A Bottom-Line Look at the Latest Consumer Health Survey

HealthLeaders Media Staff, April 27, 2009

Once again research confirms what we have been hearing anecdotally: Consumers are not accessing care at the levels they were a few years ago. They are seeing their primary care physicians less and more are holding off on non-elective procedures, according to a recent Thomson Reuters consumer health survey.

The study of 12,000 households, conducted between February and March 2009, looks at the impact of the economic downturn on consumers' ability to pay for healthcare services and insurance. It also revealed who is postponing or cancelling care and why.

Here's what you should know:

The "why" behind being uninsured matters to your bottom line
The survey found a significant decrease in the number of households who are primarily covered by traditional employer-sponsored insurance, going from a high of 59% in 2008, to 54% by 2009. Interestingly, the uninsured ranks have remained constant. However, compared to three years ago, the reasons for lack of insurance are now concentrated more on affordability, says Gary Pickens, PhD, chief research officer for the Healthcare business of Thomson Reuters and lead author on the study.

"If we look inside the uninsured group it is becoming more a group defined by its inability to pay rather than a preference or a belief they don't need to be covered," he says.

In 2006, Pickens says 43% of households that were uninsured cited affordability as the primary reason. In March 2009, that number jumped to 48%. It's a huge spike, according to Pickens, who says those numbers usually change 1% or less year to year. If you look at the period between 2006 and the start of 2009, you see significant changes in consumer behavior. In the past, when times were tough, consumers would have manipulated the parameters of their health plan, changing deductible levels or the type of prescription drug coverage they had, says Pickens. Not so today. "They are dropping coverage period," he says.

This data point signals a significant amount of stress on consumers, says Pickens. The report also shows an uptick in Medicaid and other types of government insurance as the recession has progressed. "For those who lack insurance, cost and affordability are the issues and it also raises questions about their ability to self pay when care is needed and cannot be deferred," he says. In other words, providers are at risk for increased bad debt.

Big revenue makers being deferred
In 2006, roughly 15% of consumers responding to the survey said they were postponing or cancelling care. In March 2009, that number jumped to 20%. Again, a fairly big movement from a market research perspective, says Pickens. In 2006, the main reason for cancelling or deferring care had more to do with convenience. "Today that has flipped around," says Pickens.

Now it is all about cost. While the survey shows that most care being deferred today is for physician visits, 5% to 10% of respondents are also putting off care for non-elective procedures and for diagnostics and imaging services, important sources of revenue for hospitals and other providers. The only good news is those numbers haven't reached 50%, says Pickens. But everyone knows that 10% in potential deferrals, for say, colonoscopies, hurts.

Age matters
It used to be we could expect the young to put off certain types of services. In this recessionary period, Pickens says age doesn't factor in as much compared to just three years ago when it comes to deferring care. The survey found that the postponement of care is relatively the same across age and income level. "It isn't as if all the young are putting off doctor's visits and elderly people are putting off imaging visits, it is happening across the board," he says.

Unfortunately, the numbers point to more of the same. Some 28% of survey respondents said that over the next three months they expect to delay or cancel an elective surgical procedure. More than 20% report that they expect to have difficulty paying for healthcare services or insurance. Pickens says Thomson Reuters is starting to track consumer behavior monthly to monitor the impact of the economic downturn. Have we reached the bottom? Pickens' research suggests that kind of thinking might be overly optimistic.

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