A recent consumer survey about health care plans points to a priority for Americans?access to imaging.

Debra Richman

Faced with expending their own money through higher deductibles and co-payments, US adults have identified access to advanced imaging as one of the most important features of their health care plans, as reported in a recent independent Harris Interactive poll.

There continues to be a great amount of uncertainty and many unanswered questions regarding health care reform and the nature of health care plans today and in the future. Americans are dealing with mounds of new information to process and at the same time they are weighing the impact of increased health care cost sharing. However, even in this rapidly evolving and indeterminate marketplace, US adults have definite priorities in the features they require from their health plans.

The factors that influence preferences and purchasing decisions are shifting. More than ever before, Americans are paying increased attention to their health care options. The anticipated influx of individuals (who are by nature cost-conscious buyers) entering the health insurance market through exchanges will significantly impact benefit plan design, plan selection, and enrollment.

Methodology

Harris Interactive conducted a 37-minute online survey with 2,052 adults (18?64 years of age) between October 12, 2010, and November 1, 2010, to assess American attitudes regarding health care and emerging trends. One of the poll questions sought to determine preferences for health insurance plan characteristics. Respondents were given a maximum difference trade-off exercise that forced them to choose their most preferred and least preferred health insurance plan feature, and a preference index was created by scaling the probability that a feature or benefit was the most preferred. Final results were weighted to the characteristics of the US population. This study was an independent poll, which was not financed by industry interests.

Findings

It is not surprising that in the overall rankings (Table 1 below) premium cost is rated as the top priority for US adults. This finding remained consistent throughout the study regardless of demographic stratification of the data. As US adults are asked to bear a more significant share of the monthly health care plan premium, a larger piece of the household’s limited monthly budget is being reassigned to health care and away from more gratifying purchases or even basic necessities in some instances. The result is an increasingly more cost-conscious and informed purchaser of health care plans and services. Another societal influencer that may be anchoring the cost of premiums to the number one spot is the attitude of some in the United States that health care is a right, rather than a responsibility, and some consumers are loathe to devote a sizeable portion of the monthly pie to a health care premium payment.

What is truly telling in the Harris Interactive poll is the subsequent top three rated features reported in order of rank: unrestricted access to all medical technologies such as MRI and CT; coverage of dependents; and the ability of the consumer to retain their current physicians. It seems safe to assume that after cost, the next three important features cited by US adults are the plan components on which individuals place a high value and may fear losing the most.

With unrestricted access to all medical technologies (eg, MRIs or CT scans) at the next highest position overall, the poll results indicate that US adults consistently place a high value on access to advanced imaging modalities like CT and MRI. If this finding were published 10 to 15 years ago, the response might have been “so what” since MRI and CT scans generally didn’t cost the consumers anything at that time. But in today’s environment, this high ranking for access to advanced imaging is of particular note. Despite the increasingly higher out of pocket co-payments now required of policy holders, US adults continue to place a high value on advanced imaging studies.

With the exception of nuances based primarily on presence of chronic disease states such as diabetes, access to MRI and CT unfailingly ranks in the number two or number three position for US adults. This is perhaps due in part to the fact that people with chronic disease states have a higher propensity to assign value to the doctor/patient relationship, and changes to that relationship are less palatable to routines such as those established with quarterly physician office visits by those with diabetes. US adults in the 18-34 age group flip the rankings of imaging to number three, filling in the number two spot with coverage for dependents, possibly since this age group represents the high child-bearing years. Those households with higher incomes mirror the same reversal in ranking between slots two and three for imaging and coverage of dependents, presumably for a slightly different reason. A higher age ceiling for dependent status allows children in graduate school or those facing today’s tough job market to continue health care coverage on their parents’ policy.

While this survey does not delve into the whys of health care plan values and rankings, we can speculate that US adults place a high value on access to imaging for two cumulative reasons. First, Americans associate advanced imaging with better quality of care. But, at the same time, Americans fear lack of access due to indiscriminate cost-cutting measures, which may inappropriately limit access and in turn can compromise quality of care. These concerns may be based on individuals? own experiences with denied access and anecdotal accounts from friends and family, or from the media. Of late, the media coverage of MedPac?s recommendation to use Radiology Benefit Managers (RBMs) in the Medicare program and the negative publicity associated with the Senate Commerce Committee?s investigation into an RBM in Delaware will only serve to fuel these fires of concern. As the specter of rationing of care emerges, Americans want to ensure that they personally receive high-quality care and they may be making access to technology such as MRI and CT a barometer to measure their own access to quality care. Access to advanced imaging has become a benchmark by which Americans judge their own access to and quality of care, and comprehensiveness of their health care plans.

The ability to retain their current doctor as a plan feature, which is ranked at number four overall, resonates even higher with those who have chronic disease and those in the 50-64 age bracket. The patient/physician relationship is of significant importance to the frequent user. When stratified by insurance status, the requirement to keep the same physician falls off in the most price-sensitive cells of individuals and the uninsured. Presumably this group would also be the most likely to participate in the proposed health care plan exchanges.

Ranked surprisingly low in the trade-off exercise were the bottom three health care plan features reported in descending order of rank: choice of hospital, coverage of brand name drugs, and access to prestigious institutions. An analysis of these least valued health care plan attributes shows a common denominator?an emphasis on branding with large media budgets. Most hospitals appear to have large media buy budgets directed at the consumer, via print advertising, billboards, radio, and television. And much to the chagrin of many physicians, the budgets for promotion of name brand drugs directly to consumers have grown exponentially in the last two decades. According to the survey scores, these large media budgets do not appear to have achieved the desired response.

Conclusions

Based on the priorities discussed above, it would seem that US adults value access to advanced imaging and to their own physician over choice of hospitals. Survey results tell us that, despite intensive and costly branding efforts, the patient intake process is still heavily influenced by the gatekeeper physician and ready access to advanced imaging, rather than by the hospital?s branding efforts. The data from this survey indicate that hospitals should be investing in gatekeeper physician retention programs and more practical patient outreach programs, which showcase the hospital?s ability to provide access and value. And as US adults use advanced imaging as a benchmark of quality of care, the astute hospital administrator should view the imaging department as a showcase for the hospital.

What do these findings mean for radiology? For the radiologist, a renewed emphasis on relationships with the gatekeeper physician that focuses on rapid report turnaround, and a consultative relationship working with the referring physician to ensure the right test at the right time. With the consumer, strict attention to the medical and convenience issues of the patient may be more important than efforts to create a spa-like atmosphere. Radiologists must continue to take an active role in conjunction with hospital administration in the development and operation of efficient and modern imaging departments in order to attract patients. Hospitals and providers who want to proactively align with the shifts in the market will recognize the value in offering ready access to cost-effective, high-quality advanced imaging services.

Christine Hughes is the Advocacy Research Leader at GE Healthcare and may be reached at .
Debra Richman is Vice President of Healthcare Strategy for Harris Interactive and can be reached at .