A few more consumers are engaging with their health and health care system, according to Deloitte’s second survey into health care consumers in the U.S.

Perhaps that’s because 9 in 10 Americans believe that health care costs are a threat to their personal financial security — regardless of whether they have health insurance or whether they’re sick.

Deloitte’s 2009 Survey of Health Care Consumers, in this second year of the study, finds health citizens more anxious and more critical of their health system.

As the angst grows, though, so, it seems, do behaviors that demonstrate greater health engagement — at least for some:

– 54% of people are learning more about their personal health risks, prevention, and mental health
– 2 in 3 smokers are trying to quit the habit
– 2 in 5 alcohol drinkers are trying to reduce their consumptions

“Nudging” may work with people, as 7 in 10 adults say they’d participate in a healthy living or wellness program if they received a financial incentive — like lower insurance premiums or a hard financial reward.

Deloitte’s survey is more bullish on consumers’ use of information sources for comparing doctors and hospitals: 30% of adults said they compared doctors before choosing one in the past year, up from 23% who did so in 2008. And, 32% of people said they checked to see whether their insurance covered hospital treatments before going to the hospital. In fact, insurance coverage is the most important factor to consumers in selecting a hospital, according tot he survey with 74% of people citing this as #1; 64% of adults said that their doctor recommendation or referral, or the hospital reputation, is a top factor in selecting a hospital.

23% of adults said they looked for information online about the quality of care provided by specific doctors within the past 12 months. This is a greater penetration number for quality searching than other recent studies have found.

The study sampled 4,001 American adults 18 and over, representing the U.S. population, and was conducted in October 2008.

Health Populi’s Hot Points: Only 6% of Americans believe their family is completely prepared to deal with future health care costs. 8 in 10 Americans believe that the current economic climate will make it harder for people to pay their medical bills.

Among consumers who skipped or delayed care recommended by a doctor, 2 in 5 of insured consumers did so because costs were too high. 4 in 5 uninsured people did so due to costs.

This survey confirms what I’ve been saying for several years: health care is a consumer market — and people are finding ways, and want to find more ways, to manage their health and health care the way they manage other aspects of their lives, from travel and entertainment to household finance.

However, given the fact that all people do not behave in the same ways — see Deloitte’s consumer segments listed in the chart above — tools and services need to be tailored and customized for people to effectively engage with their health. Smart benefit designs will serve to ‘nudge’ people toward healthy behaviors, including using tools for chronic care management.

This isn’t just about publishing a quality report card on doctors, or developing the greatest prescription drug to manage Type 2 diabetes, or building a glowing state-of-the-art heart hospital. To meet the needs of the new health consumers, programs need to be holistic and comprehensive, bringing together all of the elements that surround the health citizen which together help the individual enhance their personal health.