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About being insured…

December 2, 2014

No doubt about it: there are few things scarier than going without health insurance. I can vouch for that personally, and stories abound about the anxiety, stress, and frustration that go with it.

“I have been putting becoming a mother on hold for 2 yrs now til I can find a way to afford the skyrocketing insurance expenses.”

“I just, I really didn’t know any other way. So, if I had health issues, I had to wait until they became such a problem that I would up in the emergency room.”

“My family did not have health insurance, and I spent my childhood worrying that I would get sick and simply drop dead because we could not afford a doctor.”

Now, moving as these stories might be, it’s not just the personal toll that being uninsured takes. The economic costs, including lost productivity, increased health care costs due to lack of preventive care, and uncompensated care are also well-documented.

Given these risks and costs, why are people who have health insurance so negative about the industry and the experiences they have? In part, the highly politicized and generally negative nature of the health insurance discussion plays a role. However, there are other reasons that are more within the control of the industry. Understanding them may help insurers move forward to a more customer-centered future.

It’s still expensive: For many in the US, employers subsidize coverage. Yet, because of the increasing costs of health care, premiums have continued to increase, and employers have been shifting more costs to their employees. While this is a rational choice on the part of employers, and may, in fact, be the only way they can continue to offer the benefit, it stings for the employee and their family. And despite improved coverage rates through the Affordable Care Act, for some people, high deductibles pose financial barriers to actually receiving care.

The rules seem arbitrary: Why is one drug on the formulary while another seemingly less expensive drug not? Why is one wound care protocol covered while a more effective (and less costly one) is not? Why can’t I get clear information when I call, and why do I hear a recording that says the insurer may not be bound by the information that is shared by the representative I’m going to speak with? When consumers encounter this lack of transparency, a shadow falls over the industry as a whole.

Technology has not kept up: People are used to carefully-engineered shopping sites, travel booking tools, banking and mobile payment, and other ecommerce sites. They’re also very accustomed to technology being accessible across devices, including smartphones and tablets. Meet the health insurance industry, where many major players still do not even have a complete source of member email addresses. While plans are making progress with this, there’s still a gap, and consumers notice.

The issues that the industry faces can be overcome, and many health insurers are taking steps in the right direction. Teams focused on improving the consumer experience are increasingly common, and are doing practical things like rewriting member materials into more common language (instead of insurance-ese). And I love the story about the major insurer that requires executives to come to meetings prepared to share a story about a member experience—these folks are listening to their members and bringing their voices forward.   As competition for individual members increases with the rise of public and private exchanges, as well as the aging of the Boomers into the Medicare market, it’s going to be increasingly critical that insurers understand the many journeys that their members (and potential members) take with their company, mapping and optimizing to support growth and retention, and to help their members achieve the quality of life goal that lies at the heart of many a health plan’s vision statement.

Liz Reyer is Vice President of GfK’s Financial Service. For more information you may contact her at liz.reyer@gfk.com.

1 https://www.healthcare.gov/blog/jaime-s-story-life-without-health-insurance/

2 http://www.illinoishomepage.net/story/d/story/health-insurance-changes-mans-life/29428/Gf2K8-22rUO20eqj07JqSg

3 http://alishaadkins.hubpages.com/hub/Living-Dangerously-Life-Without-Health-Insurance

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