Global Economic Uncertainty Makes Affordable Health Care a Universal Challenge for Consumers

June 21, 2011 — Rising health-care costs coupled with the current economy have prompted many consumers across the globe to delay care, change household spending, and worry about their ability to pay for future health-care costs, according to the 4th annual Deloitte Center for Health Solutions "2011 Survey of Health Care Consumers."

"We have been examining consumers' interactions with the health-care system since 2008. A new trend has emerged this year suggesting that economic uncertainty has clearly altered spending habits, with many consumers reporting an impact on their out-of-pocket health-care expenses," said Paul Keckley, Ph.D., executive director, Deloitte Center for Health Solutions. "Regardless of the type of health-care system, government-run or private, consumers around the world are feeling the pinch."

Deloitte surveyed more than 1,5000 health-care consumers in 12 different countries including Belgium, Brazil, Canada, China, France, Germany, Luxembourg, Mexico, Portugal, Switzerland, the United Kingdom and the United States during April and May.

In the United States, 3 in 4 (75%) consumers say the economic slowdown has affected their health-care spending. 4 in 10 (41%) are being more cautious about it, 20% cut back on spending, and 13% have reduced it considerably. In addition, 63% say their monthly health-care spending limits their household’s ability to purchase other essentials (e.g., housing, groceries, fuel, education). To save money, 36% of prescription medication users have asked their doctor to prescribe a generic drug instead of a brand-name drug. These findings follow Deloitte's "The Hidden Costs of U.S. Health Care for Consumers: A Comprehensive Analysis," published in March, which revealed that consumers spend $363 billion more on health care than traditionally reported, outpacing housing and utility costs as a discretionary household expense.

Also, 1 in 4 (25%) U.S. consumers skipped seeing a doctor when sick or injured. Of those consumers who decided not to see a doctor in the past year, those that did so due to costs ranged from a high of 49% in the United States, followed by Belgium (39%), China (35%) and Mexico (34%), to a low of 5% in Canada and 7% in the United Kingdom and Luxembourg.

More than half of all respondents from the 12 countries surveyed, with the exception of the United Kingdom (24%) and Canada (39%), also confirmed that household spending on health care limits their ability to spend on other household essentials. Also, between 4 and 10 and 5 and 10 respondents experienced an increase in household spending on health care in the past year, with the exception of the United Kingdom (22%), Canada (29%) and China (37%).

Further highlighting the anxiety over escalating health-care costs, consumers were mixed in assessing their household capacity to handle future expenses. The least amount of confidence was in Portugal (18%), followed by Mexico (22%), Brazil (22%), and the United States (23%). Nearly one-third of consumers in Switzerland (27%), Germany (30%), Belgium (32%), China (35%) and Canada (39%) felt secure in their ability to handle future health-care costs, as did 41% of consumers in the United Kingdom and Luxembourg.

"Three core shared beliefs became apparent this year throughout our global survey: consumers remain largely confused about their health-care system; grade their system as underperforming relative to what they know of other systems; and believe spending is wasteful in their country's health system," said Bob Go, global managing director, life sciences and health care, Deloitte Touche Tohmatsu Limited. "More often, consumers' opinions are based on prior personal experience rather than a systematic view, perhaps due to its complexity."

Most consumers do not have a strong understanding of how their health care system works. Consistently across the 12 countries surveyed, with the exception of Portugal (17%) and Luxembourg (16%), around 1 in 3 consumers felt they understood the system well. 3 in 4 U.S. consumers (76%) feel they do not have a strong understanding of how the health care system works; this perception has not changed in recent years (77% in 2010, 74% in 2009).

Consumers graded the overall performance of their health care systems very differently. The health care systems in Luxembourg (69%), Belgium (57%), Switzerland (52%), France (51%) and Canada (50%) all received a grade of "A" (excellent) or "B" (very good) from more than half of consumers in those countries. Only 22% of U.S. consumers, 18% of Portuguese, 15% of Mexican and 8% of Brazilian consumers graded their country's health care systems in similar fashion. Conversely, 57% of consumers in Brazil, 44% in Mexico, 38% in the United States and 33% of consumers in Portugal rated their health care system's performance as "failing" ("D" or "F").

Approximately 4 in 10 consumers in Belgium, Canada, Germany, Switzerland and the United Kingdom (24% in the United States) felt that their health care system was "superior to most other systems." Similarly, around 4 in 10 consumers in Belgium, Canada, Germany and Switzerland (37% in United States) believed that the quality of care in their country's health care system is comparable to the best in the world. This is in stark contrast to consumers in Brazil, Mexico, Portugal and China where only around 1 in 10 felt likewise about the performance and quality of their country’s health care system.

Consumers are uniformly negative in their judgment about the success of respective governments in balancing priorities in their health care systems with less than 1 in 5 consumers in all countries agreeing with the proposition that "government is doing a good job balancing priorities in the health care system."

The Deloitte Center for Health Solutions surveyed health-care consumers in Belgium, Brazil, Canada, China, France, Germany, Luxembourg, Mexico, Portugal, Switzerland, the United Kingdom and the United States in April and May. Participants were asked about behaviors before attitudes within each topic area to reduce response bias. The sample was nationally representative of each country with respect to age and gender. The sample in the United States and Canadian surveys was further adjusted for income and geography.

Across all European and South American countries, the response margin of error was +/- 3% at a .95 confidence level. In Canada the response margin of error is +/- 2% at a .95 confidence level and in the United States it was +/- 1.6% at a .95 confidence level. A smaller cohort was surveyed in Luxembourg with a margin of error of +/- 4.1% at a .90 confidence level. A convenience sampling approach was adopted in China which reflects the nation's online population, taking into account age and gender.

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