A blog covering the health/care ecosystem and people.

In 2014, we are digital omnivores. Most people “consume” information and entertainment on more than one screen: 7 hours’ worth over a 5-hour period. You read that right: most people who watch TV, use a laptop or PC, smartphone or tablet are multitasking use of these devices in parallel. And above all, people are using smartphones as their primary screen. The AdReaction: Marketing in a multiscreen world report from Millward Brown paints a picture of global consumers who are cobbling together multiscreen experiences. The smartphone has become the “do it all” device if you don’t carry a laptop or tablet around, especially favored

IBM’s data analytics engine Watson, having cut its teeth on complex health care conditions like cancer, is now entering an even more challenging space: wellness. Why is wellness more challenging? Because understanding a person’s wellness goes beyond mining data from health care claims silos in hospitals, pharmacies, and physicians’ electronic health records. Wellness happens where we live, work, play and pray. Wellness is nurtured through choices made every day at home, in the workplace, and at moments-of-truth in the grocery store and restaurant where slick marketing messages planted in our subconscious compete with our more rational minds that tell us to

If your wallets are lighter at the end of the month, you’re likely to have less access to quality food, and more likely to be admitted to the hospital if you have diabetes. The hypothesis that people with low incomes whose household budgets are spent before the end of the month have greater health inequities was tested in the article, Exhaustion of Food Budgets At Month’s End And Hospital Admissions For Hypoglycemia, published in the January 2014 issue of Health Affairs. Researchers from the University of California – San Francisco found that, indeed, the health in households with low-income suffer from

When the head of the Consumer Electronics Association gives a shout-out to the growth of health products in his annual mega-show, attention must be paid. The #2014CES featured over 300 companies devoted to “digital health” as the CEA defines the term. But if you believe that health is where we live, work, play, and pray, then you can see health is almost everywhere at the CES, from connected home tech and smart refrigerators to autos that sense ‘sick’ air and headphones that amplify phone messages for people with hearing aids, along with pet activity tracking devices like the Petbit. If

There are thousands of downloadable apps that people can use that touch on health. But among the 40,000+ mobile health apps available in iTunes, which most effectively drive health and efficient care? To answer that question, the IMS Institute for Healthcare Informatics analyzed 43,689 health, fitness and medical apps in the Apple iTunes store as of June 2013. These split into what IMS categorized as 23,682 “genuine” health care apps, and 20,007 falling into miscellaneous categories such as product-specific apps, fashion and beauty, fertility, veterinary, and apps with “gimmicks” (IMS’s word) with no obvious health benefit. Among the 23,682 so-called

The “O” word drives health costs in America ever-upward. Without bending the obesity curve downward toward healthy BMIs, America won’t be able to bend that stubborn cost curve, either. The Economic Impacts of Obesity report from Alere Wellbeing accounts for the costs of chronic diseases and how high obesity rates play out in the forms of absenteeism, presenteeism, and direct health care costs to employers, workers and society-at-large. Among the 10 costliest physical health conditions, the top 3 are angina, hypertension and diabetes — all related to obesity and amenable to lifestyle behavior change. The top-line numbers set the context:

Where can you shop the health and beauty aisles, pick up some groceries and a prescription, get a flu vaccine, and weigh in on Obamacare and what digital health tools you like? Why, at one of several thousand retail stores where you can find a SoloHealth kiosk. As of yesterday afternoon, over 32 million encounters were recorded on SoloHealth kiosks, based on an app I saw on the company CEO Bart Foster’s smartphone. Kiosks are locatted around the United States in retailers including Walmart and Sam’s Clubs, along with major grocery chains like Schnuck’s and Publix, and the CVS pharmacy

Only 1 in 4 U.S. adults over 30 know what “personalized medicine” (PM) really is, and only 8% of people feel very knowledgeable about the concept based on Consumer Perspectives on Personalized Medicine from GfK, published online in August 2013. GfK surveyed 602 online adults 30 years and over between February and March 2013 drawn from the company’s KnowledgePanel sample of U.S. adults. Only 4% of people who have heard of personalized medicine describe it accurately as “medicine based on genome/genetic make up.” About one-half of people (52%) defined PM as medical care, treatment, or medicine geared toward individual needs. The poll

More than 127,000 people die every year in America from cardiovascular disease, accruing $17 billion in medical spending. Heart disease is a “costly killer,” according to the Union of Concerned Scientists, who has calculated The $11 trillion reward: how simple dietary changes can save lives and money, and how we get there, published in August 2013. That $11 trillion opportunity is equal to the present value of lives saved. The solution to bolstering heart (and overall health) and saving money (medical spending and personal productivity) is in food. We’re not talking about genetically engineering anything special or out-of-the-ordinary. We are talking

People who live in U.S. cities with low levels of well-being have twice the rate of heart attacks as people who live in healthier America. That’s 5.5% of the population in sicker America versus 2.8% of the population living in healthy America. The first chart illustrates this disparity, taken from the Gallup-Healthways index that examined 190 metropolitan areas in 2012. Based on this study, it’s good to live in parts of Utah, Nebraska and Colorado, but not so healthy to be a resident in West Virginia, Alabama, and parts of Kentucky and Ohio. Heart disease and diabetes are killing a plurality

3 in 4 Americans say that out-of-pocket costs are the main reason they decide whether or not to seek preventive care, in A Call for Change: How Adopting a Preventive Lifestyle Can Ensure a Healthy Future for More Americans from TeleVox, the communications company, published in June 2013. TeleVox surveyed over 1,015 U.S. adults 18 and over. That’s the snapshot on seeking care externally: but U.S. health consumers aren’t that self-motivated to undertake preventive self-care separate from the health system, either, based on TeleVox’s finding that 49% of people say they routinely exercise, and 52% say they’ve attempted to improve eating habits.

Tablets, wearables, smartphones, video and QR codes: these are fast-growing platforms moving data around the global economy. They’re also fast=growing platforms for health care where we live, work, play and pray. Mary Meeker’s annual presentation on Internet Trends at the D11 Conference, is fresh off the virtual press in its shiny new 2013 version. Meeker has been with the investment firm Kleiner Perkins Caulfield Byers (KPCB) since 2011, and was with Morgan Stanley from 1991 to 2010. She’s a veteran who’s watched the Internet basically from The Beginning. Of the 117 slides in her informative, gargantuan deck (a Meeker hallmark every

Mainstream media, both print and online, peppered their 2013 Mother’s Day gift suggestions including pod coffeemakers, bangle bracelets, candy-colored accessories and digital health devices. Say, what? In Parade magazine, Mother’s Day 2013 gift ideas included the Fitbit “smart pedometer,” linked to a “buy” site at REI. You can’t get much more mainstream than Parade. In Entertainment Weekly, Bronwyn Barnes, style maven for the magazine, wrote a one-page “Get Ready for Mom 2.0” and her recommendations included the Pebble Smartwatch, the Jawbone Up wristband, and the HoodieBuddie with earbuds built into the drawstrings. Men’s Health told sons and husbands to check

The Food & Drug Administration (FDA) launched its new website for and about patients, the Patient Network, with the tagline, “Bringing your voice to drug and device approval and safety.” With this move, the FDA moves toward social health, someplace where at least one-third of U.S. consumers already opine, shop, share personal info, crowdsource cures, and support each other on all-matters-health-and-illness. The objective of the Patient Network is, “to help FDA help patients have a bigger voice.” Dr. Margaret Hamburg, the Commissioner of the FDA, talks about the concept here. The rationale? “When patients better understand the intricacies of how

  Exploiting Big Data in industry is Big News these days, and nowhere is the potential for leveraging the concept greater than in health care. McKinsey & Company estimates that harnessing big data across five dimensions of health care could yield nearly one-half trillion dollars’ worth of value in The ‘big data’ revolution in healthcare. The chart summarizes McKinsey’s calculations on the value of Big Data in health care at its maximum. Before digging into the value potential, just what is Big Data in health care? Statistics and information are generated in the health care system about patients: say, during visits

While health care cost growth has slowed nationally, most Americans feel they’re going up faster than usual. 1 in 3 people believe their own health costs have gone up faster than usual, and 1 in 4 feel they’re going out about “the same amount” as usual. For only one-third, health costs feel like they’re staying even. As the second quarter of 2013 begins and the implementation of the Affordable Care Act (ACA, aka “health reform” and “Obamacare”) looms nearer, most Americans still don’t understand how the ACA will impact them. Most Americans (57%) believe the law will create a government-run health plan,

Digital health is attracting the likes of Bill Clinton, Lupe Fiasco, Deepak Chopra, Dr. Sanjay Gupta, Arianna Huffington, and numerous famous athletes who rep a growing array of activity trackers, wearable sensors, and mobile health apps. Will this diverse cadre of popular celebs drive consumer adoption of mobile health? Can a “cool factor” motivate people to try out mobile health tools that, over time, help people sustain healthy behaviors? Mobile and digital health is a fast-growing, good-news segment in the U.S. macroeconomy. The industry attracted more venture capital in 2012 than other health sectors, based on Rock Health’s analysis of the year-in-review. Digital health

In 2010, the folks who supported health care reform were massacred by the polls, Bill Clinton told a rapt audience of thousands at HIMSS13 yesterday. In 2012, the folks who were against health care reform were similarly rejected. President Clinton gave the keynote speech at the annual HIMSS conference on March 6, 2013, and by the spillover, standing-room-only crowd in the largest hall at the New Orleans Convention Center, Clinton was a rock star. Proof: with still nearly an hour to go before his 1 pm speech, the auditorium was already full with only a few seats left in the

At HIMSS13 there are the equivalent of rock stars. Some of these are health system CIOs and health IT gurus who are driving significant and positive changes in their organizations, like Blackford Middleton, Keith Boone, Brian Ahier, and John Halamka. Others are C-level execs at health IT companies. In this latter group, many avoid the paparazzi (read: health trade reporters) and stay cocooned behind closed doors in two-story pieces of posh real estate on the exhibition floor. A few walk the floor, shake hands with folks, and take in the vibe of the event. We’ll call them open-source personalities. The

On a recent Whole Living segment on Martha Stewart’s Sirius XM radio channel, I learned of the artisan chocolatier, Gnosis. The company, whose name is Greek for “knowledge,” grew out of the kitchen of a holistic health counselor, Vanessa Berg, who began to make nutritionally-infused sweets for her private clientele. Word-of-mouth made its way to a buyer from Whole Foods, who subsequently did a deal with Berg to sell Gnosis goods in some of the company’s stores in New Jersey and New York. Here’s a link to the radio interview. Chocolate is a health food for this company, and for

There are many ways to measure and express “patient engagement.” One such metric is “patient activation,” innovated by Dr. Judith Hibbard, long affiliated with the University of Oregon. Dr. Hibbard has written extensively about the Patient Activation Measure, PAM, first described in 2004. She and a team of researchers have determined that the higher a patient’s PAM score, the lower their health costs. Hibbard et. al. published these findings in the February 2013 issue of Health Affairs, which is entirely devoted to patient engagement – a top topic in Health Populi. The team analyzed the medical records of 33,163 patients

Americans have a clear message for the 113th Congress: I want my MTV, but I want my Medicare, Medicaid, Social Security,   health insurance subsidies, and public schools. These budget-saving priorities are detailed in The Public’s Health Care Agenda for the 113th Congress, conducted by the Kaiser Family Foundation, Robert Wood Johnson Foundation, and the Harvard School of Public Health, published in January 2013. The poll found that a majority of Americans placed creating health insurance exchanges/marketplaces at top priority, compared with other health priorities at the state level. More people support rather than oppose Medicaid expansion, heavily weighted toward 75%

There’s good news on the macro-health economics front: the growth rate in national health spending in the U.S. fell in 2011, according to an analysis published in Health Affairs January 2013 issue. Furthermore, this study found that consumers’ spending on health has fallen to 27.7% of health spending, down from 32% in 2000, based on three spending categories: 1. Insurance premiums through the workplace or self-paid 2. Out-of-pocket deductibles and co-pays 3. Medicare payroll taxes. A key factor driving down health spending is the growth of generic drug substitution for more expensive Rx brands. Generics now comprise 80% of prescribed

Reducing health care costs far outranks improving quality and safety, improving the public’s health, and upping the customer experience as Americans’ top priority for President Obama’s health care agenda, according to a post-election poll conducted by PwC’s Health Research Institute. In Warning signs for health industry, PwC’s analysis of the survey results, found that 7 in 10 Americans point to the high costs of health care as their top concern in President Obama’s second term for addressing health care issues. Where would cost savings come from if U.S. voters wielded the accountant’s scalpel? The voters have spoken, saying, Reduce payments

As I prepare remarks to present a talk about health reform and the pharmaceutical market landscape for tomorrow, Election Day, it struck me that the health industry is now facing 3 Cliffs: the patent cliff, the health care cost cliff, and the Fiscal Cliff. The patent cliff represents about $290 billion worth of sales losses to the pharmaceutical industry between 2012 and 2018. The first chart illustrates that dramatic slope downward, with this year, 2012, being the height of patent losses for the industry. EvaluatePharma, a UK consultancy, says that falling revenue for a pharma is usually a precursor to

Grocery stores are incorporating farmers market-like shelves into produce departments, offering shoppers locally grown fruits and vegetables. Kraft Foods is reinventing itself as a health brand, with   Consumers are shifting away from white starchy breakfast foods toward beans and greens. These are a few of the food-meets-health trends from the past quarter that reflect how American health citizens are incorporating new food habits into overall health behaviors. Let’s begin with the October 11, 2012, issue of The New England Journal of Medicine, which focuses on obesity, food, and health policy. Along with an excellent overview of Obama v. Romney

A teddy bear in the arms of a child with diabetes can change health care. At least, Jerry the Bear can. Yesterday kicked off the sixth autumn mega-version of the Health 2.0 Conference in San Francisco. Co-founded by Matthew Holt and Indu Subaiya, a long-time health analyst and physician, respectively, this meeting features new-new tools, apps and devices aimed at improving individual and population health, as well as health processes and workflows for physicians, hospitals, pharma, and other stakeholders in the health care ecosystem – even health lawyers, who met on October 7 to discuss up-to-the-minute  e-health law issues. Yesterday was

Among factors that contribute to patients’ positive experiences with health care providers, the doctor’s ability to access ‘my’ overall medical history is nearly as important to consumers as the doctor’s overall knowledge, training and expertise. This enlightening data point comes to us from a Harris Interactive poll conducted in July 2012 and published this week. This news is important because it’s National Health IT Week. I attended the kickoff meeting for #NHITWeek yesterday in Washington, DC, held in the Department of Health and Human Services headquarters building named for Hubert Humphrey – an early public health proponent (and trained pharmacist,

I tore out a two-page ad from the June 17, 2012, New York Times Magazine sponsored by Fidelity Investments with the headline, “Your genetic secrets may not be a secret much longer…and we see opportunity.” The ad copy went on to talk about the emerging era of personalized medicine and big data to help patients…and to be an investment growth area. Fidelity has launched a video online as part of its ThinkingBig series at Fidelity.com/thinkingbig which talk about this complex issue. Fidelity is onto something big here. In the first iteration of the Edelman Health Barometer survey, launched in 2008, we

Since the advent of the Great Recession of 2008, more Americans have been splitting pills, postponing needed visits to doctors, skipping dental care, and avoiding recommended medical tests due to the cost of those health care services. Call it health care self-rationing: the Kaiser Family Foundation (KFF) has been tracking this trend for the past several years, and the proportion of American adults rationing health demand is up to 58%. This KFF Health Tracking Poll interviewed 1,218 U.S. adults age 18 and older via landline and cell phone in May 2012. As the chart illustrates, 38% of people are “DIYing” health care

Some 500 data analytics gurus representing the health care ecosystem including hospitals, physician practices, life science companies, academia and consulting came together on the lush campus of SAS in Cary, North Carolina, this week to discuss how Big Data could solve health care’s Triple Aim, as coined by keynote speaker Dr. Donald Berwick: improve the care experience, improve health outcomes, and reduce costs. Before Dr. Berwick, appointed as President Obama’s first head of the Centers for Medicare & Medicaid Services, Clayton Christensen of the Harvard Business School, godfather of the theory of disruptive innovation in business, spokee about his journey

Even though Inside-the-Beltway economists have said The Great Recession of 2007 is officially over, it doesn’t look that way when you ask consumers about health spending in 2012, based on results from a survey conducted on behalf of the American Osteopathic Association (AOA). One in 5 U.S. adults is trying to lower their personal health spending. One in four is seeking free or alternate sources of health care. Overall, 1 in 5 people says their health has been negatively impacted by the economy. The AOA discovered that people in the U.S. whose health has been negatively impacted by the economic downturn were

As I leave Asia, where I’ve been for the past two weeks, for the U.S. today, I am reading the daily newspaper, the Korea Joongang News. On today’s op-Ed age is The Fountain column titled, Embracing the do-it-yourself attitude. In it, Lee Na-ree writes, “Making something with your own hands is part of the American pioneer spirit.” He describes the Maker Faire events and the project of Caine’s Arcade, a game developed by a Los Angeles boy who used auto parts from his dad’s shop. Na-ree observes that Americans are ‘regretting’ mass consumption. Health Populi’s Hot Points: I happened upon

Dr. Andrew Weil, the iconic guru of all-things-health, was joined by a panel of health stakeholders at this morning’s Edelman salon discussing Wellness Ignited – Now and Next. Representatives from the American Heart Association, Columbia University, Walgreens, Google, Harvard Business School, and urban media mavens Quincy Jones III and Shawn Ullman, who lead Feel Rich, a health media organization, were joined by Nancy Turett, Edelman’s Chief Strategist of Health & Society, in the mix. Each participant offered a statement about what they do related to health and wellness, encapsulating a trend identified by Jennifer Pfahler, EVP of Edelman. Trend 1: Integrative

There’s a shift in power in health care moving away from providers and suppliers like pharma and medical device companies, toward patients and payers. This is the new health world according to Ernst & Young‘s latest Progressions report called, The third place: health care everywhere. What’s underneath this tectonic shift is the need to bend that stubborn cost curve and address public health outcomes through behavior change. E&Y says look for new entrants, like retailers, IT companies, and telecomms, to be part of the solution beyond traditional health care stakeholders. These participants will be part of both delivery of care

Every patient carries her or his doctor inside, said the great Renaissance man, Albert Schweitzer. Based on Euro RSCG Worldwide’s Prosumer Report – My Body, Myself, Our Problem: Health and Wellness in Modern Times, health citizens globally have begun to take on Dr. Schweitzer’s vision. Clement Boisseau of Euro RSCG points out that people, globally, are fairly schizophrenic when it comes to thinking about empowerment over illness: check out the chart for perceptions by condition and disease state. Boisseau says that people perceive health today both in modern terms (such as feeling empowered to control some conditions), and archaic or “magically

35% of consumers who have been altering their food intake to lose weight are eating fewer processed foods, according to a recent Nielsen Global Survey. This percentage has grown from 29% in 2008. Health and wellness is one of three driving forces shaping food in 2012, according to JWT‘s What’s Cooking: Trends in Food. The other two forces, technology and foodie culture, combine with health/wellness and yield some interesting consumer trends in the milieu of food. JWT’s top food issues to watch are: – Fooducate – Nutrition scores – Fat taxes – Health and fresh vending machines – Gluten-free –

Most U.S. primary care physicians realize the health of their patients is largely out of their hands — with their social needs ranking as important as addressing their medical conditions, according to the 2011 Physicians’ Daily Life Report, conducted on behalf of the Robert Wood Johnson Foundation by Harris Interactive in September-October 2011, results published in November 2011. In fact, unmet social needs are directly leading to worse health for Americans, say 9 in 10 doctors. With that recognition, most physicians feel they’re unable to address patients’ health concerns caused by unmet social needs. This has led to most doctors confessing

There is broad consensus among doctors, patients and health administrators that the current U.S. health system is broken and unsustainable; preventive services is under-utilized and -valued, quality is highly variable from region to region and patient to patient, and costs continue to spiral upward without demonstrating value. While these 3 segments – physicians, people-patient-consumers, and hospital execs, agree on this topline assessment, what they see about the future of health delivery in America varies, according to a new survey from the new Optum Institute for Sustainable Health, Sustainable health communities: A manifesto for improvement. This is the kick-off of the Optum Institute, a member of the

Lifestyle, nutrition, the environment and the health system are four key factors that people globally say have the most impact on their health. Underlying these influences, its friends and family who most shape our health, followed by government and business. Welcome to the 2011 Edelman Health Barometer, the third year the communications firm has polled health citizens around the world on their views on health, behavior change, and the use of information and digital tools. Edelman conducted 15,165 interviews 12 countries in North America, Asia and Europe to gather health citizens’ perspectives. The top-line, globally, is that there is a knowledge-action

Apple has supplanted Google as the world’s #1 most valuable brand, worth more brand-wise than Microsoft and Coca-Cola combined (#5 and #6). the other most valuable global brands are IBM, McDonalds, AT&T, Marlboro, China Mobile, and GE. Technology brands have significantly grown in value with consumers allocating more personal disposable income to products like tablet computers and smartphones, even in the face of recessionary economics the world over. Technology companies are now 1/3 of the top 100 brands. Millward Brown, the brand consultancy that is part of WPP, the global communications firm, has conducted the BrandZ top 100 most valuable

There’s cameraphone hacking that morphs the phone into a blood test device. Embrace Labs in India builds an incubator for $25. Micro- mobile payments are financing health care on the ground in emerging economies.   At SXSW in Austin, TX, on March 12, 2011, a globally experienced quartet of panelists shared their observations of working with highly constrained budgets in developing countries during the session, Mobile Health in Africa: What Can We Learn? The answer is: plenty. Doug Naegele of Infield Health moderated the panel, which included Patricia Mechael of the Center for Global Health and Economic Development at the Earth Institute, part of Columbia University; Josh

One of the favorite holiday gifts I sent people this season was Mark Bittman’s work, The Food Matters Cookbook: 500 recipes for conscious eating. Health Populi’s definition of ‘health’ comes from the World Health Organization: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. So with an eye toward conscious eating as part of everyday health, I headed to two wonderful restaurants on a trip to New York City last week that fit the definition: Rouge Tomate, built on a philosophy of great design and sustainable, balanced food (with locations in

Americans trust their supermarkets and local hospitals more than other industries they deal with. while tobacco and oil companies remain at the bottom of the trust-list for U.S. consumers, health insurance and managed care aren’t much ahead of them. Pharmaceutical companies rank fairly low, with only 11% of U.S. adults seeing them as “honest and trustworthy.” As a result, nearly one-half of Americans would like to see increased regulation on pharma. Over 1 in 3 Americans would like to see managed care and health insurance companies more regulated. The latest Harris Poll has found that oil, pharmaceutical, health insurance and tobacco are

Virtually every primary care doctor in Denmark uses an electronic medical record. Danish health citizens can access their laboratory results, medication profiles, waiting list information, and other information through a digital signature: over 1 million of 5.5 million Danes have done so.   This week, I had the honor of kicking off the online health track at the J. Boye 2010 conference in Aarhus, Denmark. I spent time with an HIT guru from a major Scandinavian university hospital; a member of the Danish public sector HIT organization; marketers from the pharmaceutical industry; an entrepreneur building a portal for the growing private health sector to bring transparency of quality,

With peoples’ adoption of mobile phones, broadband, and apps for which they pay out-of-pocket, the new person-centered medical home is…the home. Policy wonks can wax lyrically and econometrically spin models about how to bend the health cost curve. But patients are the most under-utilized resource in the U.S. health system, as Dr. Charles Safran testified to Congress in 2004. In 2010, patients are getting more engaged as they DIY more at-home: photograph development, travel planning, stock trades, and home improvement. So health care comes home. A column written by Dr. Steven Landers of the Cleveland Clinic, featured in the October 20th 2010 issue of

There are two faces of America in The Great Recession: one is doing pretty well, thank you very much; the other is losing ground, and a lot of it. One Recession, Two Americas from the Pew Research Center is a survey of Americans’ home economics 30 months since the start of the recession which began in December 2007. The recession technically ended in June 2009, according to the National Bureau of Economic Research (NBER). One year after that ‘technical’ end, though, it appears about 1 in 2 Americans haven’t gotten the memo. Some of the Pew’s survey results appear in the chart. See the

In 2010, fewer Americans are receiving health coverage from employers. At the same time, more health citizens are being covered by government programs, including Medicaid, Medicare, military and veterans’ benefits. The proportion of people on government health insurance rolls increased from 22.5% in January 2008 to 25.4% in August 2010. This represents an increase of about 13%. The proportion of Americans covered by employers fell from 50% to 45.5%, a 9% decline. Thus, the number of U.S. health citizens getting absorbed into government-sponsored health programs is growing faster than the loss in the ranks of people covered by private sector health insurance. Data

4 in 5 U.S. health citizens are trying to take better care of ourselves in light of increasing health care costs. A growing number of people are also talking with doctors about treatment options and costs, and searching for cheaper health insurance and less expensive providers. One-quarter of people didn’t fill or skipped doses of prescribed medications in response to increased costs, the same proportion as in 2009. The 2010 Health Confidence Survey from EBRI shows an eroding sense of faith in the American health system, with people expecting challenges for accessing health services and paying for health care in the future.