2010 Survey of Health Care Consumers Consumerism and implications for the life sciences

Introduction

Conceptual framework The 2010 Survey of Health Care Consumers, conducted by the Deloitte Center for Health Solutions, is Deloittes third annual study of consumers attitudes, behaviors and unmet needs. It offers health care industry leaders and policymakers a comprehensive view of the different ways in which consumers approach health, health care, health insurance and health policy. The findings provide a timely look at how health care consumerism is evolving in America. The studys framework reflects a broad-based view of consumerism in six zones (Figure 1): Wellness and healthy living Information resources Traditional health services Alternative health services Health insurance Health policy

Highlights of survey findings for the life sciences industry are included in this summary. More detailed findings are reported in accompanying charts. Methodology A nationally representative sample of 4,008 American adults, aged 18 and older, was surveyed between December 28, 2009 and January 5, 2010, using a web-based questionnaire. The results were weighted to assure proper proportional representation to the nations population, as reflected in the 2006 US Census Public Use Microdata Sample (PUMS) file, with respect to age, gender, income, race/ethnicity and geography. The margin of error around the US point estimates is +/- 1.6% at the .95 confidence level. The survey consisted of 50 questions, with 26 potential follow-up questions. English and Spanish versions were available. Participants were asked about behaviors before attitudes within each topic area to reduce response bias. Highlights of findings for the life sciences Deloittes 2010 survey measured consumers views and actions across to a wide range of issues affecting pharmaceutical, biotechnology and medical device companies. Now in its third year, the survey continues to reveal evolving consumer behaviors, attitudes and needs, offering manufacturers and service providers enormous opportunities and challenges in the years ahead. More than half of all consumers surveyed continue to use at least one prescription medication daily, and almost half (47%) of these people take three or more prescriptions daily. Confidence in prescription medications remains high and unchanged from 2009 survey results 3 in 4 believe that the medications they take are effective.

Figure 1: Zones of health care consumer activity

2. Information resources

1. Wellness and healthy living

3. Traditional health services

Health care consumerism

6. Health policy 5. Health insurance 4. Alternative health services

2010 Deloitte LLP. All rights reserved.

2010 Survey of Health Care Consumers: Consumerism and implications for the life sciences

Cost continues to drive consumers to switch medications and request generics. 1 in 4 consumers says they asked their physician to prescribe a generic therapy because of cost concerns; of consumers who switched medications, 13% say they switched to another brand because it was covered by insurance and 1 in 10 say they used a manufacturer coupon to mitigate costs. 2 out of 3 consumers indicate that they would choose a generic over a branded therapy, a slight decrease from the 71% who said they would do so in 2009. Consumers health care spending and their anxiety about health care costs are stable. Fewer respondents (43% vs. 47%) say that their health care costs increased and slightly more (46% vs. 42%) report they stayed the same compared with 2009. 1 in 4 remains confident that they are able to deal with future medical costs; however, like 2009, confidence ranges widely by consumers insurance coverage. The uninsured continue to feel the brunt of rising health care costs. They tend not to have primary care physicians, they tend to choose between essentials and prescription drugs and they tend to delay or forego treatment. Consumers continue to use alternative therapies. 1 in 5 reports using alternative remedies to treat health problems, but more are using them before or in addition to traditional medicine. More consumers in this years survey (17%) say they sought an alternative therapy before seeing a physician compared to 2009 (12%). Furthermore, more consumers are using alternative therapies with their prescription regimens (20% in 2010 compared to 16% in 2009).

The Internet remains a major source of information about medical treatments. Unchanged from 2009, more than half of consumers (55%) say they looked online for information about treatment options. Also equivalent to 2009, consumers rank health plans and life sciences manufacturers among the least-trusted sources of treatment information; the majority of consumers trust medical associations and academic medical centers most. A small number of consumers, 5%, say they are using social networking sites such as Facebook and Twitter to look for information about treatments. Interest in in-home monitoring devices has decreased, with all age groups showing decreased interest. While 64% of consumers showed interest in an in-home monitoring device in 2009, significantly fewer (49%) express interest in 2010. Slightly fewer (33%) are concerned about the security and protection of online personal health records (PHRs) compared to 2009 (38%). Consumers are maintaining PHRs but younger consumers are more interested in using their mobile phones to access these records. 1 in 10 of all consumers continues to maintain a PHR, which is equivalent to 2009. Almost 1 in 4 Generation X and Generation Y consumers say they would be very likely to do so if given the chance compared with 15% of Baby Boomers and 12% of Seniors. Selected findings are described by zone, and are followed by a discussion of key considerations for life sciences organizations. (For the full report of US findings and other information pertaining to the 2010 survey, please visit: www.deloitte.com/centerforhealthsolutions.)

Survey highlights for the life sciences

Zone One: Wellness and healthy living 7 of 8 consumers report that they are in excellent, very good or good health but more than half continue to have one or more chronic conditions (54% in 2010 vs. 55% in 2009). 1 in 5 consumers and 1 in 4 consumers with chronic conditions participates in a wellness program, unchanged since 2009. More Seniors (24% in 2010 vs. 15% in 2009) say they participated in a wellness program in the last 12 months than reported doing so in 2009. Compared with their older counterparts, Generation Y (18%) consumers are the least likely to join a wellness program (vs. 23% Generation X and 24% of Seniors and Baby Boomers). Zone Two: Information resources More than half (55%) of consumers say they sought information online about treatment options or a particular treatment in the last year. A small number of consumers (5%) use Facebook or Twitter to find out about prescription drugs. Consumers continue to trust academic medical associations (45%) and academic medical centers the most for information on the safety and effectiveness of treatments; almost 1 in 3 consumers says they trust manufacturers (31%) and employers (33%) the least (Figure 2). For information about treatment costs, consumers continue to consider academic medical centers (35%) and medical associations (32%) to be the most trustworthy (compared to 37% and 35% in 2009), followed by community hospitals (29%) and health plans (21%); consumers continue to trust employers (27%) and manufacturers (32%) the least (22% and 31% in 2009). 1 in 10 continues to maintain a PHR (9% in 2009). Slightly fewer consumers are concerned about the privacy and security of online PHRs than last year (33% compared with 38% in 2009). Younger consumers are interested in accessing their records through their mobile phone: 22% of Generation X and 23% of Generation Y say they would be very likely to access their records this way compared with Seniors (15%) and Baby Boomers (17%).

Figure 2: If you wanted information about the most effective and safe treatment(s) for a certain health condition, how much trust would you have in the following third-party sources to provide reliable information?
Medical associations/societies Academic medical centers/teaching hospitals Community hospitals Pharmacies US Department of Health and Human Services State Departments of Health and Human Services US Food and Drug Administration (FDA) Independent health-related web sites (e.g., WebMD) Health insurances companies/health plans Pharma, biotech, medical device manufacturers Employers 32% 35% 32% 31% 32% 33% 5% 7% 5% 7% 9% 8% 11% 10% 13% 16% 14% 17% 17% 17% 12% 14% 51% 45% 50% 41% 31% 28% 28% 26% 31% 24% 28% 23% 27% 23% 28% 22% 13% 10% 11% 9% 10% 9%

n = 4,001 in 2009 and 4,008 in 2010 2009 Distrust for this purpose (ratings of 1,2,3) 2010 Distrust for this purpose (ratings of 1,2,3) 2010 Deloitte LLP. All rights reserved. 2009 Trust for this purpose (ratings of 8,9,10) 2010 Trust for this purpose (ratings of 8,9,10)

2010 Survey of Health Care Consumers: Consumerism and implications for the life sciences

Zone Three: Traditional health services Prescription medications Use of prescription and over-the-counter supplements and therapeutics remains high: Similar to 2009, only 1 of 7 is a non-user and more than half take one or more prescription medications. Of the 56% who take prescription medications, almost half (47%) take three or more (51% in 2009). 1 in 3 consumers (31%) reports taking a single prescription therapy and 1 in 4 (22%) takes two medicines daily. These numbers are comparable to 2009 (27% and 22%). Of those taking prescription medication, 74% of consumers are confident their medications are effective (75% in 2009); confidence increases with consumer age. Similar to 2009, in 2010 29% of consumers say they switched medications; consumers primarily switched because of side effects and costs (Figure 3). 67% of consumers indicate that they would choose a generic medicine over a branded one if given a choice, a slight decrease from 2009 (71%). 2 in 7 say they asked a physician to prescribe a generic therapy because of cost concerns. 1 in 10 (12%) says they asked the doctor to switch prescriptions for a brand that was covered by insurance. More Generation Y consumers (16%) are likely to choose a brand name than other age groups. 1 in 10 says they used a company coupon to defray prescription costs. 1 in 5 reports using a mail order pharmacy.

Figure 3: Consumers who switched prescription medication in 2009 and 2010

Switched prescription medication in the last 12 months (2009)

Reasons: 32% 28% switched to another brand because of side effects 28% switched another brand because the medication was not working

Switched prescription medication in the last 12 months (2010)

29%

24% switched to a generic to save money 13% switched to another brand because insurance did not pay

20%

30%

40%

2010 Deloitte LLP. All rights reserved.

Medical devices Interest in in-home monitoring devices has decreased: Almost half of consumers (49%) say they would be interested in using an in-home medical device that could help them know what to do and when, to improve their health or treat a health condition, down from 64% in 2009 (Figure 4). Interest in in-home monitoring devices has decreased among consumers with chronic conditions, from 71% in 2009 to 55% in 2010. Interest in in-home monitoring devices has dropped among all age groups: 58% vs. 67% of Baby Boomers; 48% vs. 67% of Seniors; 46% vs. 61% of Generation X and 44% vs. 51% of Generation Y express interest in 2010 compared with 2009. 1 in 5 consumers are interested in using their mobile phone to access their health information; Generation X (22%) and Generation Y (23%) are the most interested in this technology.

Figure 4: If given access to an in-home medical device that could help you know what you need to do and when to improve your health or treat a health condition, how interested would you be in using this device?
30% 25% 22% 20% 15% 10% 5% 1% 0% 1 Not at all 2 3 4 5 6 7 8 9 10 Completely 3% 2% 11% 8% 3% 3% 11% 8% 19% 15% 10% 25% 22% 17%

17%

More consumers are seeking alternative or natural remedies before seeing a physician (17% in 2010 compared with 12% in 2009). Similar numbers say they substituted an alternative or natural therapy for a prescription medication (9% in 2009 vs. 10% in 2010). Unchanged from 2009, 1 in 10 consumers prefers a physician who integrates holistic approaches into their practice. Seniors (13%) have a slight preference for holistic medicine compared with 7% of Generation Y. Zone Five: Health insurance Perceived health care costs and associated anxiety has stabilized: Similar to 2009, 1 in 4 remains confident that they are able to deal with future medical costs (25% in 2009 vs. 24% in 2010). Confidence in managing future health care costs continues to range widely, from those with military insurance (46% in 2010 and 48% in 2009) to the uninsured (6% in 2010 and 2009). When choosing a health plan, 61% of consumers say that generic medicine coverage influences their decision and 51% say brand name medication coverage influences their choice. Zone Six: Health policy Slightly more consumers are for (42%) than against (38%) government requirements for health insurance coverage. More (42%) say they would choose an employersponsored plan than the governments (25%), all other factors being equal The majority (69%) of consumers believe that a government-sponsored, Medicare-like plan for people under age 65 would stimulate better competition among commercial plans Less than half (46%) believe that competition from the government would be fair.

1%2%

1%

2009 (n = 4,001)

2010 (n = 4,008)

2010 Deloitte LLP. All rights reserved.

Similar to 2009, 15% of consumers say they used a retail clinic in the past 12 months (13% in 2009): Convenience and cost drive use, especially among Generation X and Generation Y consumers. Younger adults remain core users of retail clinics: Generation Y (19%) and X (17%) remain the heaviest users (17% and 15% in 2009, respectively); 13% of Baby Boomers and 10% of Seniors are users (compared to 13% and 7% in 2009). Zone Four: Alternative health services Unchanged from 2009, 1 in 5 consumers reports using an alternative treatment approach or natural therapy to treat a health problem in the last year. More consumers say they added an alternative treatment approach or natural therapy to a prescription medication in 2010 (20% vs. 16% in 2009).

2010 Survey of Health Care Consumers: Consumerism and implications for the life sciences

Key considerations for the life sciences

Although this years findings suggest that the state of US health care consumerism has changed little since 2009s survey, the beliefs and behaviors of US consumers continue to raise several important considerations for pharmaceutical, biotechnology and medical device companies. #1: Consumers want information to make their own health care decisions, whether it is from the Internet or their own data generated through their mobile devices; however, consumers do not trust manufacturer information. To increase credibility and remain relevant as consumers have an increasing choice of information sources, life sciences companies may consider strategies that improve the quality of the information they disseminate to consumers and incorporate consumers channel preferences. Considerations for all life sciences companies: Within appropriate regulatory guidelines, provide accurate and helpful information on company and branded web sites. Consider using educational videos and webinars to help educate consumers about their conditions. Link content to academic medical centers, foundations and medical societies. Consider the consumer experience and design integrated alerts and reminders that help alleviate compliance and adherence burdens. Link alerts to consumers mobile devices. Design clinical trials that use self-reporting through mobile devices to better personalize therapies. Help consumers understand the relevant components of their health records so they can track their progress on chronic medications. Continue to invest in companion diagnostics that help consumers understand the best medicine for both their condition and prognosis. Additional considerations for biotechnology companies: As commercial and academic efforts to catalog biomarkers and develop personalized medicines progress, consider building tools to help consumers understand how their genetic and other biomarkers impact their health status. Consider sponsoring or supporting an online community on a third-party web site that specializes in PHRs. Use online communities to gather information about the use and administration of biologics and their impact on daily life to design useful applications for mobile devices. Additional considerations for medical device firms: Improve availability of point-of-care diagnostics. Incorporate an understanding of care pathways and consumer decisions into device engineering and placement.

#2: Similar to 2009, consumers want value in their medications and are cost-sensitive. Almost 30% of consumers are switching medications and most are switching therapies because the drug has side effects, is perceived to be ineffective or a cheaper alternative is available. 2 in 7 have asked for a generic because of its cost. Considerations for all life sciences companies: Help manage expectations about side effects and balance clear articulation of potential side effects with management strategies and long-term outcomes. Continue to inform consumers about the long-term value of their products and provide them with accurate and helpful information about the impact on their health condition. Continue to invest in long-term pharmacoeconomic studies that can inform both payors and consumers about the long-term value of therapies and the cost of non-compliance. As more generics become available, recognize that consumers will increase their use of generic products: Manufacturers may want to consider diversifying their offerings in the health care space (e.g., retail clinics). Seek to develop products that are differentiated by greater convenience, personalization and improved capabilities to self-monitor, especially for chronic conditions such as diabetes and dyslipidemia. Continue to invest in pharmacogenomics and other diagnostic strategies to tailor medications to address side effect sensitivity.

#3: Consumers understand the concepts of wellness, healthy lifestyles and the impact of personal choice on health status. They are interested in alternative therapies and in using them in conjunction with traditional prescription medications. Furthermore, consumers are using retail clinics, particularly younger consumers who are drawn to convenience and cost considerations. Considerations for all life sciences companies: Contemplate branching out from prescription medications into the nutraceutical space to capture more of the consumer value chain. Consider testing whether alternative therapies can boost the tolerance to and/or efficacy of prescription medications, by tracking their use in clinical trials or patient registries. Invest in the therapies that promote wellness and healthy living as well as the accompanying holistic programs that ensure compliance and success (e.g., weight loss therapies with accompanying exercise and menu planning, smoking cessation therapies with meditation and acupuncture programs). Consider alternative pricing and rebate strategies for high-volume retail clinic therapeutics, such as vaccines.

2010 Survey of Health Care Consumers: Consumerism and implications for the life sciences

Closing thoughts

As Deloitte reported in 2009, health care consumerism is a meaningful trend, not an interesting fad. Despite the poor economy and the specter of health care reform, consumer attitudes in 2010 about their role in the US health care system did not change appreciably from the 2009 survey results. As consumers use increasingly sophisticated technology to seek information and an improved understanding of how their decisions impact their health care, we believe that consumerism will only increase in ensuing years.

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Contacts

Authors Paul H. Keckley, PhD Executive Director Deloitte Center for Health Solutions pkeckley@deloitte.com Michelle Hoffman, PhD Senior Research Manager Deloitte Center for Health Solutions mihoffman@deloitte.com Contributors Thanks to many Deloitte colleagues for their contributions and participation. The team that developed this life sciences report was led by: R.T. (Terry) Hisey Vice Chairman and US Life Sciences Leader Deloitte LLP rhisey@deloitte.com Terri Cooper, PhD Principal Deloitte Consulting LLP tecooper@deloitte.com

Acknowledgements We would like to thank Jennifer Bohn, Kathryn Hafner, Kerry Iseman and My Di Le for contributing their insights and support at various stages of this project. How to access the complete survey results Visit our web site to access the full report of US findings, various cohort reports and other information pertaining to the 2010 survey: www.deloitte.com/ centerforhealthsolutions. Contact information To learn more about the Deloitte Center for Health Solutions, its projects and events, please visit: www.deloitte.com/centerforhealthsolutions. Deloitte Center for Health Solutions 555 12th Street N.W. Washington, DC 20004 Phone 202-220-2177 / Toll free 888-233-6169 Fax 202-220-2178 Email healthsolutions@deloitte.com Web http://www.deloitte.com/centerforhealthsolutions

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