Top Health Industry Issues of 2011

2011 is a makeover year for health industry organizations reacting to and preparing for new rules and payment models. Continuing cost pressures and new customer demands require a fresh look at existing roles of industry players.

This issue is one of six health industry issues for 2011. For the full Top Health Industry Issues of 2011 report, please see www.PwC.com/us/TopIssues2011

Issue #4 Highlights:

Nowhere else to cost shift: Consumers could continue to reduce utilization

In 2011, for the first time, most employers are expected to have a deductible of $400 or more built into their employer-sponsored health insurance. The trend in rising deductibles has been remarkably fast. In 2008 and 2009, the most common plan had no deductible, according to PwC's survey of 700 employers. By 2010, the most common plan among employers surveyed by PwC had deductibles of $400 to $999. In addition, according to the PwC survey, high-deductible plans are now the primary plans for 13% of employers surveyed in 2010, up from six percent in 2008 (See Figure 4).

This level of deductibles is expected to trickle down to providers. Research has shown that as consumers are forced to pay higher deductibles, they reduce utilization because they have nowhere else to shift their portion of the costs. That's likely to be especially true in a slowly recovering economy. With coinsurance as with high deductibles, workers become more aware of the full cost of the drugs or services they're using and consequently would be more likely to shop around for, delay or avoid services.

With more employees being squeezed with high-deductible plans and coinsurance, their increased cost sensitivity will push them to make hard decisions on how often to go to the doctor or what prescriptions to fill. The danger lies in whether short-term cost avoidance could lead to more expensive conditions in the long term. Sixty percent of consumers surveyed by PwC said they expected to continue paying more out of pocket for healthcare.

Look for more discussion in the full Top health industry issues of 2011 report www.PwC.com/us/TopIssues2011

Implications:

• Physicians and pharmaceutical companies will be affected first because consumers' first dollar spending tends to be on office visits and drugs, which are paid under high deductibles.
• Fewer physician visits reduces sales of other medical products regardless of patient cost-sharing. When patients don't go to the doctor, fewer lab tests, imaging scans and other diagnostics are ordered.
• Looking for a way out of paying more for acute medical care, consumers could start seeking more preventative services, especially if they are given the incentive to do so.
• Rather than bluntly implementing higher deductibles, more companies will look at value-based benefit design in which cost-sharing is linked to the value of services. This type of design could increase patient adherence to taking certain medications while discouraging overutilization of low-value medical services.