A blog covering the health/care ecosystem and people.

New research points out that real people live real lives, and our assumptions about social determinants of health (SDOH) may need to be better informed by those real lives. I read three reports in the past week sobering up my bullish #SDOH ethos dealing with food deserts, transportation, and health service access — three key social determinants of health. To remind you about the social determinants, here’s a graphic from Kaiser Family Foundation that summarizes the key pillars of SDOH. Assumption 1: Food deserts in and of themselves diminish peoples’ healthy nutrition lifestyles. Low-income households who are exposed to the same food-buying

The fact that the average U.S. employer committed to spend nearly $27,000 a year for a PPO to cover a family of 4 in America in 2017 is the most important rationale underlying the announcement that Amazon, Berkshire-Hathaway, and JP Morgan made on 30th January 2017. That news immediately shook Wall Street trading, sending downward shocks down the proverbial spines of healthcare insurance plans and suppliers to the industry — legacy healthcare companies that scale patient-members and healthcare supplies, like pills and surgical implants. The “new competition” chart published in the Wall Street Journal in the morning illustrates those shock

Picture this scenario: you, the consumer, take a dollar and spend it, and you get 90 cents back. In what industry is that happening? Here’s the financial state of healthcare in America, explained in the 2016 Health Care Cost and Utilization Report from the Health Care Cost Institute (HCCI). We live in an era of Amazon-Primed consumers, digital couponing, and expectations of free news in front of paywalls. We are all in search of value, even as the U.S. economy continues to recover on a macroeconomic basis. But that hasn’t yet translated to many peoples’ home economics. In this personal

On this day appreciating the legacy of Martin Luther King, Jr., I post a photo of him in my hometown of Detroit in 1963, giving a preliminary version of the “I Have a Dream” speech he would deliver two months later in Washington, DC. Wisdom from the speech: “But now more than ever before, America is forced to grapple with this problem, for the shape of the world today does not afford us the luxury of an anemic democracy. The price that this nation must pay for the continued oppression and exploitation of the Negro or any other minority group

For this end-of-year post leading into 2018, I choose to address the big topic of how long we live in America, and what underpins the sobering fact that life expectancy is falling. Life expectancy in the United States declined to 78.6 years in 2016, placing America at number 37 on the list of 137 countries the World Economic Forum (WEF) has ranked in their annual Global Competitiveness Report 2017-2018. The first chart shows the declining years for Americans compared with health citizens of Australia, France, Canada, Finland, and the UK. While Australians’ and Britons’ life expectancies declined from 2015-16, their

The biggest healthcare spenders in the United States are households and the Federal government, each responsible for paying 28% of the $3.3 trillion spent in 2016. Private business — that is, employers covering healthcare insurance — paid for 20% of healthcare costs in 2016, based on calculations from the CMS Office of the Actuary’s report on 2016 National Health Expenditures. The positive spin on this report is that overall national health spending grew at a slower rate in 2016, at 4.3% after 5.8% growth in 2015. This was due to a decline in the growth rates for the use of

It takes more than enrolling in a high-deductible health plan (HDHP) for someone to immediately morph into an effective health care “consumer.” Research from Dr. Jeffrey Kullgren and his team from the University of Michigan found that enrollees in HDHPs could garner more benefits from these plans were people better informed about how to use them, including how to save for them and spend money once enrolled in them. The team’s research letter was published in JAMA Internal Medicine on 27 November 2017. The discussion details results of a survey conducted among 1,637 people 18 to 64 years of age

Above the economy, trust in government, crime, war, terrorism, and taxes, health care is the top cause of stress in America. For ten years, the American Psychological Association has gauged Americans’ collective mood in their ongoing study, Stress in America. The latest report is The State of Our Nation, published this month, finding that we’re at the “lowest point in our nation’s history” according to 59% of Americans. The 2016 national election in the U.S. raised the stress-stakes, when APA released a stress study we discussed here in Health Populi. The election season was a source of stress for 52%

“With Mad Men still in charge, ad campaigns miss the mark,” an editorial published this week in the Financial Times asserts. Leave it to a fiscally conservative British publication to be spot-on about a particularly, but not uniquely, American challenge, in this post-Weinstein (Miramax), -Price (Amazon), and today, -Halperin (MSNBC) moment of sexual harassment revelations. In health/care, women are key consumers, buyers and influencers, yet under-represented in the Mad Men demographic of senior advertising executives, as the data-driven FT essay points out. So it’s especially heartening to find this month a few examples of empowering, inspiring ad campaigns getting health/care marketing

Old-age inequality among current retirees in the U.S. is already greater than in ever OECD country except Chile and Mexico, revealed in Preventing Ageing Unequally from the OECD. Key findings from the report are that: Inequalities in education, health, employment and income start building up from early ages At all ages, people in bad health work less and earn less. Over a career, bad health reduces lifetime earnings of low-educated men by 33%, while the loss is only 17% for highly-educated men Gender inequality in old age, however, is likely to remain substantial: annual pension payments to the over-65s today are

Healthcare and the economy tied for US voters’ top issue last week, as the prospects for repealing the Affordable Care Act faded by the weekend. This Morning Consult poll was published 28th September 2017, as it became clear that the Graham-Cassidy health reform bill would lose at least three key votes the legislation needed for passage: from Rand Paul, Susan Collins, and John McCain. Liz Hamel, who directs the Kaiser Family Foundation’s survey research, told Morning Consult that, “when people say ‘health care,’ they often are actually talking about the economic issue of health care.”          

The average cost of an employer=sponsored health plan for a family reached $18,764 in 2017. While this premium grew overall by a historically relative low of 3.4%, employees covered under that plan faced an increase of 8.3% over what their plan share cost them in 2016, according to the 2017 Employer Health Benefit Survey published today by the Kaiser Family Foundation. [Here’s a link to the 2016 KFF report, which provided the baseline for this 8.3% calculation]. Average family premiums at the workplace rose 19% since 2012, a slowdown from the two previous five-year periods — 30% between 2007 and 2012, and

Happy anniversary to me…well, to the Health Populi blog! It’s ten years this week since I launched this site, to share my (then) 20 years of experience advising health care stakeholders in the U.S. and Europe at the convergence of health, economics, technology, and people. To celebrate the decade’s worth of 1,791 posts here on Health Populi (all written by me in my independent voice), I’ll offer ten health/care milestones that represent key themes covered from early September 2007 through to today… 1. Healthcare is one-fifth of the national U.S. economy, and the top worrisome line item in the American

Three-quarters of patients’ decisions on whether to seek services from healthcare providers are impacted by high deductible health plans. This impacts the finances of both patients and providers: 56% of patients’ payments to healthcare providers are delayed some of the time, noted in Optimizing Revenue: Solving Healthcare’s Revenue Cycle Challenges Using Technology Enabled Communications, published today by West. Underneath that 56% of patients delaying payments, 12% say they “always delay” payment, and 16% say they “frequently delay” payment. West engaged Kelton Global to survey 1,010 U.S. adults 18 and over along with 236 healthcare providers to gauge their experiences with

    The Affordable Care Act (ACT) was implemented in 2010. Since the inception of the ACA, the proportion of uninsured women in the U.S. fell by nearly one-half, from 19 million in 2010 to 11 million in 2016. The Commonwealth Fund has documented the healthcare gains that American women made since the ACA launch in their issue brief, How the Affordable Care Act Has Helped Women Gain Insurance and Improved Their Ability to Get Health Care, published earlier this month. The first chart talks about insurance: health care plan coverage, which is the prime raison d’être of the ACA. It’s

As we look for signs of stability in U.S. health care, there’s one stakeholder that’s holding firm: employers providing healthcare benefits. Two studies out this week demonstrate companies’ commitment to sponsoring health insurance benefits….with continued tweaks to benefit design that nudges workers toward healthier behaviors, lower cost-settings, and greater cost-sharing. As Julie Stone, senior benefits consultant with Willis Towers Watson (WLTW), noted, “The extent of uncertainty in Washington has made people reluctant to make changes to their benefit programs without knowing what’s happening. They’re taking a wait-and-see attitude.” First, the Willis Towers Watson 22nd annual Best Practices in Health Care Employer

After diving into Walnut Lake in suburban Detroit, Adam Niskar sustained a spinal injury that would paralyze much of his body for the rest of his life. The trauma didn’t paralyze his life and living, though. But today, my family will celebrate that life at Adam’s memorial service. Adam was my cousin. He was one of the best-loved people on the planet, and that was part of a therapeutic recipe that sustained him from the traumatic accident in 1999 until Monday, July 31st, 2017, when Adam passed away from complications due to an infection that, this time around, his body

I quote directly from the Twitter feed of Anthony Scaramucci, @scaramucci: “@dhank2525 agree. We already have Univ Health Care, we made decision long ago to treat everyone that enters an emergency room.” Mr. Scaramucci is President Trump’s Communications Chief, replacing Sean Spicer. Mr. Scaramucci is neither veteran journalist nor healthcare policy wonk. He’s a successful businessman, which I respect for his savvy and ability to build a fund, attract investors, and create a media persona which he has telegenically broadcast on CNBC and elsewhere over the past decade. He’s got a engaging public personality, and goes by the moniker, “Mooch.” But

The Netherlands, France and Germany are the best places to be a patient, based on the Global Access to Healthcare Index, developed by the Economist Intelligence Unit (EIU). Throughout the world, nations wrestle with how to provide healthcare to health citizens, in the context of stretched government budgets and demand for innovative and accessible services. The Global Access to Healthcare Index gauges countries’ healthcare systems in light of peoples’ ability to access services, detailed in Global Access to Healthcare: Building Sustainable Health Systems. The United States comes up 10th in line (tied with Spain) in this analysis. Countries that score the

Total prescription drug sales have been trimmed, based on calculations of EvaluatePharma which forecasts a $390 bn drop in revenues between 2017 and 2022. “Political and public scrutiny over pricing of both new and old drugs is not going to go away,” EvaluatePharma called out in its report. The intense scrutiny on pharma industry pricing was fostered by Martin Shkreli in his pricing of Daraprim (taking a $13.50 product raising the price to $750), Harvoni and Sovaldi pricing for Hepatitis C therapies, and last year’s EpiPen pricing uproar. A May 2017 analysis of prescription drug costs by AARP judges that, “Nothing

While Americans’ financial worries are softening in 2017, one issue tops the list of fiscal fears: not having enough money to pay the costs involved in a serious illness or accident, Gallup found in a consumer poll fielded in early April 2017. 54% of Americans fear an inability to cover healthcare costs in the event of an accident or serious illness. This percentage was 60% in 2016, and 55% in 2015. This year’s data point ties with Americans financial worry about not having enough money for retirement, but healthcare cost concerns rank higher in terms of being “very worried” versus

Former Surgeon General Dr. Regina Benjamin was the first person who quoted to me, “Health isn’t in the doctor’s office. It’s where people live, work, play and pray,” imparting that transformational mantra to me in her 2011 interview with the Los Angeles Times. I wrote about that lightbulb moment here in Health Populi. Dr. Benjamin was the 18th Surgeon General, appointed by President Obama in 2009. As “America’s Doctor,” she served a four-year term, her mission focused on health disparities, prevention, rual health, and children’s health. Today, Dr. Benjamin wears many hats: she’s the Times Picayune/NOLA.com professor of medicine at

Health care costs are out-of-reach for more Americans, among both people who have insurance through the workplace or via health insurance exchanges. The first chart illustrates the growing healthcare affordability challenge for American health consumers, discussed in a data note to the Kaiser Family Foundation Health Tracking Poll in March 2017. In 2017, 43% of consumers found it difficult to meet the health care deductible before insurance would kick in 37% of consumers found it difficult to pay for the cost of health insurance each month 31% said it was difficult to pay for copayments for doctor visits and prescription drugs.

U.S. consumers love technology, retail, and consumer products; automotive company reputations are improving, even with Volkswagen’s emission scandal potentially tarnishing the industry segment. The only corporate sector whose reputation fell in 2016 was the pharmaceutical industry’s, according to the Harris Poll’s 2017 Reputation Quotient report. The line chart illustrates the decline of pharma’s reputation, which puts it on par with its consumer perceptions in 2010 — just before Medicare Part D was legislated and implemented, which improved pharma’s image among American health citizens (especially older patients who tend to be more frequent consumers of prescription drugs). Pharma’s reputation quotient is back

Most Americans do not believe that TrumpCare, the GOP plan to replace the Affordable Care Act (the ACA, aka  ObamaCare), will make things better for U.S. health citizens when it comes to peoples’ health insurance coverage, the premium costs charged for those health plans, and protections for people with pre-existing medical conditions. The March 2017 Kaiser Family Foundation Health Tracking Poll examined U.S. adults’ initial perceptions of AHCA, the American Health Care Act, which is the GOP’s replacement plan for the ACA. There are deep partisan differences in perceptions about TrumpCare, with more Republicans favorable to the plan — although not

Geography is destiny, Napoleon is thought to have first said. More recently, the brilliant physician Dr. Abraham Verghese has spoken about “geography as destiny” in his speeches, such as “Two Souls Intertwined,” The Tanner Lecture he delivered at the University of Utah in 2012. Geography is destiny for all of us when it comes to our health and well-being, once again proven by Gallup-Healthways in The State of American Well-Being 2016 Community Well-Being Rankings. The darkest blue circles in the U.S. map indicate the metro areas in the highest-quintile of well-being. The index of well-being is based on five metrics, of consumer self-ranking

Results of two polls published in the past week, from the Kaiser Family Foundation and Pew Research Center, demonstrate growing support for the Affordable Care Act, aka Obamacare. The Kaiser Health Tracking Poll: Future Directions for the ACA and Medicaid was published 24 February 2017. The first line chart illustrates the results, with the blue line for consumers’ “favorable view” on the ACA crossing several points above the “unfavorable” orange line for the first time since the law was signed in 2010. The margins in February 2017 were 48% favorable, 42% unfavorable. While the majority of Republicans continue to be solidly

An abbreviated version of this post appeared in the Huffington Post on 9 February 2017. This version includes the Health Populi Hot Points after the original essay, discussing the consumer’s context of retail experience in healthcare and implications for the industry under Secretary of Health and Human Services Tom Price — a proponent of consumer-directed healthcare and, especially, health savings accounts. We’ll be brainstorming the implications of the 2016 CAQH Index during a Tweetchat on Thursday, February 16, at 2 pm ET, using the hashtag #CAQHchat. America ranks dead-last in healthcare efficiency compared with our peer countries, the Commonwealth Fund

Healthcare consumers are in a “state of denial,” according to research conducted for Alegeus, the consumer health benefits company. Overall, 3 in 4 consumers feel fear when it comes to their healthcare finances: most people worry about being hit with unexpected healthcare costs they can’t afford, and nearly half fear they won’t be able to afford their family’s healthcare needs. The wordle illustrates consumers’ mixed feelings about healthcare: while people feel frustrated, overwhelmed, powerless, confused and skeptical about healthcare in America, there are some emerging adjectives hinting at growing consumer health muscle-building: optimistic, hopeful, supported, engaged, accountable. Still, denial and

Health and money are the two issues about which Americans have set New Year’s resolutions, according to the Harris Poll, Americans Look to Get Their Bodies and Wallets in Shape with New Year’s Resolutions. The top goals U.S. consumers have set for 2017 are to: Eat healthier, 29% of all U.S. adults Save more money, 25% Lose weight, 24% Drink more water, 21% Pay down debt, 17% Spend more time with family and friends, 15% Get organized, 15% Travel more, 15% Read more, 14% Improve relationships, 14%. There are some marked differences between American men versus women across these resolutions;

  Two in three U.S. consumers are willing to see a doctor online. American health consumers welcome the opportunity to engage in virtual healthcare services via telehealth. American Well’s 2017 Telehealth Index surveyed 2,100 U.S. adults 18 and over in August and September 2016 to gauge consumers’ views on healthcare services, access, and receptivity to virtual care modes of delivery. Underneath the 66% of consumers open to telehealth are demographic differences: people with children are more likely to value virtual care, as well as people between 45 and 54, the survey found. Note, though, that a majority of older Americans over

More Americans are worried about their out-of-pocket health care costs than they are about repealing the Affordable Care Act (ACA), according to the Kaiser Family Foundation (KFF) Health Tracking Poll published 6th January 2017, the first KFF poll for the new year. Cost worries fall into two buckets of concerns: the cost of health care, and the cost of prescription drugs. Managing the opioid epidemic falls in third place after health care costs. Repealing the Affordable Care Act? It’s #4 on Americans’ health care priorities as of mid-December 2016, followed by shrinking the Federal’s government’s role in and spending on

Health citizens in America will need to be even more mindful, critical, and engaged healthcare consumers in 2017 based on several factors shaping the market; among these driving forces, the election of Donald Trump for U.S. president, the uncertain future of the Affordable Care Act and health insurance, emerging technologies, and peoples’ growing demand for convenience and self-service in daily life. The patient is increasingly the payor in healthcare. Bearing more first-dollar costs through high-deductible health plans and growing out-of-pocket spending for prescription drugs and other patient-facing goods and services, we’re seeking greater transparency regarding availability, cost and quality of

Think “Hormel,” and you may have visions of SPAM, Chi-Chi’s salsa, Skippy peanut butter, and Dinty Moore corned beef hash. So what’s Hormel doing in the title of a Health Populi post, anyway, you might ask? Like many food companies, Hormel is broadening its product portfolio expanding with health. The company isn’t just moving to healthy eating for wellness’s sake, but boldly going where most food companies haven’t yet gone: developing products for people battling cancer. Vital Choices, a well-titled line of frozen meals, was developed by Hormel in collaboration with the American Cancer Society, Cancer Nutrition Consortium, the Culinary Institute

It’s the 9th of November, 2016, and Donald Trump has been elected the 45th President of the United States of America. On this morning after #2016Election, Health Populi looks at what we know we know about President Elect-Trump’s health policy priorities. Repeal-and-replace has been Mantra #1 for Mr. Trump’s health policy. With all three branches of the U.S. government under Republican control in 2018, this policy prescription may have a strong shot. The complication is that the Affordable Care Act (aka ObamaCare in Mr. Trump’s tweet) includes several provisions that the newly-insured and American health citizens really value, including: Extending health

  Consumers have grown accustomed to Amazon, and increasingly to the just-in-time convenience of Amazon Prime. Today, workers who sign onto employee benefit portals are looking for Amazon-style convenience, access, and streamlined experiences, found in the Aflac Workforces Report 2016. Aflac polled 1,900 U.S. adults employed full or part time in June and July 2016 to gauge consumers’ views on benefit selections through the workplace. Consumers have an overall angst and ennui about health benefits sign-ups: 72% of employees say reading about benefits is long, complicated, or stressful 48% of people would rather do something unpleasant like talking to their ex or

More U.S. patients are faced with spending more out-of-pocket for health care services, to meet high-deductible health plans and rationally spend their health savings account investments. As rational economic men and women, some are seeking care outside of the United States where many find transparently priced, high-value, lower-cost healthcare. Check out the table from the Medical Tourism Association, and you can empathize with cash-paying patients looking for, say, gastric bypass surgery or a heart valve replacement. My latest column in the Huffington Post discussed this trend, which points first to the Cleveland Clinic — a top-tier American healthcare brand that’s

The average hospital cost per day in the U.S. is $5,220. In Switzerland it’s $4,781, and in Spain that inpatient day looks like a bargain at $424. An MRI in the U.S. runs, on average, $1,119. In the UK, that MRI is $788, and in Australia, $215, illustrated in the first chart. Drug prices are strikingly greater in the U.S. versus other developed nations, as shown in the first chart for Xarelto. If you live in the U.S. and have a television tuned in during the six o’clock news, chances are you’ve seen an ad for this drug featuring Arnold

Health care payment responsibility continues to shift from employers to employee-patients, More of those patients are morphing into financially burdened health consumers, according to TransUnion, the credit agency and financial risk information company, in the TransUnion Healthcare Report published in June 2016. Patients saw a 13% increase in their health insurance deductible and out-of-pocket (OOP) maximum costs between 2014 and 2015. At the same time, the average base salary in the U.S. grew 3% in 2015, SHRM estimated. Thus, deductibles and OOP costs grew for consumers more than 4 times faster than the average base salary from 2014 to 2015.  In

Millions of U.S. patients have more financial skin in the American health care game. But are they behaving like the “consumers” they are assumed to be as members in consumer-directed health plans? Not so much, yet, explained John Park, Chief Strategy Officer at Alegeus, during a discussion of his company’s 2016 Healthcare Consumerism Index. This research is based on an online survey of over 1,000 U.S. healthcare consumers in April 2016. Alegeus looks at healthcare consumerism across two main dimensions: healthcare spending and healthcare saving. As the chart summarizes, consumers show greater engagement and focus on buying a TV or car, choosing

“Gas ‘N’ Health Care” is one of my most-used cartoons these days as I talk with health/care ecosystem stakeholders about the growing and central role of consumers in health care. You may be surprised to learn that the brilliant cartoonist Michael Maslin created this image back in 1994. That’s 22 years ago. When I first started using this image in my meetings with health care folks, they’d all giggle and think, ‘isn’t that funny?’ Legacy health care players — hospitals, doctors, Pharma, and medical device companies — aren’t laughing at this anymore. At a Costco a 20 minutes’ drive from

The top health-related activities among U.S. adults include routinely taking vitamins and supplements, and prescription medicines, according to Frost & Sullivan’s report, Are We Engaged Yet? Their response to the titular question lies in in the subtitle: “US consumers appear confused or ambivalent about what it means to be proactive or engaged in their health.” 1 in 2 U.S. adults says they’re “somewhat engaged” in their healthcare, according to Reenita Das’s write-up on the study in Forbes magazine. She notes that: Consumers with higher incomes have more confidence in their access to health care services and quality of care Budget-constrained consumer

6 in 10 people in the US would like to replace the Affordable Care Act with a national health insurance program for all Americans, according to a Gallup Poll conducted on the phone in May 2016 among 1,549 U.S. adults. By political party, RE: Launch a Federal/national health insurance plan (“healthcare a la Bernie Sanders”): Among Democrats, 73% favor the Federal/national health insurance plan, and only 22% oppose it; 41% of Republicans favor it and 55% oppose it. RE: Repeal the ACA (“healthcare a la Donald Trump”): Among Democrats, 25% say scrap the ACA, and 80% of Republicans say to do

“Health comes to your local store,” explains the recently-launched portal, GoHealthEvents. This site is a one-stop shop for health consumers who are seeking health screenings and consults in local retail channels like big box stores, club stores, drug stores, and grocery stores. Events covered include cholesterol, diabetes, heart health, nutrition, osteoporosis, senior health, vaccinations and immunizations. By simply submitting a zip code, a health consumer seeking these kinds of services can identify where and when a local retailer will provide it. I searched on my own zip code in suburban Philadelphia, and found the following opportunities taking place in the

Financial stress impacts health, relationships, and work productivity and attendance for employees in the U.S. It’s the American worker’s trifecta, a way of life for a growing proportion of people in the U.S. PwC’s 2016 Employee Financial Wellness Survey for 2016 illustrates the reality of fiscally-challenged working women and men that’s a national epidemic. Some of the signs of the financial un-wellness malaise are that, in 2016: 40% of employees find it difficult to meet their household expenses on time each month 51% of employees consistently carry balances on their credit cards (with a large increase here among Baby Boomers

Older workers and retirees in the U.S. are most pleased with their healthcare experiences and have the fewest problems accessing  services and benefits. But, “younger workers [are] least comfortable navigating U.S. healthcare system,” which is the title of a press release summarizing results of a survey conducted among 1,536 U.S. adults by the Harris Poll for Accolade in September 2015. Results of this Accolade Consumer Healthcare Experience Index poll were published on April 12, 2016. Accolade, a healthcare concierge company serving employers, insurers and health systems, studied the experiences of people covered by health insurance to learn about the differences across age

8 in 10 Americans would like one trusted person to help them figure out their health care, according to the Accolade Consumer Healthcare Experience Index Poll, conducted by The Harris Poll. The study gauged how Americans feel about their healthcare, especially focusing on employer-sponsored health insurance. One-third of people (32%) aren’t comfortable with navigating medical benefits and the healthcare system; a roughly percentage of people aren’t comfortable with their personal knowledge to make financial investments, either (35%). Buying a car, a home, technology and electronics? Consumers are much more comfortable shopping for these things. Consumers say that the most onerous

People who more consistently track their calories and food intake are more likely to be fiscally fit than people who do not, suggesting a link between healthy eating and financially wellness. I learned this through a survey conducted in February 2016 among 4,118 people using the Lose It! mobile app, which enables people to track their daily nutrition. Some 25 million people have downloaded Lose It! The app is one of the most consistently-used mobile health tools available in app stores. The Rutgers School of Environmental and Biological Sciences has explored the financial impact of improved health behaviors, asserting that,

As HIMSS 2016, the annual conference of health information technology community, convenes in Vegas, an underlying market driver is fast-reshaping consumers’ needs that go beyond personal health records: that’s personal health-financial information and tools to help people manage their growing burden of healthcare financial management. There’s a financial risk-shift happening in American health care, from payers and health insurance plan sponsors (namely, employers and government agencies) to patients – pushing them further into their role as health care consumers. The burden of health care costs weighs heavier on younger U.S. health citizens, based on a survey from the Xerox Healthcare