• This is the idea that healthcare is a consumer market wherein transactions (purchases) are made by the actual users (consumers) based on quality, service, price and other attributes they deem important.

• Below are key laws/initiatives that helped shape the evolution of healthcare consumerism:

http://www.deloitte.com/dtt/cda/doc/content/us_chs_consumerdirectedhealthplans_1207_v1w.pdf

• Health Insurance Portability and Accountability Act of 1996 (HIPPA) – Medical savings accounts in this plan were the precursors to the Health Reimbursement Arrangements (HRA)/Healthcare Spending Accounts (HSA).
• Medicare Modernization Act of 2003 – The intent was to encourage consumers to become more involved in their healthcare decisions and this includes a provision allowing individuals to buy HSA’s.
• Value Based Healthcare Initiative – This is a public-private collaboration that emphasizes collection of quality-of-care data (using health information technologies), transparency of quality and cost information, and participate in incentive programs that reward high-quality, cost-effective care and encourage consumers to actively seek the care they need.

Self-directed care

• Self Directed Health Plans (SDHPs) or Consumer-Driven Health Plans (CDHPs) are becoming more popular. 
• The intent is to give consumers more freedom of choice in making health care decisions.
• http://www.doityourself.com/stry/selfdirectedplans
• Moving to consumer orientation rather than patient orientation means doctor’s become coaches rather than decision-makers, enabling consumers to consider all options, shifting more responsibility to them and expecting them to be aware and accountable for spending.

• Benefits of this type of care: http://www.doityourself.com/stry/selfdirectedplans
• Administrative costs on referrals, pre-certifications, gatekeepers, etc are eliminated allowing more dollars to be spent on the wellness of the patient.
• Consumers have an incentive to keep costs down and look for the best service because any cost over the allowance of treatment is out-of-pocket to them.  The allowance of treatment is based on average costs of the procedure in that particular region. 
• In managed care health systems, added costs for acute or chronic conditions are passed on to everyone through higher premiums – so a person who is relatively healthy may pay more in premiums to cover the acute and chronic patients. 
• Employers reduce their financial burden as consumers take more control and become more cost-conscious.

• People enrolled in these programs tend to be healthier than others.  As sick workers stay in the traditional plans, costs rise causing the plans to become less affordable and resulting in more uninsured people.    http://www.americanprogress.org/issues/2008/05/consumer_care.html

• Consumer behavior under these types of plans:

http://www.americanprogress.org/issues/2008/05/consumer_care.html

• 33 to 42% of people in CDHP’s are extremely or very satisfied with their plan compared to 63% with traditional plans.
• Employee Benefit Research Institute found that people in these plans are twice as likely to delay or avoid care and about three times as likely to pay a large fraction of their income on health costs as those in comprehensive insurance.
• Two thirds of people prefer an employer-selected set of plans to an employer-funded account or choosing insurance on their own.
• A Deloitte study found that 54% of consumers would prefer to get insurance through their employer, while 46% would prefer to shop around as long as they can get the same cost as employer-based insurance. http://www.deloitte.com/dtt/cda/doc/content/us_chs_ConsumerSurveyExecutiveSummary_200208.pdf
• New research by two University of Oregon experts found that people did not use more health information, higher generic drug use or more comparison shopping.  They did see two to three times more likely for people to drop drugs for chronic illnesses.   http://www.eurekalert.org/pub_releases/2008-07/uoo-moc070608.php

What do consumers want?  Online scheduling, access to medical records online, customized insurance coverage – all of this information is from: http://www.deloitte.com/dtt/cda/doc/content/us_chs_ConsumerSurveyExecutiveSummary_200208.pdf

• Consumers want better value, service, increased transparency and personalization of services from doctor’s hospitals and health plans.
• They want access to more information, are looking for better service, and think their physicians should make better use of information technology.

• 3 out of 4 respondents in a 2007 Deloitte survey said they want their doctors to provide online services to get results, schedule appointments, exchange emails, and access medical records. 1 out 4 said they would pay more for this service.

• 88% of respondents want in-home monitoring devices that could reduce the number of doctor visits and allow them to be more active in their care. 
• 2 in 3 respondents are interested in wellness programs to improve their health and/or save money.  1 in 4 said they would pay more for this service.
• The internet was the most useful source of information for these respondents

• Consumers trust their doctors more than hospitals, plans, government, online web sites and other sources for information on the best treatment.

• A growing number of consumers are aware of distinctions between practices that use electronic medical records and those that do not.  In some instances, it’s a major differentiator and determining factor in the selection of a physician.

• Nearly 80% of consumers want access through their doctor to an integrated medical record that combines information about tests, doctor visits and hospital stays. 

• 78% of consumers want to customize their insurance product by selecting benefits and features they value which may or may not increase overall cost of their coverage.