A new nationwide study finds Americans are largely unhappy with the healthcare they receive, with some 80 percent giving the system a grade of “C” or lower. The findings from the Deloitte Center for Health Solutions reveal 52 percent of respondents believe that half or more of the dollars spent on healthcare are wasted, while nearly three-quarters of Americans (73 percent) are confused about how the system works. No doubt reflecting the nation’s deteriorating economy, a full 94 percent say they believe healthcare costs are a threat to their financial security.

 

“The results of this study are conclusive: consumers want better performance from their healthcare system,” says Paul Keckley, the center’s executive director, in a written statement. “They think it is wasteful, inefficient, complex, and expensive.” The study of 4,001 was conducted in October 2008 using a web-based questionnaire. Only 20 percent of respondents give the U.S. system a grade of “A” or “B,” with 42 percent giving it a “C” or below, and 38 percent giving it a “D” or “F.”Dutch Masters).

 

When it comes to reform, consumers are looking for innovation that increase self-care, convenience, personalization, and control of personal health information, the study says. Among the responses, some 40 percent support performance-based payment systems that pay providers based on clinical results and outcomes rather than number of patients served or services rendered. Only 21 percent of respondents oppose a shift to a pay-for-performance system. Another 74 percent back boosting teaching programs to raise the supply of primary care physicians in the United States. As for automating medical records, 57 percent say they want to be able to go online—securely—to view their records, schedule office visits, refill prescriptions, and pay medical bills.

 

“Although the healthcare consumer market is complex, it is imperative that providers, payors, policymakers, device, pharmaceutical, technology, and biotech organizations understand and respond to consumers’ expressed concerns, interests, and needs,” says Keckley. “Engaging consumers appropriately is fundamental to healthcare reform.”

 

Despite the worsening financial crisis, President Barack Obama has vowed to go forward with plans to reform the health system, including efforts to roll out healthcare information technology as well as expand coverage of the uninsured. The nearly $800-billion stimulus package signed into law by Obama in February included $20 billion for healthcare IT. His $3.6-trillion fiscal 2010 budget would set aside a $634-billion reserve fund over a decade to start paying for expanded access to healthcare.

 

On the reform front, 53 percent of respondents in the Deloitte survey say they would like employers to be required to provide health insurance, while 17 percent oppose. But respondents seem more wary about moves that they perceive as limiting their individual choice. Only 37 percent are in favor of a mandate that would require every American to obtain health insurance either through a direct purchase or through an employer or government program. Such a mandate is a key element of the Dutch healthcare system, which insures more than 98 percent of the country’s population and is being considered by some as a possible model for the U.S. system (see

 

The study has some surprising findings in other areas. A remarkable seven out of eight Americans say they are in good health. But that contrasts with the National Center for Health Statistics showing more than 34 percent of Americans are obese. And medication adherence is low, the study finds. Only four in 10 say they take their prescription medication as directed.

 

Meantime, Americans appear to be increasingly turning to alternative forms of healthcare delivery. Some 13 percent of consumers say they went to a medical clinic located in a retail setting, such as a pharmacy or big-box store, in the last 12 months, and another 30 percent said they would be likely to go to such a clinic if they could save 50 percent or more over going to the doctor. Medical tourism is growing, with 8 percent saying they accessed services outside their local community in the past 12 months. Another 43 percent say they would do the same if they could save more than 50 percent.

 

American consumers “want better value for the dollars they spend and believe fundamental changes are needed to achieve those goals,” Keckley says.