Rising health care costs, coupled with the current state of the economy, have prompted many consumers across the globe to delay care, alter household spending and worry about their ability to pay for future health care costs according to the 4th annual Deloitte Center for Health Solutions "2011 Survey of Health Care Consumers."

"We have been examining consumers' interactions with the health care system since 2008. A new trend has emerged this year suggesting that economic uncertainty has clearly altered spending habits with many consumers reporting an impact on their out-of-pocket health care expenses," saidPaul Keckley, Ph.D., executive director, Deloitte Center for Health Solutions. "Regardless of the type of health care system, government-run or private, consumers around the world are feeling the pinch."

Deloitte surveyed more than 15,000 health care consumers in 12 different countries includingBelgium,Brazil,Canada,China,France,Germany,Luxembourg,Mexico,Portugal,Switzerland, theUnited Kingdomandthe United Statesduring April and May.

Inthe United States, three in four (75 percent) consumers say the recent economic slowdown has impacted their health care spending. Four in 10 (41 percent) are being more cautious about it, 20 percent cut back on spending, and 13 percent have reduced it considerably. In addition, 63 percent say their monthly health care spending limits their household's ability to purchase other essentials such as housing, groceries, fuel and education. To save money, 36 percent of prescription medication users have asked their doctor to prescribe a generic drug instead of a brand name drug. These findings follow Deloitte's, "The Hidden Costs of U.S. Health Care for Consumers: A Comprehensive Analysis," published inMarch 2011, which revealed consumers spend$363 billionmore on health care than traditionally reported, outpacing housing and utility costs as a discretionary household expense.

Additionally, one in four (25 percent) U.S. consumers skipped seeing a doctor when sick or injured. Of those consumers who decided not to see a doctor in the past year, those that did so due to costs ranged from a high of 49 percent inthe United States, followed byBelgium(39 percent),China(35 percent) andMexico(34 percent), to a low of 5 percent inCanadaand 7 percent in theUnited KingdomandLuxembourg.

More than half of all respondents from the 12 countries surveyed, with the exception of theUnited Kingdom(24 percent) andCanada(39 percent), also confirmed that household spending on health care limits their ability to spend on other household essentials. Additionally, between 4 in 10 and 5 in 10 respondents experienced an increase in household spending on health care in the past year with the exception of theUnited Kingdom(22 percent),Canada(29 percent) andChina(37 percent).

Further highlighting the anxiety over escalating health care costs, consumers were mixed in assessing their household capacity to handle future expenses. The least amount of confidence was inPortugal(18 percent), followed byMexico(22 percent),Brazil(22 percent) andthe United States(23 percent). Nearly one-third of consumers inSwitzerland(27 percent),Germany(30 percent),Belgium(32 percent),China(35 percent) andCanada(39 percent) felt secure in their ability to handle future health care costs as did 41 percent of consumers in theUnited KingdomandLuxemburg.

"Three core shared beliefs became apparent this year throughout our global survey: consumers remain largely confused about their health care system; grade their system as underperforming relative to what they know of other systems; and believe spending is wasteful in their country's health system," said Bob Go, global managing director, life sciences and health care, Deloitte Touche Tohmatsu Limited (DTTL). "More often, consumers' opinions are based on prior personal experience rather than a systematic view, perhaps due to its complexity."

Consumers confused about their health care system

Most consumers do not have a strong understanding of how their health care system works. Consistently across the 12 countries surveyed, with the exception ofPortugal(17 percent) andLuxembourg(16 percent), around one in three consumers felt they understood the system well. Three in four U.S. consumers (76 percent) feel they do not have a strong understanding of how the health care system works; this perception has not changed in recent years (77 percent in 2010, 74 percent in 2009).

Report card grades of health care systems vary widely

Consumers graded the overall performance of their health care systems very differently. The health care systems inLuxembourg(69 percent),Belgium(57 percent),Switzerland(52 percent),France(51 percent) andCanada(50 percent) all received a grade of "A" (excellent) or "B" (very good) from more than half of consumers in those countries. Only 22 percent of U.S. consumers, 18 percent of Portuguese, 15 percent of Mexican and 8 percent of Brazilian consumers graded their country's health care systems in similar fashion. Conversely, 57 percent of consumers inBrazil, 44 percent inMexico, 38 percent inthe United Statesand 33 percent of consumers inPortugalrated their health care system's performance as 'failing' ("D" or "F").

Approximately four in 10 consumers inBelgium,Canada,Germany,Switzerlandand theUnited Kingdom(24 percent inthe United States) felt that their health care system was "superior to most other systems." Similarly, around 4 in 10 consumers inBelgium,Canada,GermanyandSwitzerland(37 percent inUnited States) believed that the quality of care in their country's health care system is comparable to the best in the world. This is in stark contrast to consumers inBrazil,Mexico,PortugalandChinawhere only around 1 in 10 felt likewise about the performance and quality of their country's health

care system.

Consumers are uniformly negative in their judgment about the success of respective governments in

balancing priorities in their health care systems with less than one in five consumers in all countries agreeing with the proposition that ''government is doing a good job balancing priorities in the health care system."

Consumers identify waste in the system

Many consumers saw health care spending in their health care systems as wasteful. Specifically, inthe United States, consumers blame redundant paperwork (55 percent), individuals not taking responsibility for their own health (49 percent), defensive medicine (46 percent), lack of adherence to evidence-based approaches (40 percent), and extreme measures taken at the end of life to extend life for a short period of time (35 percent) as the top causes for wasteful spending.

"Despite the challenges consumers observe with their health care system, most still believe it is possible to both improve quality and decrease costs simultaneously," said Keckley. "Technology-enabled solutions are widely thought to be part of the solution."

Consumers seek technology solutions to manage their health

• Consumers are highly interested in using medical devices to monitor their conditions and send information electronically to their doctors, ranging from a low of 46 percent of consumers inBelgiumto a high of 79 percent of consumers inMexico. Inthe United States61 percent of consumers confirmed interest.
• Consumers inBrazil(43%),China(47%) andMexico(50%) are very likely to use their smart phones or PDAs for health care monitoring. Consumers inFrance(65%),Germany(64%) andBelgium(63%) are not at all likely to do so. In the United States 19 percent were very likely to use their phones for this purpose and 48 percent were not at all likely to do so.
• Less than 1 in 5 consumers surveyed said they maintain a personal health record (PHR) electronically, with the exception of consumers inChinawhere 1 in 3 have such a record. The percentage of U.S. consumers who maintain a PHR in some type of electronic format remains low, but is increasing gradually: 8 percent in 2008, 9 percent in 2009, 10 percent in 2010, and 11 percent in this year's report.
• Consumers were concerned that an internet-based PHR might put privacy and security of personal health or medical information at risk. The degree of concern ranged from a low of 19 percent inLuxembourgto a high of 50 percent inGermanyandMexico. In the United States 38 percent of consumers expressed similar concerns.

Consumers are also open to alternative approaches to traditional health care such as visiting retail clinics or traveling outside their local community for health care:

• Of the countries that have a retail medicine sector, more than half of consumers inBelgium(50 percent),China(51 percent) andPortugal(51 percent) said that they had used a walk-in or retail setting for non-urgent care. Consumers inCanada(32 percent),Mexico(32 percent), theUnited Kingdom(22 percent),Brazil(21 percent),the United States(19 percent) andSwitzerland(16 percent) also said they had used these services.
• The percent of U.S. consumers (19 percent) using retail-clinics in the past year is higher than in previous years (15 percent in 2010 and 13 percent in 2009).
• Between 1 in 10 and 3 in 10 consumers traveled outside of their local areas for care in the past year and a very small number had traveled outside of their home country for medical care. Inthe United States, approximately 1 in 4 (25 percent) say they would consider traveling outside the country to have a necessary hospital procedure, (22 percent) say maybe and 3 percent are definite); 75 percent say it is highly unlikely that they would travel to a foreign country for care
• Additionally, 39 percent of U.S. respondents report they would definitely travel to a hospital located outside their local town or city (e.g., in a major city or different city) for necessary care if that distant hospital was known to provide better quality care or faster access to services; 32 percent would travel the distance for elective care.

"The findings of our report identify three global trends that suggest health system leaders must think of patients as consumers: clinical innovations are driving solutions to medical problems that enable consumers to take care of themselves; governments and employers face shrinking budgets while health cost obligations are soaring and consumers are paying attention to health care as never before,"concluded Keckley. "As health reform takes hold in countries like the U.S., our studies identify significant opportunity to engage consumers more effectively and address their unmet needs. It requires policymakers and industry stake holders to align interests toward their engagement as they undergo the transition from patients to consumers."