chapter 9
PUBLIC OPINION ABOUT HEALTH CARE

As with many other social issues, public opinion about health care systems, providers, plans, coverage, and benefits varies in response to a variety of personal, political, and economic forces. Personal experience, and the experience of friends, family, and community opinion leaders—trusted sources of information such as members of the clergy, prominent physicians, and local business and civic leaders—exert powerful influences on public opinion. Health care marketing executives have known for years that the most potent advertising any hospital, medical group, or managed care plan can have is not a full-page newspaper advertisement or primetime television ad campaign. It is positive word-of-mouth publicity.

Political events and election campaigns can focus public attention on a particular health care concern, supplant one health-related issue with another, or eclipse health care from public view altogether. Health care reform and a strong push for national health insurance were hallmarks of former U.S. President Bill Clinton's campaigns in the 1990s but by 2000 were all but forgotten in favor of debates about Medicare reform, prescription drug benefits, and passage of a patients' bill of rights. The events of September 11, 2001, also realigned health concerns as much as they affected other national priorities. In the final months of 2001, several public opinion surveys reported preventing bioterrorism as Americans' numberone health concern. During September 2002 the media were focused on U.S. preparations to take military action in Iraq. As a result, there were far fewer news stories about the upcoming open-enrollment period (when employees can switch health plans) than usual.

By 2004, economists, political observers, and pollsters opined that after concern about the U.S. economy and Iraq, health care costs would be a prominent issue in the election year. A record 9.5% increase in health care spending in 2002—the largest annual increase in more than a decade, followed by a 7.4% increase in 2003—coupled with consumer and media attention to issues such as prescription drug costs combined to intensify Americans' concerns about their ability to afford health care services.

The national economy and the rate of increase of health care costs, especially out-of-pocket expenses, play important roles in shaping public opinion. When unemployment rates are high, the proportion of persons without insurance increases, workers fear losing their jobs and their health care coverage, and dissatisfaction with the present health care system grows. Multiple surveys have shown a direct relationship between rising out-of-pocket expenses and dissatisfaction with the health care system. The recent spike in health care costs coupled with survey findings that employers intend to pass off some of the increasing costs to their employees will likely inspire renewed interest in health care reform.

There also is evidence that Americans do not anticipate that reform will substantially improve health care access, availability, or quality in the foreseeable future. A 2004 Gallup Poll revealed that Americans anticipate that health care will continue to be a problem twenty-five years from now (Raksha Arora, "Future Imperfect: Americans Predict Woes of 2029," The Gallup Poll Tuesday Briefing, February 2004). Survey respondents named healthcare as likely to be the fifth most pressing problem, and concern about Social Security and Medicare was considered the second most pressing problem, following concern about the economy in general. (See Figure 9.1.)

Demographic changes, particularly the aging of the "baby boomer" generation (people born between 1943 and 1960) into Medicare eligibility, may also fuel dissatisfaction with the health care system. If the health care futurists who have projected glaring deficiencies in the current system's capacity to meet the needs of the aging population are correct, this generation may become the largest and most vocal advocates for health care reform.

FIGURE 9.1

Finally, the influence of the news media, advertising, and other attempts to sway health care consumers' attitudes and purchasing behaviors cannot be overlooked. A single story about a miraculous medical breakthrough or lifesaving procedure can reflect favorably on an entire hospital or health care delivery system. Similarly, a lone mistake or misstep by a single health care practitioner can impugn a hospital or managed care plan for months or even years, prompting intense media scrutiny of every action taken by the facility or organization.

Some industry observers believe that health care providers, policymakers, biomedical technology and research firms, and academic medical centers have fanned the flames of consumer dissatisfaction with the health care system by "overselling" the promise and the progress of modern medicine and the U.S. health care system. They fear that overzealous promotion of every scientific discovery with a potential clinical application has created unrealistic expectations of modern medicine. Health care consumers who believe there should be "one pill for every ill" or feel that all technology should be made widely available even before its efficacy has been demonstrated are more likely to be dissatisfied with the present health care system.

MOST AMERICANS BELIEVE THAT ACCESS TO HEALTH CARE IS A RIGHT

A January 2004 Kaiser Family Foundation poll reconfirmed Americans' belief that everyone should have equal access to health care ("Health Care Should Be Provided Equally to Everyone," Kaiser Health Poll Report, Washington, DC: Henry J. Kaiser Family Foundation, February 2004). Since 1993, eight in ten survey respondents resolved that health care should be provided equally to all, and more than half agreed "completely" that access to health care should be provided independent of age, income, health status, or employment. In 2004 more than three-quarters of survey respondents (76%) affirmed "strongly" or "somewhat" that access to health care should be a right. (See Figure 9.2.)

In addition to agreeing that everyone should have access to health care, about two-thirds of Americans feel that the federal government should guarantee medical care for the uninsured. There is, however, little consensus about the extent to which the government should intervene to solve this problem. A May 2003 poll, "Major Versus Limited Effort to Help the Uninsured" (Kaiser Health Poll Report, Washington, DC: Henry J. Kaiser Family Foundation, February 2004), found Americans divided about whether the government should commit to a major initiative or a limited effort to provide health insurance to the uninsured. When offered a range of policy options to extend health insurance coverage to more people, Americans voiced majority support for every option except a national health plan financed by taxpayers, but when asked to select the best course of action, no single plan won widespread support. (See Figure 9.3.)

Public Opinion about Health Care Costs, Access, and the Uninsured

A Kaiser Family Foundation Health Poll Report Survey conducted in February 2004 revealed persistent widespread concern about a number of key health care issues. Some 82% of Americans said it was very important for the President and Congress to act to lower the costs of health insurance and prescription drugs. More than three-quarters of survey respondents felt it was vital to increase the number of Americans covered by health insurance, and 75% thought that families should receive financial assistance to help pay for long-term care for older adults or persons with disabilities. (See Figure 9.4.)

When forced to choose the most important health priority from a list, increasing the number of Americans covered by health insurance was named by about one-fifth (21%) of the respondents, behind reducing the cost of health insurance (25%), but ahead of other pressing issues such as lowering the cost of prescription drugs (15%) and helping families finance long-term care (11%). (See Figure 9.4.) While health care costs were clearly the priority for survey respondents, nearly one-quarter expressed concern about access including universal health coverage and access to health care for the poor. (See Figure 9.5.)

A Kaiser Family Foundation Health Poll Report Survey conducted in April 2004 confirmed that one-third of insured Americans are deeply concerned about the prospect of losing their health insurance, and nearly half (47%) of all survey respondents (insured and uninsured) were worried about having to pay more for their health insurance.

MANY AMERICANS ARE CONCERNED ABOUT THEIR ABILITY TO PAY FOR HEALTH CARE

Although a Gallup Organization poll conducted in April 2004 named retirement planning—Americans' fears that they will be unprepared to retire from the workforce because they will not have enough money—as number one in terms of urgent concerns, anxiety about health care costs was a close second (Lydia Said, "Retirement Planning Leads Americans' Financial List," Gallup Poll News Service, The Gallup Organization, May 18, 2004). Nearly half of the adults surveyed (47%) said they were worried about their ability to pay for the costs associated with a serious illness or accident, and 37% were worried about paying for normal or routine health care services. Two of the top five financial concerns expressed by the survey respondents centered on fears about health care costs. (See Figure 9.6.)

The Gallup Poll also revealed that the proportion of Americans that is fearful—very worried or moderately worried—about the ability to pay for routine or serious medical care costs has not significantly changed in recent years. For example, the proportion of Americans who were very worried about being unable to pay for normal health care was comparable in 2001 (22%) and 2004 (21%). Similarly, in 2001 27% of survey respondents worried about being unable to pay medical care costs in the event of a serious illness, and in 2004 26% expressed this concern. More than one-third of Americans worry about how to pay for routine medical expenses, according to the 2004 data, and nearly half are concerned about their ability to pay the costs associated with a serious illness or accident. (See Table 9.1.)

While the percentage of Americans who worry about their ability to pay for health care has remained relatively constant in recent years, the percentage of Americans who are very dissatisfied with the availability of affordable health care steadily increased from 37% in January 2001 to 45% in January 2004. (See Figure 9.7.)

Who Is Most Concerned about Health Care Costs?

The January 2004 Gallup Poll found significant differences among adults who said they were worried about their ability to pay for medical care in the coming months. More women (38%) than men (25%) expressed concern about paying for health care. Not surprisingly, more than half of respondents with annual household incomes under $30,000 worried that they would be unable to pay medical bills in the coming year, compared to only 12% of those with household incomes in excess of $75,000. Interestingly, concern about paying health care costs varied based on political party affiliation. Just 15% of Republicans said

FIGURE 9.6

they worried about paying for health care compared to 37% of Democrats and 43% of Independents.

CONSUMER SATISFACTION WITH HEALTH CARE FACILITIES

Despite the problems that continue to plague hospitals such as shortages of nurses and other key personnel, diminished reimbursement, shorter inpatient lengths-of-stay, sicker patients, and excessively long waiting times for patients in emergency and other hospital departments, consumer satisfaction with hospital services has remained relatively constant since 2000. Gallup data revealed that satisfaction with inpatient hospital care dropped slightly between 2000 and 2001 (from a mean score of 3.51 in 2000 to 3.49 in 2001), yet since 2001 it has improved slightly each year, rising to 3.50 in 2002 and 3.51 in 2003. (Rick Blizzard, "Patient Satisfaction Stable among Unstable Conditions," The Gallup Poll Tuesday Briefing, The Gallup Organization, May 18, 2004.)

In view of the challenges faced by emergency departments, it is not surprising that these hospital departments received the lowest overall satisfaction scores. Still, in terms of consumer satisfaction, emergency departments did not lose ground during the four-year period. (See Figure 9.8.)

Outpatient services received the highest scores for consumer satisfaction. According to Blizzard in The Gallup Poll Tuesday Briefing, outpatient surgery was the highest-rated area in terms of patient satisfaction, earning 3.68 and 3.69 out of a possible four across the four years of the survey. Outpatient testing and treatment also earned high marks. Since these services are often consumers' first encounters with hospitals, these high levels of satisfaction may have a favorable impact on consumers' overall perceptions of hospitals.

TABLE 9.1

Interestingly, patient satisfaction with hospital care was also linked to the hospital's success in meeting patients' spiritual and emotional needs. (See Figure 9.9.) This finding, that satisfaction is associated with intangible qualities of the hospital experience such as sensitivity, attention, and responsiveness to emotional and spiritual needs, underscores the fact that many health care consumers assess the quality of service they receive in terms of the care and compassion displayed by hospital personnel.

Americans Still Trust Hospitals and Physicians but Pharmaceutical Companies Have Lost Ground

An April 2003 Harris Poll survey, in which Americans maligned health insurance companies and managed care plans for failing to adequately meet their needs, nevertheless found hospitals high on the list of companies that consumers credited with good performance records (Humphrey Taylor, "Supermarkets, Food Companies, Hospitals, and Banks Top the List of Industries Doing Good Job for Their Consumers," The Harris Poll, Harris Interactive, May 28, 2003). Nearly three-quarters (73%) of survey respondents said they felt hospitals were doing a good job of serving consumers.

In contrast, pharmaceutical companies are no longer held in high esteem. At the top of the list of companies Americans admired in 1997, pharmaceutical companies dropped from fourth place to eleventh place by 2003. Pharmaceutical companies' positive ratings have declined steadily from 79% in 1997, to 73% in 1998, 66% in 1999, 59% in 2000, to 49% in 2003. Industry observers attribute the sharp decline to adverse media publicity about prescription drug costs.

While physicians may not enjoy the preeminence and reputations for infallibility they held in the past, most Americans still have confidence in their personal physicians. More than 80% of respondents to a 2002 survey conducted by the Kaiser Family Foundation, Harvard University's Kennedy School of Government, and National Public Radio said they trusted their doctor to take correct action "just about always" (48%) or "most of the time" (33%). The majority of respondents (77%) even expressed confidence that their physicians would inform them if a mistake were made in their care.

EMPLOYER-SPONSORED HEALTH PLANS

The Employer Health Benefits 2003 Annual Survey, conducted since 1999 by the Henry J. Kaiser Family Foundation and the Health Research and Educational Trust (Washington, DC, 2003), found that despite escalating premiums and increases in worker cost sharing, overall levels of coverage have not declined. In 2003 more than twothirds of all firms offered health coverage to their workers. The decision to offer health benefits varies by company size—nearly all firms with fifty or more workers offer health benefits. Benefits are offered by 84% of firms with twenty-five to forty-nine employees, 76% of firms with ten to twenty-four workers, and 55% of companies with three to nine employees. More than 90% of companies that employ union workers offer health benefits.

The survey revealed that as employers endeavor to rein in the rising cost of health insurance, the vast majority of workers pay for premiums and encounter substantial cost sharing (deductibles, coinsurance, and co-payments) for services such as office visits, prescription drugs, and hospital admissions. Nearly four in five workers pay a deductible before health care expenses are covered by their plans. More than two in five employees pay a separate deductible, co-payment, or coinsurance when they are admitted to a hospital, and almost all workers pay a copayment or coinsurance for physician office visits. The majority of workers also are in plans with cost-sharing arrangements for prescription drugs.

Rising Premiums and Reduced Benefits May Reduce Satisfaction with Employer-Sponsored Plans

Between May 2002 and May 2003, employer health insurance premiums rose 13.9%, which was the third consecutive year of double-digit insurance premium increases and the sharpest increase since 1990, according to the Employer Health Benefits 2003 Annual Survey. Average annual premiums rose to $3,383 for individual coverage and $9,068 for family coverage for employer-sponsored

FIGURE 9.7

plans. The percentage of premiums paid by workers was essentially unchanged over the last two years, at 16% for single coverage and 27% for family coverage. Health maintenance organizations (HMOs), which enrolled 24% of covered workers in 2003, remain the least costly, and preferred provider organizations (PPO plans), which enrolled more than half of all employees with health coverage, continue to offer the most expensive family coverage. Indemnity insurance, which provides reimbursement for medical expenses regardless of who provided the service, enrolled only 5% of employees.

The survey attributed the high rate of premium growth in 2003 to the combined effects of rapid inflation in the costs of health care services and insurers' intensified efforts to assure profitability. Employers attributed increases in health insurance premiums to higher spending for prescription drugs (61%) and higher spending for hospital services (55%). Skyrocketing premiums have prompted many employers to consider alternatives to their current health plans. More than 60% claimed that they shopped for a different arrangement, and 33% reported that they either changed carriers or plan type. Despite their enthusiasm for less costly alternatives, a scant 5% of employers opted to offer high deductible health plans (defined as plans with a deductible of $1,000 or more for single coverage), which have been extolled by insurers and benefit experts as effective methods to reduce health spending.

The survey also found retiree benefits dwindling—just 38% of large employers (two hundred or more workers) offer retiree benefits compared to 66% in 1988. Health care benefits administrators and industry observers contend that reduced benefits, higher costs, and fewer small employers offering coverage may combine to sharply reduce employee satisfaction with employer-sponsored health plans.

SATISFACTION WITH HEALTH INSURANCE PLANS

Harris Interactive and other researchers report increasingly negative public attitudes about managed care. In fact, the April 2003 Harris Poll that asked Americans how well they thought different industries were serving their customers found the health insurance industry and managed care plans at the bottom of the list. Just 40% of respondents felt health insurance companies were doing a good job, and 30% credited managed care plans with a job well done. The Harris Poll researchers distinguish the growing dissatisfaction with the concept of managed care from how consumers feel personally about their own plans. The researchers contend that the personal experiences of most Americans are not as awful as the accounts described in the media (Humphrey Taylor, "Supermarkets, Food Companies, Hospitals, and Banks Top the List of Industries Doing Good Job for Their Consumers," The Harris Poll, Harris Interactive, May 28, 2003).

FIGURE 9.8

In contrast to public opinion and many media reports, many people are quite satisfied with their health plans. In "Satisfaction with Own Health Insurance Remarkably Stable"(Health Care News, Harris Interactive, vol. 4, issue 5, March 29, 2004), Humphrey Taylor and Robert Leitman observed that for the fifth consecutive year the majority of the insured public continues to report high levels of satisfaction with their health plans. In 2004 about two-thirds of health plan members gave their plans high marks—As and Bs.

In 2004 more than three-quarters of adults with health insurance (76%) said they would "probably" or "definitely" recommend their plan to a family member or friend who was healthy, and more than two-thirds (68%) said they would likely recommend their plan to a family member or friend suffering from a serious or chronic illness. (See Table 9.2 and Table 9.3.) Persons insured by employers or unions were even more likely to recommend their health plans. Nearly 80% would "probably" or "definitely" recommend their plan to a healthy family member or friend, and 70% would likely recommend their plan to a family member or friend suffering from a serious or chronic illness. (See Table 9.4 and Table 9.5.)

According to Taylor and Leitman in the Harris Interactive survey, overall consumer dissatisfaction with health plans has not substantially changed from 2001 to 2004. Slightly more Medicare recipients (29%) gave their health plan low grades in 2004 than in 2001 (24%), and there was a comparable increase in the percentage of Medicare recipients who would not recommend their plans to their healthy friends.

More Medicaid beneficiaries are dissatisfied than persons enrolled in Medicare or employer-sponsored health plans. According to Taylor and Leitman, some 18% of Medicaid recipients awarded their health plan a failing

FIGURE 9.9

grade (D or F) compared to 12% of persons with employer-provided plans, 15% of Medicare beneficiaries, and 11% of persons who purchased private insurance. Dissatisfaction with Medicaid has also increased in recent years—33% of recipients reported in 2004 that they would not recommend it to friends or family members who have serious or chronic illnesses, compared to 24% in 2001.

Are Members of For-Profit HMOs Less Satisfied with Care Than Members of Nonprofit HMOs?

During the 1980s just one-quarter of all HMO members were enrolled in for-profit HMOs. However, conversion of many not-for-profit plans resulted in a dramatic shift, and by the late 1990s nearly two-thirds of HMO members were enrolled in for-profit plans. Some industry observers worried that large, for-profit health plan owners might jeopardize the quality of care delivered by denying members needed services to save money. Investigators Ha Tu and James Reschovsky at the Center for Studying Health System Change in Washington, D.C., looked at the relationship between members' assessments of their care and the profit status of their HMOs to find out if profit status affected members' perceptions of the quality of health care they received.

The investigators examined data from more than thirteen thousand HMO members and published the results of their analysis in the New England Journal of Medicine (vol. 346, no. 17, April 25, 2002). They found that slightly

TABLE 9.2

TABLE 9.3

TABLE 9.4

more members of nonprofit HMOs were very satisfied with their care (64%) than members of for-profit plans (58.1%). In the for-profit HMOs, sick members reported greater dissatisfaction than healthy members, with sick members reporting more delays in receiving care, unmet needs, organizational or administrative obstacles to receiving treatment, and higher out-of-pocket expenses. In nonprofit HMOs, the only difference between sick and healthy members was that sick members expressed greater confidence that they would be referred for care when necessary.

The investigators speculated that while there may have been significant differences in the operation of for-profit and nonprofit plans in the past, in recent years all

TABLE 9.5

plans have been subjected to comparable market pressures and economic constraints, rendering the plans nearly indistinguishable from one another in terms of quality and health service delivery.

REPORT CARDS MAY HELP CONSUMERS MAKE INFORMED CHOICES

Report cards that grade health plans, hospitals, and other providers offer consumers a way to make accurate comparisons and informed choices. Since the early 1990s the number of agencies, organizations, and employer coalitions issuing report cards has grown. In 1995 the federal government initiated the Consumer Assessment of Health Plans Study (CAHPS) to develop a consumer information project. By 1999, nine million federal employees had access to CAHPS data about available health plans. In 2002 Medicare beneficiaries also gained access to CAHPS data about Medicare managed care plans. CAHPS data are available to the public in print and on the Internet.

Many federal and state employees as well as workers employed in large corporations have become accustomed to comparing health plans using report cards, but report cards examining the quality of health care systems are relatively new additions to quality improvement and consumer education programs. Researchers from the Health Research Center, Park Nicollet Institute, and Minnesota Health Data Institute studied consumer response to report cards that compared health care systems that deliver care rather than health plans that provide insurance coverage. Barbara Braun and her colleagues published their findings in American Journal of Managed Care (vol. 8, no. 6, June 2002).

The report cards that the study participants were given measured seven aspects of care:

• Obtaining care without long waits
• Physician-patient communication
• Courtesy of office staff
• Ease of obtaining needed medical care
• Overall rating of the clinic experience
• Rating of health care provided
• Rating of the health care provider

The investigators found that most study participants had been unaware of the widespread use of report cards to compare health plans and the more recent use of them to measure and compare health service delivery. Nonetheless, the survey participants were very interested in quality measurement and considered report cards to be most valuable in two different circumstances—when they were faced with the personal choice of health care delivery system, and as a way to direct system-wide quality improvement efforts. Participants felt they would be most likely to consider report card data if they were dissatisfied with their current providers of medical care. Many said their own personal experiences and the opinions of friends and family would remain their primary and most trusted means of evaluating health care quality.

A GROWING NUMBER LOOK FOR HEALTH INFORMATION ONLINE

Although trust in hospitals and personal physicians remains high, and many people receive health education from physicians, nurses, and other health professionals, a growing number of Americans are seeking health information

TABLE 9.6

online. Harris Poll researchers have dubbed the more than 110 million adults who seek information about specific diseases or tips about how to maintain health on the Internet "cyberchondriacs."

When the nationwide survey was updated in February 2004, Harris Poll researchers found a relatively stable percentage of adults seeking health information online between 1998 and 2004 (Humphrey Taylor and Robert Leitman, "No Significant Change in the Number of Cyberchondriacs," Health Care News, Harris Interactive, vol. 4, issue 7, April 12, 2004). From mid-1998 to February 2004, the number of adults who had ever looked for health information online more than doubled from 54 million to 111 million. As of 2004, 69% of all adults who were online said they had sought health care information on the Internet. (See Table 9.6.)

The 2002 Harris Poll found that like the most frequent users of the Internet, cyberchondriacs tended to be young adults—82% of those between the ages of eighteen and twenty-nine had looked for health information online. Cyberchondriacs also were more likely to have had postgraduate education (84% of those adults looking for information online) and were more likely to be wealthier (77% of those reporting incomes in excess of $75,000 had looked for information online).

Table 9.7 shows that when cyberchondriacs go online in search of health information, they are more likely to use a portal or search engine (51%) to search multiple sites rather than look for information at a specific health Web site (23%). Despite the proliferation of sites devoted to health and medical care, the proportions of cyberchondriacs that visit them first when seeking health information has not changed from 2001 to 2004.

MARKETING PRESCRIPTION DRUGS TO CONSUMERS

Although health care consumers continue to receive much of their information from physicians, nurses, other health professionals, and the Internet, many also learn about health care services and products from reports in the news media and from advertising. Media advertising—promotion of hospitals, health insurance, managed care plans, medical groups, and related health services and products—has been a mainstay of health care marketing efforts since the 1970s. During the early 1990s pharmaceutical companies made their first forays into advertising of prescription drugs directly to consumers. Prior to the 1990s pharmaceutical companies' promotion efforts had focused almost exclusively on physicians, the health professionals who prescribe their products.

Since the mid-1990s, spending on prescription drugs has escalated and has become the fastest-growing segment of U.S. health care expenditures. In 1997 the Food and Drug Administration (FDA) released guidelines governing direct-to-consumer advertising and seemingly opened a floodgate of print, radio, and television advertisements promoting prescription drugs. Industry observers wondered if this upsurge of direct-to-consumer advertising had resulted in more, and possibly inappropriate, prescribing and higher costs.

Researchers from the Harvard School of Public Health and the Sloan School of Management at the Massachusetts Institute of Technology (MIT) examined the relationship between spending for promotional purposes and prescription drug sales and published their findings in the New England Journal of Medicine (vol. 346, no. 7, February 14, 2002). The researchers observed that pharmaceutical companies' budgets for promotion increased from $266 million in 1994 to almost $2.5 billion in 2000, and that television advertising, which accounted for 13% of direct-to-consumer promotions in 1994 and 64% in 2000, contributed to this growth. They found that direct-to-consumer advertising was generally used to promote long-term-use drugs prescribed for chronic conditions such as allergies, elevated blood cholesterol, and ulcers.

Is Direct-to-Consumer Advertising Effective?

It stands to reason that pharmaceutical companies must be receiving significant returns on their direct-to-consumer advertising investments in order to justify increasing budgets for consumer advertising, but it is difficult to measure the precise impact of consumer advertising

TABLE 9.7

on drug sales. The Harvard and MIT researchers observed that consumer awareness of prescription drug ads, in terms of adults surveyed who reported having seen drug ads, has more than doubled from nearly 40% in 1993 to more than 90% of consumers surveyed in 2000.

Mollyann Brodie evaluated consumers' reactions to drug ads by showing research participants actual prescription drug ads and recording their responses. In Understanding the Effects of Direct-to-Consumer Prescription Drug Advertising (Washington, DC: Henry J. Kaiser Family Foundation, November 2001), Brodie reported that one in three adults said they talked with their doctor after seeing an ad for a prescription drug and nearly half of those who spoke with their physicians about the drug (44%) received a prescription for that drug. Brodie also found that two-thirds of consumers who viewed prescription drug ads trusted the information they received in the ads, and 84% said the ads did an excellent or good job informing them about the condition that the advertised drug was intended to treat. Despite the ad viewers' perception that they were well informed, Brodie found that recall about potential drug side effects, and viewer knowledge about where they could find more information about the advertised medication, varied widely. In view of the speed with which some television drug ads announce potential side effects and adverse reactions, it was not surprising that as many as 75% of viewers could not accurately identify many of the advertised drug's side effects.

FIGURE 9.10

A nationwide survey of adults conducted by Harris Interactive between July 2001 and January 2002 reconfirmed the marketing impact of direct-to-consumer advertising. The overwhelming majority of survey respondents (86%) recalled seeing or hearing the direct-to-consumer advertising of prescription drugs, and more than one-third (35%) discussed an advertised drug with a physician (Humphrey Taylor and Robert Leitman, "The Impact of Direct-to-Consumer Advertising of Prescription Drugs on Consumer Behavior, Diagnosis and Treatment," Health Care News, Harris Interactive, vol. 3, issue 11, June 23, 2003). Further, the survey aimed to determine the specific conditions that were diagnosed as a result of physician visits prompted by direct-toconsumer advertising, the actions taken during such visits, and the outcomes that resulted from taking prescription medication prescribed during these visits.

The researchers found that at one-quarter of the physician visits prompted by advertising, the physician diagnosed new conditions—identifying previously undiagnosed conditions. The most common new diagnoses were allergies, GERD (gastroesophageal reflux disease), high cholesterol, arthritis, hypertension, diabetes, depression, anxiety, heartburn, heart disease, and the effects of menopause. (See Figure 9.10.) Nearly three-quarters of physician visits prompted by advertising resulted in a prescription being

TABLE 9.8

TABLE 9.9

written, and in 43% of visits the prescription was for the drug the patient had seen advertised. (See Table 9.8.)

The majority (81%) of patients who received prescriptions at their advertising-induced physician visits reported overall improvement in their health. Interestingly, patients who were prescribed the advertised drug were more likely to report favorable health outcomes than those who received prescriptions for drugs other than the advertised drug. (See Table 9.9.)