Episode Transcript:
Rajiv Leventhal:
Patients simply don't know the cost of care or treatment before they're getting it. They're getting sicker as a result of not paying for it. We've hit a tipping point and patients are going to explore alternative options because the status quo is not working.
Marcus Johnson:
Hey gang, it's Thursday, January 18th. Lisa, Rajiv, and listeners, welcome to the Behind the Numbers Daily, an eMarketer podcast. I'm Marcus. Today I'm joined by two folks who both are on our digital health team. We start with our principal analyst, Lisa Phillips, based in Connecticut.
Lisa Phillips:
Hi Marcus. It's nice to be here.
Marcus Johnson:
Hello. Hello. And we're also joined by Rajiv Leventhal, who is one of our senior analysts based in New Jersey.
Rajiv Leventhal:
Hey Marcus. Thanks for having me.
Marcus Johnson:
Hey, chap. So today's fact. Okay, I'm hoping that this term translates into American, otherwise this is going to be just for our UK listeners. Do you know the term to ring true? If something is to ring true?
Rajiv Leventhal:
Sure.
Lisa Phillips:
Mm-hmm.
Marcus Johnson:
Okay. Okay, cool. All right, good. So where did that term come from is today's fact. So to ring true, so it means to appear authentic, to seem likely. And the allusion here is to the former method of testing coins by dropping them on a hard, cold surface. Those of pure silver or gold had a distinctive ring, i.e., they rang true while those of base metal had a duller sound. This was a way of testing if money was real.
Today, a bit more complex. We've got national mints that have adopted multiple anti-counterfeiting technologies to protect paper money, so it's a bit more advanced. There's like serial numbers and color changing ink and micro printing and security threads, 3D ribbons, watermarks, all kinds of stuff. But back in the day, you just dropped the coin on the floor and listened.
Lisa Phillips:
Probably-
Marcus Johnson:
A simple time-
Lisa Phillips:
... happened in Colonial America too.
Marcus Johnson:
Yeah. Yeah. Yeah, but next time I get change at the grocery store, I'm just going to drop on the floor and be like, "One second. It's legit. Okay, fair enough." Anyway, today's real topic, The Great Behind the Numbers Takeoff, Health Trends 2024.
In today's episode, first in the lead we'll cover health trends for 2024. No in other news today. This is The Great Behind the Numbers Takeoff Bakeoff star episode, Health Trends 2024.
In today's episode, our takers or bakers will be cooking up some health specific expectations for the coming new year. Three rounds, the signature take, the how it will technically play out challenge, and the showstopping argument. Let's meet the contestants' predictions.
Lisa, what is yours?
Lisa Phillips:
Healthcare is going to be a hyper-partisan issue in the 2024 US election campaigns, and that will affect how people think about and deal with their own healthcare going forward.
Marcus Johnson:
Perfect. It's going to be a rosy episode.
And Rajiv, how about for you?
Rajiv Leventhal:
Not much rosier unfortunately. 2024 will create unprecedented challenges for patients when it comes to affording their care and treatment. As they rack up medical debt and become sicker, they'll look to other options for accessing and pain for their healthcare.
Marcus Johnson:
Good God. All right. It's pretty bleak. If you want to stop listening folks, I don't blame you. But we're going to press on in case you do want to hear the rest of the show, some fascinating predictions. Very interesting to hear how these are going to unfold.
We start with round one, which of course is signature take. Our chefs will have one minute to explain the premise of their trends. So we go back to Lisa talking about how healthcare is going to be a hyper-partisan issue in the 2024 US election campaigns. Tell us a bit more about this, Lisa.
Lisa Phillips:
Well, Donald Trump has said that he'll try to repeal the Affordable Care Act, which was passed in 2011, 2010, and if he's reelected, we expect to hear a lot more about that.
On the other side, KFF, formerly known as Kaiser Family Foundation, published a poll from November 2023 that said voters want presidential candidates to talk a lot about healthcare related topics. Even though 99% said inflation is their biggest worry, 99% also said the cost of healthcare was very or somewhat important for presidential candidates to talk about. You're welcome Rajiv, for teeing you up on that.
But they're also like 97% said they're concerned about the future of Medicare and Medicaid and about the same said are upset about the cost of prescription drugs and they want to hear candidates talk about mental health, the opioid crisis, the future of the Affordable Care Act and abortion. So it isn't just the politicians that'll be looking at this. It's voters who are looking to the politicians to talk about it.
Marcus Johnson:
Yeah. Yeah. Healthcare seems to be at the top of the list to Gallup's poll when they're asking what are the main issues for voters, for Americans. It's typically economy, then jobs, and then healthcare is typically quite high up and some other ones that will fluctuate based on what's going on in the news, whether that is taxes or whether that's inflation, Covid. But healthcare does live at the top of those charts. So yeah, it's perfectly understandable.
Rajiv, how about for you? You're talking about this year creating challenges for patients when it comes to affording healthcare and treatment and what they're going to do as a result.
Rajiv Leventhal:
Yeah. So the writing is really on the wall for anyone who's paying attention. I've got some pretty interesting and alarming data points for you, Marcus. We know that more than one in three adults, so over a third, even those with insurance deferred care or treatment in the past year because they couldn't pay for it. So over a third skipped out on medical visits or medications because they couldn't pay for it. And that's according to a July 2023 Commonwealth Fund healthcare survey.
Another issue is that patients simply in many cases, again with insurance, don't know the cost of care or treatment before they're getting it. They're hit with surprise bills often after the fact. They don't know the price of their medication until they're at the counter picking it up, and sometimes they might just skip out and not complete that transaction. And almost half of adults in another survey said that they've skipped out on getting care treatment because they didn't have that upfront price information.
These patients can't just put off care forever. They're getting sicker as a result of not paying for it. And in that Commonwealth Fund survey, half of people who admitted that they put off care due to financial reasons, got sicker because they did skip out on that care or treatment. So we've hit a tipping point and patients we're going to get into this in the next round, but patients are going to explore alternative options because the status quo is not working.
Marcus Johnson:
Yeah. Yeah, there's some quite shocking numbers, especially when you're starting to get close to what you would refer to as most people.
Let's move to round two and get a bit more detail on some of these. This is of course the how it will technically play out challenge. Our chefs will explain in more detail how they expect the trend to unfold throughout the year.
Lisa, we bounce back to you talking about healthcare being hyper-partisan in 2024. How do you see this manifesting throughout the next 12 months?
Lisa Phillips:
Everybody's losing trust in healthcare institutions. I'll say I have some numbers. So the pandemic created a lot of mistrust and misinformation around Covid, the vaccines and various treatments. And now there's a big divide between Democrats, Republicans and Independents over who they trust most. And my doctor is almost universally trusted by 95% of both Republicans and Democrats said, my doctor is who I trust the most. Only 86% of Independents said the same thing. But when it comes to the CDC, the Centers for Disease Control and Prevention, 87% of Democrats trust that institution, but only 56% of Independents and just 49% of Republicans say they trust the CDC.
When it comes to the Food and Drug Administration, which approves prescription drugs and medical devices, 79% of Democrats trusted the FDA, 55% of Independents and 54%, almost just about half of Republicans said the same.
And when it comes to their local and state public health officials, I mean just three quarters, 74% of Democrats said they trusted it, 58% of Republicans and 50% of Independents, included in that was who would trust the Biden administration. And Democrats would far more than Republicans as well as. And vice-versa for a Trump administration. People are really falling out and not getting vaccines, not getting care as we know, or even health flu shots now.
Marcus Johnson:
Depending on who's telling them to do it, right?
Lisa Phillips:
Yeah, yeah, exactly.
Marcus Johnson:
It does seem as though people will choose to believe the information based on the institution. I mean, like you said, CDC, Democrats will trust it. Republicans and Independents less so. Same for the FDA. Biden administration, staggeringly in favor of Democrats versus Republicans. Trump administration, former President Trump, the complete opposite. So that is quite shocking.
You mentioned their doctor. That was about 90% or give or take-
Lisa Phillips:
95-
Marcus Johnson:
... across the board though, Independents just below, Republicans and Democrats just above-
Lisa Phillips:
Same-
Marcus Johnson:
... 95. Pretty high. Yeah, exactly. Same for Democrats and Republicans, which is surprising that they agree on something.
But in terms of that's trusting their doctor. But you have some research in this trends report, health trends report for 2024 showing that if you do some research, you basically become a doctor because you say among young people at least, 18 to 34, nearly half. So the average person who has done their own research is just as knowledgeable as a doctor on most health matters according to Edelman. So they may trust their doctor, but at the same time they don't trust them it seems as much as they might trust themselves after doing a little bit of homework online.
Lisa Phillips:
Yes. That's true. It's scary. It's true.
Marcus Johnson:
Yep. And then taking the totality of the health industry, another stat, people just don't trust healthcare in America. The healthcare industry, only 35% approval rating according to Gallup, and it's on a downward slide as well.
Lisa Phillips:
Has been for some years, yeah.
Marcus Johnson:
Not good news. Okay. Wow.
Rajiv, let's move to you. Talk to us a bit about how your trends of Americans turning away from the healthcare industry to alternatives is going to play out.
Rajiv Leventhal:
Yeah. If you operate under the premise that patients are really, many patients are frankly frightened about what their medical bill is going to be or what the price of their prescription drug will be because many don't understand how deductibles work, et cetera, they're going to start exploring other options. And you mentioned social media. This might range from, well, okay, maybe I can't access a doctor because of affordability issues, but there's a healthcare influencer on TikTok who's talking about the symptoms I have. I'm going to click that video and at least maybe put off the need of going to the doctor or taking a medication.
There are other conditions specific online groups or communities, self-diagnosis, that scary stat that you just noted. This might not end well, right? You're skewing the system because you can't pay for it and you're looking at these other options that might be free or low cost, but you have no idea if this is credible information, if this is knowledge that will help your condition or your symptoms. So it's pretty scary stuff.
And then from a pure cost perspective, we might see, I believe we will see a lot of consumers searching for healthcare providers that offer subscription or bundled based medical services so they don't get slammed with a huge surprise bill after a visit. They might look for cash pay services that aren't available necessarily in their insurance network. Well, yes, that might cost more than going through your insurance. At least from an upfront standpoint they'll have that price knowledge upfront and you won't get a bill for $1,000 four weeks after service or you won't see your medication costing $200 because you haven't had your deductible when you thought it would be one fifth of that. So those types of upfront pricing services that we see in other industries could very well expand to healthcare. You're already seeing that happen somewhat.
And then lastly, I think we'll also see more patients use discount or coupon cards to save money on their medications. We're seeing a bunch of pharma manufacturers and other pharmacy startups and pharmacy players try to roll those out so that consumers will actually pick up their medications at the pharmacy because if they don't, of course that hurts pharma companies bottom line.
So I think those are some of the developments that we'll see unfold this year as a result of just the conventional system being tough to afford for so many patients.
Marcus Johnson:
So help us quickly to understand this idea of the more people exploring subscription based healthcare bundles. What might be some examples of those and why is it that the list prices are so much more transparent than more of a traditional insurance plan?
Rajiv Leventhal:
Well, it's for non-emergent primary care type issues, but we're seeing retailers like GNC and Costco and even CVS and Walgreens don't have subscription based primary care services, but they do show you the cost of a service online as you're looking to schedule a visit.
So while people might not want to pay for that on top of whatever their insurance premium is, they might just be sick of the lack of access and the high cost of potentially what their insurance covers or doesn't cover. We know that insurance denials are increasing significantly. A patient goes to a doctor and they get a service and they find out a few weeks later that, well, your insurance actually didn't cover this, so who's on the hook for that? Well now the provider has to work that out with the patient. And these are really friction points that are frustrating the consumer and ...
Lisa Phillips:
And physicians too.
Rajiv Leventhal:
And physicians, yeah. And that's why these other options are emerging. So maybe you can get unlimited access, telehealth access through one of these subscription programs and you pay a certain amount each month and you get to text or video chat your doctor really whenever you want. So those are the type of things that we're seeing.
Marcus Johnson:
Okay.
Lisa Phillips:
Well, I'd say that Rajiv, you and I are coming at the same thing with this.
Rajiv Leventhal:
It's pretty intertwined, yeah. Yeah, there's a lot of overlap. And that's why our trends theme was for patient fragmentation. The patient care journey is going to become fragmented because of these kind of subtrends that are funneling into the overall theme of ...
Lisa Phillips:
Affecting behavior.
Rajiv Leventhal:
Yeah.
Lisa Phillips:
And to your point, and you said you get a surprise bill four weeks after. I'd say four months, four years. I actually got some kind of, I forget if it was some kind of a bill from Greenwich Hospital 18 years after I had a procedure there.
Rajiv Leventhal:
Oh my god.
Lisa Phillips:
Really. We moved out of the house and the person who we sold it to still lived there and he contacted us-
Rajiv Leventhal:
Oh my God-
Lisa Phillips:
... saying, "This came and it looks kind of official. So I just wanted to let you know." And it's ridiculous.
Rajiv Leventhal:
And every entity has their own process for tracking down people who have outstanding medical debt. They might put a debt collector on it if it's a really large amount. We saw a health system last year cut off patients who racked up a certain amount of medical debt. Let's say the bills are just too high and the patient simply couldn't pay it. They tried to log back into the system to schedule a future appointment and they were blocked. So you can only imagine the type of disruptions in care that outstanding medical debt and provider insurer actions, what kind of disruptions those can cause.
Marcus Johnson:
Yeah. All right folks, let's move to round three is of course our show stopping argument. Our chefs will pull out their best closing arguments as to why their trend is most likely to happen. In 20 seconds Lisa, tell us about why you think your trend is more likely to happen than Rajiv's, even though they're kind of the same.
Lisa Phillips:
They're kind of the same, yeah. The more Americans hear about the healthcare system in the election campaign of 2024, I think the more their trust will erode, at least for a lot of people. I think some may be getting care altogether will stop getting care, as Rajiv was saying, and they'll suffer the consequences. A lot of them are turning to social media and social media influencers to check symptoms and treatments and they could suffer the consequences of doing that.
Nothing is going to change fundamentally in the US healthcare system in 2024 is my prediction, but watch out in 2025 depending on who is elected.
Marcus Johnson:
It was a shocking stat you had. It's just a sea of misinformation online with regards to health information and people just not knowing up from down. 8 in 10 Americans believe there's a prevalence of false or misleading health information on social media, but nearly as many 7 in 10 admit they're unable to access, sorry, unable to assess true from false or misleading information according to Health Affairs Scholar.
Rajiv Leventhal:
And that's really the key. They know that a lot of this crap information is out there. They just don't know how to discern the reliable information from the disinformation and the misinformation. And that's really scary because if you can't tell what's right and what's wrong, well how is that going to affect what you act on?
Marcus Johnson:
Yeah. And Rajiv, your showstopping argument?
Rajiv Leventhal:
Well, because every aspect of US healthcare is just getting more expensive from regular visits to the primary care physician to hospital stays that are more complex and to paying for medications. So that's all going to lead to more out-of-pocket spending for consumers reflected through higher insurance premiums, more denials, which puts patients on the hook for an increased amount of what they owe.
And then more spending on drugs. We're seeing the craze of GLP-1 weight loss drugs. Well, none of these are going to get cheaper and with every part of the US health system getting more expensive, it's just going to lead to a world where patients cannot afford their regular care and their treatment and they look at alternative options.
Marcus Johnson:
Yeah. Very nice folks. All right, that's it for the episode. Time to crown a star taker or a baker, and today it has to be both of you because you started off in separate kitchens and eventually ended up in the same one making the same meal. A lot of overlap. Some really, really-
Lisa Phillips:
We're a team. That's for sure-
Marcus Johnson:
... interesting trend. Absolutely, this is fantastic takes. So congratulations to both of you. You are both our star taker or bakers today.
That's all we've got time for this episode. Thank you so much to you both. Thank you, Lisa.
Lisa Phillips:
Oh, thank you Marcus. It's been wonderful.
Marcus Johnson:
Absolutely. Thank you so much to Rajiv.
Rajiv Leventhal:
Hey, thanks Marcus.
Marcus Johnson:
Yes, indeed. Thank you to Victoria who edits the show. James, who copy edits it. Stu who runs the team, and Sophie who does all of our social media stuff. Thank you to everyone for listening in. Tune tomorrow for The Behind the Numbers Weekly Listen, an e-Marketer podcast.
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