Seniors were more likely than Baby Boomers or Gen X respondents to have had a virtual health consultation, the most likely were millennials. Moreover, seniors are less likely than any other age groups to have logged onto their doctor’s or hospital’s patient portal to view their health information (7%), again millennials were the most likely group to have done so (22%).

Trust and sharing data

As explored in our report ‘Connected Health: How digital technology is transforming health and social care’,4 technology can connect patients and healthcare providers, leading to better outcomes and a more personalised service through informing/educating, two-way remote monitoring and supporting treatment adherence. Connecting patients and providers depends on being able to share data between the two parties. The consumer health survey found the majority of respondents are at least somewhat willing to share health information.

The primary reason consumers were unwilling to share data was due to privacy concerns (53%), and not knowing what the information will be used for (52%). Our research for our report, Shaping the future of UK healthcare: Closing the digital gap, shows that health care providers need to improve communication with patients about the benefits of sharing data and explain clearly how their data will be used and for what purposes.5 Moreover, that by improving transparency in the use health data there is the potential to build consumer trust and develop a more connected healthcare system.

Although most respondents (74%) were somewhat or very willing to share their health data with a doctor, the majority of respondents have not shared their tracked health data. More than half reported that this was because they did not think their doctor would be interested in the information. Given that most consultations are only for between 7 and 10 minutes the concern that doctors won’t have time to take on board this information is understandable. However the Long Term Plans expectations are that all patients will be able to have a virtual consultation by 2022, educating patients about the benefits of providing relevant health information, and assuring patients that doctors and nurses will review and act on such information, is a key to having a digital first, primary care led healthcare system.

Conclusion

In our 2014 report, Healthcare and life sciences predictions 2020: A bold future, we predicted that patients would become more like consumers, have high expectations of healthcare and the outcomes they get and would be embracing prevention, and devoting time, energy and money to staying healthy.6 At the time it did indeed seem a bold prediction as there was little evidence of this happening at anything like scale. Fast forward to 2019 and our annual consumer health survey provides a wealth of information and insights which demonstrate that UK citizens are now starting to behave more like health consumers. However, there is still a long way to go in realising our prediction. Armed with the results of the survey we can however see where attention is needed and what needs to happen to enable patients to embrace the idea of co-creation and self-care. This is not only key to the vision of a health care system focused more on prevention and wellness than a paternalistic approach based on treating ill health; but is also key to improving health outcomes.

The full, article on Deloitte’s 2019 Global Survey of Health Care Consumers, exploring the results of the 2019 global survey is available to download.

Unwrapping the gift of global health consumerism in 2020

By David Betts, Principal, Deloitte Consulting, LLP (United States)

Now that the holidays are behind us and gifts have been unwrapped, I suspect many people are tinkering with the features on their new smart watches or fitness trackers. Some people might have received genetic test kits as gifts and are now shipping off DNA samples to learn more about their heritage, their genetic risk for disease, even their unique metabolism and biome.

Wearable devices and genetic test kits can be fun, but they can also be powerful tools that could arm consumers with a much deeper level of knowledge of their health and well-being. This information could encourage them to spend time researching a condition (or potential condition) so they can have informed discussions with their clinicians.

Over the past 12 years, the Deloitte Center for Health Solutions has surveyed US consumers to find out about their experiences and attitudes about health, health insurance, and health care in general. Last year, we expanded our survey to include consumers in seven other countries (Australia, Canada, Denmark, Germany, the Netherlands, the United Kingdom, and Singapore). The results from the 2019 Global Health Care Consumer survey found that more than 40 percent of US respondents have used tools to measure fitness and to track health-improvement goals—up significantly from just 17 percent in 2013. In Singapore, however, 53 percent of consumers have used such tools. Our results also indicate that consumers in some countries are much more comfortable using at-home genetic testing to identify current or future health risks than are consumers in other countries.

Consumers are no longer passive participants

A patient today is more likely to show up at the doctor’s office with detailed information about symptoms, fitness, even their genetic information. A patient might even come across a relevant study that the physician hasn’t seen.

People in some countries appear to be more willing to challenge a physician or ask questions when compared to people in other countries, according to our survey results. For example, nearly 60 percent of US consumers said they would be “very likely” (37 percent) or “extremely likely” (21 percent) to tell a doctor that they disagree with them. Just 5 percent said they were “not at all likely” to challenge their doctor. Consumers in the United Kingdom and Singapore, however, are far less likely to question their doctor. I’m not suggesting that people in other countries don’t disagree with their doctors, they just appear less vocal about it.

A willingness to disagree with a doctor could shape the way that patients and physicians engage with each other. An informed consumer is more likely to want to understand all of the options to treat a condition. They will likely be interested in results/health outcomes, cost-effectiveness, and potential side effects.

Consumers appear to have taken their health research beyond typing symptoms into a search engine. While they might start there, they might also tap into other information sources such as online listservs, social media sites, and disease-specific forums where they can compare notes with people who have a similar condition. Some consumers might be prompted to learn about a disease after seeing symptoms described in a TV commercial. The quality of these information streams varies, but it is better and deeper than it has ever been.

I see parallels between what is going on in the health sector and what happened in the automotive industry a few years ago. People who enter a car dealership today typically know as much about a car, and the price, as the sales team. Consumers tend to do extensive research before they ever show up at a dealership for a test drive. The role of the salesperson has shifted from selling cars to helping ensure the consumer has a good experience and has all of the information needed to make a decision.

One of the expectations that we have for the future of health is that the more educated (maybe also more agitated) consumers will force change. This could make some physicians uncomfortable because they have traditionally been seen as the arbiters of information. However, the patient is now in the driver’s seat (to get back to my car dealership analogy) and the physician is becoming more of a facilitator who helps the patient make decisions.

‘Ringing’ in the New Year

We recently started a “close the ring challenge” on my team where we use our smartphones to track each other’s fitness goals. In 2019, Deloitte joined the Perelman School of Medicine at the University of Pennsylvania to determine whether gamification and competition could make fitness trackers more effective. The STEP UP study determined that participants who used a fitness tracker that was paired with an element of competition took an average of 1,166 more steps per day than participants who had a fitness tracker alone.

Along with motivating people to stay active, these devices can also send me information about my heart rate and warn me if there are any signs of arrythmia. I can track and trend my sleep patterns to make sure that I’m getting enough sleep when I’m on the road. As we all become more informed about our health and well-being—aided by fitness trackers and genetic test results—I suspect we will become more comfortable with challenging diagnoses and treatment decisions.

Expect more virtual visits in 2020

Where do we go from here? The US typically views itself as being on the cutting edge of technology…but we are not when it comes to our use of virtual care. This doesn’t appear to be related to any reimbursement trends. Between 13 and 29 percent of consumers in the countries we surveyed have had a virtual visit/consultation with a care provider. Consumers in Denmark and Singapore have had more virtual visits than consumers in the other countries surveyed. Consumers in Germany were least likely to have a virtual visit.

The US ranks highest in user satisfaction among people who say they have had a virtual visit, according to our survey results. It could be that the US has been more deliberate about its role-out of virtual care than other countries. Nearly 80 percent of virtual care users in the US said they were “completely” or “very” satisfied with the experience—substantially higher than in other countries.

Around the world, we are moving into an era of shared decision-making. I predict this will become increasingly prevalent in the years ahead. Once people are armed with reliable information, they can begin to take some agency for their own health and are no longer passive consumers. The fitness trackers, smart watches, and genetic tests that many of us received as gifts might be gifts that keep on giving if they give consumers a deeper understanding of their health.