What Do Americans Want Out of Healthcare?
Team 2: Michael Drescher, Tim Geiger, Heather O’Dell, Carla Raynor

Part A: Consumer Preferences and Desires

Overview

We began with online research, surveying a group of healthcare consumers, in an effort to better understand what Americans want out of their healthcare system. Our aims were to determine what these consumer’s valued, their product and service preferences, consumption patterns, and their capacity and willingness to purchase healthcare. To facilitate this process we used Survey Monkey.

Demographics of respondents

We garnered responses from 80 individuals with the following characteristics:

* * 65% of respondents are age 30 – 49

* Nearly all respondents are married and work full-time

* Half of respondents combined annual household income in 2014 of $150,000 or more; 32% have incomes between $75,000 - $150,000 * 3 of 4 respondents were female - consistent with fact that women make most healthcare purchasing decisions for their families

* 36.25% of respondents have a graduate degree; 26.25% have a bachelor degree & 26.25% attended some college but do not have a degree

* 70% pay for healthcare via employer-sponsored insurance; 17% have individual/family plans * 66% share healthcare purchasing decisions with others; 1 in 3 is the sole decision maker

Summary of Findings

Consumption of heathcare services: Two thirds of respondents receive only an annual exam and up to 2 acute visits per year. A smaller group, 17.5% reported having a chronic health condition, using healthcare services frequently. And 13.75% indicated they rarely use healthcare services, perhaps once per year, but only when they are really sick.

Value: Most people found reasonable value in their current healthcare but 41% feel rushed during their visit with a physician. Only 1 in 3 classifies doctor visits as “great.” Some respondents independently noted that healthcare prices were inflated.

Quality: Respondents overwhelmingly define quality as going to the best doctor with best medical outcomes. Only 24% define quality as having easy access to affordable care.

Access: Nearly half believe online appointment scheduling and reserved appointment times are the preferred ways to improve access. One in three respondents prefer services such as telehealth to improve access to doctors.

Relationship with Provider & Tradeoffs: Respondents value their relationship with their healthcare provider, until introduced with the option to trade access to that provider for a price discount. When asked what they would trade for lower prices, 30% said they would trade going to a specific doctor and having access to a narrow choice of hospitals. Over a quarter are willing to pay for preventive care out-of-pocket and 26% would limit their drug choices to primarily generic drugs. Several people noted that there should not be trade-offs for receiving appropriate care.

Part B: What Will Be Purchased In The Future?
Based on the above market research, key drivers for future healthcare purchases will be based on the following consumer-directed decisions: * Willingness to make trade-offs on cost for more control; leads to a market driven by consumer choice and preference. * Willingness to pay out of pocket for critical care, acute care and primary care; results in less reliance on pre-paid healthcare. * Resistance to rising cost for care, which is viewed as too expensive; creates markets where consumers are more willing to pay out of pocket, then shop for services. * Desire to pay for “better care and medical outcomes” incentivizes providers to provide the best quality at the best price.

Recommendations:
In the future, consumers must have a higher level of involvement in purchasing their healthcare in the open market, much like car or home insurance. This is made possible in three ways: 1. Mandated, catastrophic coverage 2. Mandated Health Savings Account (HSA) for chronic and acute primary care as well as maintenance care 3. Optional acute care policy to help with non-catastrophic, unexpected expenses

In this scenario, elasticity would increase and price would decrease. Additionally, demand would become more elastic due to the high deductible and increased consumer responsibility.

Employers will no longer be the default administrator of insurance benefits, rather only withhold for mandated Health Savings Accounts (HSA) similar to a 401k. Catastrophic | Maintenance & Chronic | Unexpected Acute Care | Funding | * Government mandated coverage * Purchased by consumers via health insurance carriers * Mandatory level of coverage requirements | * Government mandated HSA account * Mandatory contributions | * Optional supplemental acute care coverage * Purchased by consumer via health insurance carriers | Care Covered | High-cost, low-probability events: * Trauma * Transplant * Cancer | Preventative care * Acute and chronic * Immunizations * Home health Ancillary services * Dental * Vision | Unexpected acute events * Emergency care * Pre-defined list of surgery and/or services. | Considerations | * Avoid moral hazard by requiring a $5,000 annual deductible, and place caps on hospitalizations (i.e. Medicare). * Utilize tools like bundled payments to keep the costs more predictable. | * Cumulative over an individual’s lifetime * Transferrable to dependents. | * High deductible, supplemental coverage * Allows the consumer to buy up based on their risk aversion. |
The new insurance products available in the market would be based on three levels of care and funded by the these mechanisms:

Demand Elasticity:
In this proposal, demand for primary and maintenance care would become more elastic when the consumer is directly purchasing care—price would decrease with this increase in elasticity. Demand for acute as well as catastrophic care would also become more elastic with the consumer responsible for high-deductibles and being able to “shop around” in an open market.

Summary - What Is Insurable?
We found that people were willing to pay out of pocket for primary care, insuring only high-cost, low-probability events. Consumers are willing to partially invest in these unexpected events with substantial deductibles. The three mentioned health coverage options would ensure consumer investment and involvement at the point of purchase, naturally regulating the price of care to be more appropriate.

Additionally, with consumers more immediately invested and responsible for their own care, this will empower consumers to be active participants and maximize their health outcomes through other means (i.e., diet, exercise).

Summary of Key Findings
Summary of Key Findings