RESEARCH REPORT

In brief

In brief

  • The complexity of the US healthcare system is driving people to choose the ER for acute care needs instead of less expensive care settings.
  • People with low healthcare system literacy use the ER much more than those with a better understanding of the healthcare system.
  • Tackling this issue means introducing simplicity into the system with changes that make the right choice the easy choice for people.


Complexity doesn't help care for people

While the US healthcare system is all about caring for people, it is not naturally centered around them. Its notorious complexity takes a significant toll, impacting access to care, quality of experience and health outcomes.

We quantified this impact by assessing emergency room (ER) use with eye-opening results. People with low healthcare system literacy use the ER much more than those with a better understanding of the healthcare system. This translates to $47 billion in avoidable medical spend for US healthcare each year.



What's drawing people to the ER?

When asked about care received in the previous year, people with low healthcare system literacy were much more likely to have gone to the ER for services than those with a better understanding of the healthcare system.

Their preference comes down to the path of least resistance. In a system riddled with puzzling terminology, confusing rules and regulations, and opaque processes, people are defaulting to the ER for its accessibility. It’s easier than trying to navigate a complex system that refuses to meet them halfway.

1.3x

More likely to feel their insurer did not provide enough information to find a new doctor when they needed it.

1.8x

More likely to feel that they are unable to use their first-choice method to find a doctor.

1.6x

More likely to be disappointed about the amount of time it took to receive care.

The problem could get worse

The impact of low healthcare system literacy may grow in the coming years, especially given the nature of the COVID-19 virus, which remains a public health threat. When asked about likelihood of getting the COVID-19 vaccine, people with the highest level of health system literacy were 25% more likely to be very willing to get it than people with low system literacy.

People with low healthcare system literacy cannot correctly identify terms related to their health insurance coverage including premium, deductible, co-payment, coinsurance and out-of-pocket maximum.

Humanizing healthcare: From complex to simple experiences

By recognizing the attributes that draw people to the ER and reinterpreting them across physical and digital experiences, payers can help direct people toward convenient, effective and less costly care.

Simplify healthcare insurance products

Take a "clean slate" approach to innovating health insurance products in ways that reflect people’s needs, not entrenched processes.

Commit to pricing transparency

Create healthcare "shopping" experiences that make cost and quality information available to help people make decisions in real time.

Work with providers to cut complexity

Collaborate with provider networks to influence people’s decision making and lead them to appropriate sites for their care.

Reimagine experiences with a human-first lens

Provide human-centered guidance, intuitive workflows and proactively present information to influence people’s behaviors.

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Jean-Pierre Stephan

Managing Director – Health, Engagement Practice Lead


Julian Feeley

Consultant – Strategy Consulting, Health, North America

Contributor

Loren McCaghy

Director – Consulting, Health, Consumer Engagement and Product Insight

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