Survey Reveals One In Five Insured Americans Avoid Seeing A Doctor Due To Fear Of Cost

Results suggest significant implications for those with chronic conditions

A recent online survey conducted by Harris Poll on behalf of SCIO Health Analytics revealed that approximately two in five insured Americans (38 percent) do not have a good understanding of which healthcare services are covered under their current plan. One in five insured Americans, or approximately 44 million^[1] people, have avoided visiting a doctor for a general health concern within the past 12 months because of cost concerns.

The online poll surveyed more than 2,000 U.S. adults aged 18-plus about their general sentiments around theAffordable Care Act (ACA) or Obamacare, healthcare costs and their overall understanding of the healthcare system, as well as services covered under their health plan.

Ambiguity and cost fears prevent millions with a chronic condition from visiting their doctor.

Approximately half of U.S. adults (117 million) have at least one chronic condition^[2], of which 14 percent of (or 16.4 million) have avoided a doctor’s visit in the past 12 months because of cost concerns. While chronic conditions such as heart disease, asthma, and diabetes are generally incurable, they can be managed through early detection, improved lifestyle and treatment.

“These findings are particularly relevant at this time as millions of Americans are once again deciding their annual healthcare benefit options through Open Enrollment,” said Siva Namasivayam, CEO, SCIO Health Analytics. “While Americans are spending more time researching health plans, the survey reveals a significant knowledge gap in the specifics of their health care options that may eventually lead to unnecessary risks and costs.”

Namasivayam warned that the implications of these findings are even more staggering when you consider treatment costs for Americans with chronic conditions are already around $277 billion annually.^[3] Avoiding medical treatment for these conditions can lead to an increased risk of complications, emergency room visits, hospitalizations, readmissions, work absenteeism and disability that could potentially drive healthcare costs even higher and cripple an already over-burdened system.

When asked how their healthcare situation has changed since the introduction of the Affordable Care Act:

• 41 percent of Americans say they have spent more time researching what is covered by insurance plans (either in their own plan or other plans)
• 60 percent of Americans say they do not have a better understanding of the healthcare system despite the media coverage and public/political discourse around Obamacare
• Among those insured, 44 percent did not know the out of pocket costs/co-pay for prescription drugs, and 61 percent did not know the costs for urgent care/walk-in clinic visits

The survey also found that age and gender play a role in understanding healthcare costs and services. Among insured adults, 48 percent of those aged 18-34 say they do not have a good understanding of what healthcare services are covered under their plan, compared to 27 percent of those aged 65 and older. Younger insurance holders, especially men, are also much more likely to be cost-conscious when visiting the doctor. When asked if they avoided visiting the doctor for a general health concern in the past 12 months because of cost concerns, 40 percent of insured men aged 18-34 said yes, whereas 27 percent of insured women in the same age group responded the same (compared to an overall average of 20 percent for all adults age 18+).

While the ACA has encouraged the U.S. healthcare system to become more consumer-focused, this study suggests that health plan managers need to be more aware of the needs of the millions of Americans who are new to health insurance and better communicate with more targeted messages and education around plan coverage and cost.

“It’s like buying a car without a manual or taking a test drive. You are left somewhat disoriented in the driver’s seat,” said Dave Hom, Chief Solutions and Business Development Officer at SCIO Health Analytics. “Health insurance companies need to adopt customized solutions based on big data to understand and reach these new members. Through the use of segmentation and consumer data such as medical literacy, communication preferences and geographic access to care, companies can find the most effective channels and messages to educate members on coverage, costs, and how to get the care they need.”

How do Americans want to receive health plan information?  According to the survey:

●     62 percent (the majority) say they would be likely to better understand their health plan information using the websites offered by their healthcare plan provider

●     41 percent would be likely to better understand their health plan information using member phone support offered by their healthcare plan provider

●     37 percent of U.S. adults say they get information about healthcare costs and services from their insurance company

●     31 percent get information about healthcare costs and services from their doctor

For more information, visit www.sciohealthanalytics.com

Survey Methodology
This survey was conducted online within the United States by Harris Poll on behalf of SCIO Health Analytics from October 28-30, 2014 among 2,026 adults ages 18 and older, of which 1,872 currently have health insurance. This online survey is not based on a probability sample and therefore no estimate of theoretical sampling error can be calculated. For complete survey results and methodology, including weighting variables, please contacteric@vscpr.com, or visit sciohealthanalytics.com/harrispoll.

About SCIO Health Analytics
Based in West Hartford, Connecticut, SCIO Health Analytics is a leading health analytics services company, serving more than 50 health care organizations including 15 of the top 25 insurers that represent more than 80 million members and 4 of the top 5 PBMs. SCIO’s consumer analytics provide actionable insights on consumers, helping healthcare organizations gain insight into consumer preferences and drivers affecting their behavior to streamline their experience and improve engagement. Through the use of integrated healthcare data, proprietary algorithms and technologies, SCIO focuses on predictive analytics, business services and insights in the areas of payment integrity, risk and care management, opportunity analysis and incentive design, consumer segmentation and engagement, marketing analytics, ACO and network analytics. For more visitwww.sciohealthanalytics.com

About The Harris Poll
Over the last five decades, Harris Polls have become media staples.  With comprehensive experience and precise technique in public opinion polling, along with a proven track record of uncovering consumers’ motivations and behaviors, The Harris Poll has gained strong brand recognition around the world. The Harris Poll offers a diverse portfolio of proprietary client solutions to transform relevant insights into actionable foresight for a wide range of industries including health care, technology, public affairs, energy, telecommunications, financial services, insurance, media, retail, restaurant, and consumer package