Health Care in California: The Chronically Ill A report for the California HealthCare Foundation prepared by Prepared for the California HealthCare Foundation by Harris Interactive
Contents About this project 3 Findings Facing the Financial Burden of Paying for Medical Care 4 A Consumer Response to Changing Health Benefits 13 Disease Management Provides a Ray of Hope 19 Methodology 23 Prepared by Harris Interactive Inc. 1-2
Overview Recent surveys show how changing health insurance trends are affecting three broad segments of the California market. 1. Employers are altering their health care benefits to contain the rising costs of insurance. 2. Consumers in general, seeing their share of employersponsored insurance costs increase, are changing the way they use health care services. 3. The chronically ill feel the impact of these changes more deeply than do other consumers. Many are responding in ways that affect their financial security, access to care, and compliance with treatment. This report summarizes the challenges facing California s chronically ill adults. Prepared by Harris Interactive Inc. 1-3
The Chronically Ill in California: Facing the Financial Burden of Paying for Medical Care A report for the California HealthCare Foundation prepared by For some, chronic illness is an economic calamity
For many, chronic illness is a financial handicap Chronically ill consumers assessment of the financial burden of paying for their medical care CA U.S. 25% 26% 29% 32% 33% 25% 17% 14% Have chronic illness Major Burden Moderate Burden Minor Burden Not a Burden Prepared by Harris Interactive Inc. 1-5
The poorer the health, the greater the burden Percentage of chronically ill Californians saying medical care costs are a moderate or major burden 38% 43% 55% 26% Have chronic illness All Excellent / Very Good Good Fair / Poor Health Status Prepared by Harris Interactive Inc. 1-6
Those without insurance feel greater financial pain 63% Percentage of chronically ill Californians saying medical care costs are a moderate or major burden 55% 43% 47% 36% 35% 36% 33% 37% 33% Uninsured Insured No Yes Co-pay Coinsurance Employer- Sponsored Self- Purchased Medicare Medicaid Insurance Status Have Rx Coverage Rx Coverage Type Primary Insurance Have chronic illness Note: Co-pay is a flat amount paid by patients for each service; coinsurance is a percentage of each claim, usually 20 percent, paid by the patient. Prepared by Harris Interactive Inc. 1-7
Incremental increases cause hardship for those who spend more on care Percentage of chronically ill Californians saying medical care costs are a moderate or major burden Moderate Burden Major Burden 50% 71% 42% 29% 35% Have chronic illness 18% 23% 14% 27% 16% 3% 6% Less Than 1% 1 2% 2 3% 3% or More Percent of Income Spent Out-of-Pocket on Medical Care Prepared by Harris Interactive Inc. 1-8
Increased cost of doctor visit has larger impact on less affluent Percentage of chronically ill Californians acting in response to an increase in physician visit co-pays Income All < 25K 25 50K 50 100K 100K+ Postponed or delayed a visit to the doctor 24% 38% 30% 18% 16% Skipped a visit to the doctor 17% 26% 24% 13% 9% Switched to a different doctor 3% 5% 4% 2% 5% Switched to a nurse practitioner 3% 3% 3% 1% 2% Have chronic illness and physician visit cost sharing increased in past year Used the Internet for health information instead of a doctor 10% 16% 13% 5% 8% None of these 69% 50% 63% 75% 81% Prepared by Harris Interactive Inc. 1-9
Most chronically ill prefer a health plan with higher monthly premiums and lower point-of-care payments Given the choice, which of the following plans would you prefer? Lower Monthly Premiums and Higher Payments When Receiving Services 40% 46% CA U.S. Higher Monthly Premiums and Lower Payments When Receiving Services 54% 60% Currently insured Prepared by Harris Interactive Inc. 1-10
Chronically ill Californians in fair or poor health spend nearly $600 a year more than their healthier counterparts Mean out-of-pocket expenses for health-care services in past year $1,396 $1,340 $1,316 $1,623 $1,511 $1,225 $1,803 $701 Currently insured U.S. CA Employer- Sponsored Self- Purchased Primary Insurance Medicare Medicaid Excellent Fair / Poor Health Status Prepared by Harris Interactive Inc. 1-11
One-quarter of chronically ill Californians set aside money for medical expenses each month Among those who budgeted for medical expenses, the mean amount budgeted per month: $214 23% 22% 21% 30% 21% 31% 24% 22% Currently insured and budgeted for medical expenses All Excellent / Very Good Good Poor / Very Poor Employer- Sponsored Self- Purchased Health Status Primary Insurance Medicare Medicaid Prepared by Harris Interactive Inc. 1-12
The Chronically Ill in California: A Consumer Response to Changing Health Benefits A report for the California HealthCare Foundation prepared by As consumers pay an increasing share of the cost of care, the chronically ill make difficult choices
One-third of chronically ill Californians disregard a doctor s treatment advice 36 percent of Californian respondents with a chronic illness (versus 29 percent of the chronically ill nationwide) have not followed their doctor s advice or treatment plan in the last year. Reasons for not following doctor s advice Too Costly Disagreed with Doctor's Recommendation Too Difficult 20% 22% 19% 18% 18% 28% CA U.S. Currently insured respondents who have not followed doctor s advice in past year Problem Understanding Instructions Other Reason 1% 3% 46% 53% Prepared by Harris Interactive Inc. 1-14
Chronically ill Californians who spend more of their income on medical care are more likely to skip a prescribed drug Percentage of Californians with a chronic illness who do not use a drug as prescribed by their doctor because of cost 20% 30% 16% 10% 6% Have chronic illness All Less than 1% 1 2% 2 3% 3% or More Percent of Income Spent Out-of-Pocket on Medical Care Prepared by Harris Interactive Inc. 1-15
Those who spend more of their income on care are more likely to seek alternatives to the rising cost of drugs Percentage of chronically ill insured consumers acting in response to an increase in prescription drug cost sharing Percentage of Income on Medical Care All < 1% 1 2% 2 3% 3% + Asked doctor or pharmacist for generic Rx 36% 27% 27% 42% 45% Asked doctor to prescribe less expensive alternative Rx 21% 10% 13% 18% 35% Have chronic illness, have prescription drug coverage, and amount paid to fill a prescription increased a lot or a little in past year Did not get prescription filled 16% 11% 11% 16% 25% Used mail-order service to fill Rx 18% 14% 21% 16% 18% Nothing 46% 58% 51% 40% 34% Prepared by Harris Interactive Inc. 1-16
When insurance plans provide incentives to spend less on drugs, chronically ill Californians respond Percentage of insured consumers acting in response to an increase in the price of prescription drugs Asked for a Generic Rx Asked for a Less Expensive Rx 12% 21% 44% 25% Used Mail-Order Service 12% Have chronic illness; have prescription drug coverage and amount paid to fill a prescription increased a lot or a little in past year Did Not Get Prescription Filled 8% 21% 20% Single-tier Rx Benefit Multi-tier Rx Benefit Note: Single-tier plans provide one level of coverage for all prescription drugs; multi-tier plans increase the consumer s share of costs for using more expensive medications. Prepared by Harris Interactive Inc. 1-17
The Chronically Ill in California: Disease Management Offers a Ray of Hope A report for the California HealthCare Foundation prepared by Patient education programs provide a useful response to chronically ill consumers
Chronically ill Californians are more likely to receive services that help them manage their disease Percentage of chronically ill that receive services to help manage their conditions Have chronic illness Physician Appointment Reminders Patient Education Materials Advice on How to Better Manage Condition Diagnostic Test Reminders Feedback on How Well Patient is Managing Condition Ways for Providers to Track Patient between Visits Assessment Questionnaires Nurse Phone Check-ups between Visits Medication Reminders None of These 10% 11% 10% 7% 7% 8% 5% 7% 4% 4% 2% 19% 17% 19% Diabetes: 13% Obesity: 13% 24% 29% 29% Diabetes: 22% Obesity: 16% 40% Diabetes: 33% Digestive disorder: 26% Obesity: 26% Anxiety disorder: 25% 43% CA U.S. 0% 10% 20% 30% 40% 50% 50% Prepared by Harris Interactive Inc. 1-19
Health plans are the main sponsors of patient education programs especially in California Nearly one in ten chronically ill (CA: 8 percent; US: 9 percent) are currently enrolled in a comprehensive patient education program.* Type of Organization that Provides the Education Program(s) U.S. Health insurance company or plan 42% 64% Physician 32% 23% CA Pharmaceutical company 14% 11% Employer 10% 7% Medical device manufacturer 1% 4% Other 19% 20% Have chronic illness and currently enrolled in patient education program *An ongoing program including information about, and monitoring of, a patient s medical condition. Prepared by Harris Interactive Inc. 1-20
In California, diabetics are most likely to be enrolled in a patient education program Percentage enrolled in a patient education program by type of condition Have chronic illness Diabetes 20% Obesity 13% Heart / Circulatory Disease Asthma Anxiety / Depression Digestive Disorders All Pain Allergies Thyroid Skin conditions 11% 10% 10% 9% 8% 8% 8% 7% 7% 0% 5% 10% 15% 20% 25% Prepared by Harris Interactive Inc. 1-21
The methodology for this survey and a glossary of terms are available online (www.chcf.org). A report for the California HealthCare Foundation prepared by California HealthCare Foundation 476 Ninth Street Oakland, CA 94607 www.chcf.org