Navigating Healthcare Challenges: Key Insights from the Latest Patient Experience Survey
Discussions about healthcare access and affordability have taken center stage in recent years. The Patient Experience Survey (PES) sheds new light on insured Americans’ real-world struggles as they navigate the healthcare system, revealing critical gaps in access and financial barriers. This survey, conducted by Ipsos with the KnowledgePanel®, represents over 2,500 adults across the U.S., offering a comprehensive look at patient perspectives on healthcare access, affordability, policy priorities, and the role of innovation in health outcomes. Here’s an in-depth analysis of the survey’s key findings and what they mean for the future of healthcare.
1. Access to Healthcare: Delays, Denials, and Patient Concerns
Healthcare access is essential for timely treatment, yet the PES reveals that many insured Americans face significant barriers. In fact, 41% of insured Americans who take prescription medications report that they or a family member have experienced delayed or denied care due to insurance requirements. These barriers become more pronounced for those managing chronic conditions, with 51% reporting issues with obtaining necessary care.
Another alarming statistic is that 43% of insured Americans worry that their insurance could deny care in the future. This anticipation of possible denials indicates a deep-rooted lack of confidence in current insurance practices, especially regarding step therapy (fail-first) and prior authorization requirements. Such practices often delay access to medications or treatments until other, typically less expensive, options have been attempted.
The survey also shows that about half of insured Americans struggle to understand their health insurance coverage and lack clarity about what they will be expected to pay for prescriptions. This confusion complicates healthcare access, leaving patients unsure about costs until they are at the pharmacy or doctor’s office. The survey highlights the public’s widespread support for reducing restrictive practices—64% of insured Americans and 62% of all Americans support efforts to limit policies that restrict patient access to medications. This suggests a growing demand for transparency and consistency in insurance practices.
2. Affordability: Out-of-Pocket Costs, Deductibles, and Financial Strain
Affordability is another critical issue, with many Americans expressing deep concerns about healthcare expenses, especially out-of-pocket costs. The PES finds that 52% of both insured Americans and Americans overall worry about affording healthcare and grocery costs. This financial strain is even greater for those managing chronic conditions, where routine care and medications can add up quickly.
Healthcare costs continue to rise, with 33% of insured Americans reporting increased out-of-pocket costs for healthcare services in the past year, and 38% noting higher out-of-pocket costs for prescriptions. This increase in expenses has led to outstanding medical debt for many, with 18% of respondents saying they currently have medical debt. Among those with debt, the most significant contributors are hospital stays, doctor’s visits, and diagnostic testing.
For those struggling with high out-of-pocket costs, adherence to prescribed treatments becomes challenging. One in four insured Americans taking prescription medicines reported they couldn’t take their medication last year because of cost, primarily due to unaffordable copays. To mitigate these financial pressures, 89% of insured Americans support the idea of consistent, predictable out-of-pocket costs for medications. Reducing financial unpredictability would give patients greater assurance about their healthcare costs, which could, in turn, improve medication adherence and health outcomes.
3. Policy Priorities: What Americans Want from Policymakers
As healthcare remains a significant issue in the U.S., Americans are looking to policymakers for solutions. Despite healthcare not being a top election issue this cycle, 94% of Americans agree that it’s essential for policymakers to understand the barriers patients face. Out-of-pocket costs stand out as a central concern, with 32% naming them the most important healthcare issue for policymakers to address.
Americans widely support specific policy solutions, such as setting a maximum cap on annual out-of-pocket costs for medications (88%) and ensuring that any rebates or discounts are passed on to patients rather than retained by health insurers or pharmacy benefit managers (91%). These policies would alleviate some of the cost burden patients face, making healthcare more affordable and accessible.
The survey also indicates that Americans want policymakers to address systemic inefficiencies within the healthcare industry. Eighty percent of insured Americans believe reducing bureaucratic inefficiencies is essential, while 78% prioritize lowering overall healthcare costs. This consensus shows that people are not only concerned about their personal healthcare expenses but are also frustrated with the inefficiencies and lack of transparency within the healthcare system.
4. The Role of Innovation: Choice, Personalization, and Prevention
Beyond access and affordability, Americans value the role of innovation and personalization in their healthcare. An overwhelming 91% of respondents view the availability of new and innovative treatments as a source of hope for the future, particularly when it comes to severe and costly diseases. This sentiment underscores the importance of continued investment in medical research and development, as it brings both potential cures and improved treatment options to patients.
Preventative care is another area where Americans see great value. Ninety percent of insured respondents believe preventative measures, such as vaccines, reduce healthcare costs by avoiding expensive hospitalizations and frequent doctor visits. A proactive approach to health is seen as a crucial way to maintain wellness, reduce long-term healthcare costs, and improve quality of life.
Americans also want the healthcare system to offer more choice and flexibility, enabling them to tailor care to their needs. A large majority (91%) emphasize the importance of having options for medication, while 95% advocate for healthcare solutions that are more personalized and convenient. These findings reflect a shift toward a more patient-centered healthcare model that values individual preferences, innovative solutions, and personalized treatments.
Conclusion: Moving Toward a More Patient-Centered Healthcare System
The Patient Experience Survey (PES) brings to light the many challenges insured Americans face in accessing and affording healthcare, even with coverage in place. The survey highlights a clear demand for reforms aimed at enhancing transparency, reducing out-of-pocket costs, and streamlining insurance processes to ensure patients can receive the care they need when they need it.
Policy solutions such as capping out-of-pocket costs, enforcing rebate pass-throughs, and simplifying coverage terms have strong support among Americans. These measures could significantly alleviate the financial strain on patients, particularly those with chronic conditions, and foster a healthcare environment where patients are better informed and empowered.
Furthermore, Americans’ support for innovation, personalization, and prevention in healthcare emphasizes the need for a system that is proactive and flexible. Patients value choices in their treatment options and trust that new advancements in medicine will enhance their quality of life and overall health.
As healthcare continues to evolve, it’s crucial for industry leaders, policymakers, and patient advocates to consider these survey insights. By addressing the gaps in access, affordability, and patient-centered care, we can create a healthcare system that better serves all Americans. The PES findings make it clear: Americans are ready for change, and the future of healthcare must prioritize patient needs, affordability, and accessible innovation.
Study Link: https://www.ipsos.com/en-us/many-insured-americans-experience-delays-and-denial-care-because-health-insurance?utm_source=costcurve.beehiiv.com&utm_medium=newsletter&utm_campaign=new-data-underscores-that-access-barriers-for-patients-are-high-and-getting-higher