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Health Insurance - US - April 2009

Reforming the U.S. health care system has been on the top of politicians’ agendas for decades and is finally seeing some real focus by President Obama and his administration. Problems with the system abound, from the high cost of services, to the technical inefficiencies of the system, to the 46 million Americans who are at this time uninsured. Within his first months in office, President Obama has already outlined a plan that would overhaul the industry, changing the business in many ways and providing opportunities for those companies who are willing to adapt.

Readers of this report will be better informed about the massive shifts taking place in the industry and better positioned to understand the strategic decisions they must make to succeed in this increasingly challenging industry.

Topics covered in this report are:

  • How the recession is affecting the health care industry
  • The success of Medicare Part D
  • How President Obama is planning to begin the work of reform
  • Specific insights on what certain companies are doing to drive reform and what opportunities may be available to those companies that seek them

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Table of contents

  1. Scope and Themes

    • What you need to know
      • Methodology
        • Abbreviations and terms
        • Executive Summary

          • Industry overview
            • The recession is taking a toll
              • The new administration is taking action
                • The consumer and healthcare
                  • Who has responsibility for healthcare?
                    • What is important in a health plan?
                    • Insights and Opportunities

                      • Become proactive in healthcare reform
                        • Reduce healthcare costs
                          • Concentrate on wellness programs
                            • Invest in technology
                              • Investigate critical illness insurance
                                • Voluntary health benefits play a bigger role
                                  • Figure 1: Worksite life insurance sales, by lines of business, 2007
                                  • Figure 2: Group and individual worksite sales, 2002-07
                                  • Figure 3: Worksite sales, by distribution segment, 2007
                              • Inspire Insights

                                  • Trend: Over-Optioned Consumers
                                    • What we have seen
                                      • Implications
                                        • Trend: Customization
                                          • What we have seen
                                            • Implications
                                              • Trend: Health 2.0
                                                • Implications
                                                • Market Size and Forecast

                                                  • Key points
                                                    • NHE continue to grow, albeit at a slower pace
                                                      • Figure 4: Growth in NHE and GDP, 2003-18
                                                    • The growth of the uninsured…
                                                      • Figure 5: Number of insured/uninsured in U.S., 1999-2007
                                                    • …and the underinsured
                                                      • How America spends its healthcare money
                                                        • Figure 6: Sources of U.S. healthcare funds, 2006
                                                    • Competitive Context

                                                      • Key points
                                                        • Americans are shopping more for healthcare
                                                          • Fortune magazine’s World’s Most Admired Companies define corporate reputations
                                                            • Figure 7: 2009 Fortune magazine’s most admired companies, managed care category
                                                        • Marketing Channels

                                                          • Key point
                                                            • Online marketing is more prevalent
                                                              • Storefronts
                                                              • Market Drivers

                                                                • Key points
                                                                  • Health insurance and the recession
                                                                    • Rising costs are changing the way people use the healthcare system
                                                                      • Individuals are paying more
                                                                        • Legislation expands COBRA
                                                                          • Obama’s healthcare reform proposal
                                                                            • Mergers and acquisitions remain commonplace in the health insurance industry but have become a source of concern
                                                                              • The popularity of HSAs has exploded
                                                                                • Figure 8: Enrollment in HSAs, 2005-08
                                                                              • Medical tourism is becoming more popular
                                                                                • CDHPs and HDHPs
                                                                                    • Figure 9: Percentage of respondents extremely or very satisfied with quality of care, 2005-08
                                                                                    • Figure 10: Percentage extremely or very satisfied with out-of-pocket costs, 2005-08
                                                                                    • Figure 11: Percentage of those who believe that their health plan will protect them against an expensive illness, 2005-08
                                                                                • Leading Companies

                                                                                  • Key points
                                                                                    • Figure 12: Top health insurance groups, by direct premiums, 2007
                                                                                    • Figure 13: Top health insurers, by premiums, 2006 vs. 2007
                                                                                    • Figure 14: Largest health insurance companies, by revenues, 2007
                                                                                  • UnitedHealth Group
                                                                                    • Aetna
                                                                                      • WellPoint
                                                                                      • Innovation and Innovators

                                                                                        • Key point
                                                                                          • Massachusetts’ 2006 health insurance plan has earned strong approval
                                                                                            • Montana expands healthcare coverage for children
                                                                                            • Advertising and Promotion

                                                                                              • Key points
                                                                                                  • Figure 15: Health insurance direct mail volume, Q3 2007-Q3 2008
                                                                                                  • Figure 16: Mail volume, by product*, Q3 2008
                                                                                                • Direct mail
                                                                                                  • Figure 17: Direct mail from Blue Cross & Blue Shield of Illinois, November 2008
                                                                                                  • Figure 18: Direct mail piece from Golden Rule Health Company, November 2008
                                                                                                  • Figure 19: Direct mail from Aetna/AARP, April-May 2008
                                                                                                  • Figure 20: Anthem Blue Cross & Blue Shield direct mail piece promoting preventative care, October 2008
                                                                                                  • Figure 21: Humana mailing reminding of the need for a flu shot, October 2008
                                                                                                  • Figure 22: Direct mail from UnitedHealthcare, July-August 2008
                                                                                                  • Figure 23: AFLAC customer loyalty piece, March-July 2008
                                                                                                • Print advertising
                                                                                                  • Figure 24: Medicare plan ad, January 2009
                                                                                                  • Figure 25: Ad for heart scan gift certificate, February 2009
                                                                                                  • Figure 26: Ad for CarePlus, January 2009
                                                                                                • Television ads
                                                                                                  • Figure 27: “More choices, more options,” Assurant Health, 2008
                                                                                                  • Figure 28: eHealth.com, 2008
                                                                                                  • Figure 29: AFLAC, 2008
                                                                                                  • Figure 30: Aflacforbusiness.com, 2008
                                                                                                  • Figure 31: UnitedHealthcare through AARP, 2008
                                                                                                  • Figure 32: Humana all-in-one health plan, 2008
                                                                                              • The Consumer—Enrollment and Type of Plan

                                                                                                • Key points
                                                                                                    • Figure 33: Respondents enrolled in a health insurance plan, by gender and age, November 2008
                                                                                                    • Figure 34: Respondents enrolled in a health insurance plan, by race/Hispanic origin and household income, November 2008
                                                                                                    • Figure 35: Type of health insurance, by gender and age, November 2008
                                                                                                    • Figure 36: Type of health insurance, by race/Hispanic origin and household income, November 2008
                                                                                                • The Consumer—Satisfaction with Components of Current Plan

                                                                                                      • Figure 37: Satisfaction with components of medical plan, net satisfied by gender and age, November 2008
                                                                                                      • Figure 38: Satisfaction with components of medical plan, net satisfied by race/Hispanic origin and household income, November 2008
                                                                                                      • Figure 39: Satisfaction with components of medical plan, November 2008
                                                                                                  • The Consumer—Importance of Components in Choosing A New Plan

                                                                                                        • Figure 40: Importance of components of medical plan in choosing a new plan, by gender and age, November 2008
                                                                                                        • Figure 41: Importance of components of medical plan in choosing a new plan, by race/Hispanic origin and household income, November 2008
                                                                                                        • Figure 42: Importance of components of medical plan in choosing a new plan, by existing plan type, November 2008
                                                                                                        • Figure 43: Importance of components of medical plan in choosing a new plan, summary of means, by gender with age, November 2008
                                                                                                    • The Consumer—Degree of Trust in Healthcare and Insurance Providers

                                                                                                        • Figure 44: Degree of trust in healthcare and insurance providers, November 2006
                                                                                                        • Figure 45: Level of trust in various medical professionals, by gender and age, November 2008
                                                                                                        • Figure 46: Level of trust in various medical professionals, by gender and age, November 2008
                                                                                                        • Figure 47: Level of trust in various medical professionals, by race/Hispanic origin and household income, November 2008
                                                                                                        • Figure 48: Degree of trust in healthcare and insurance providers, by marital status and presence of children, November 2008
                                                                                                    • The Consumer—Who is Responsible for Increasing Healthcare Costs?

                                                                                                        • Figure 49: Degree to which healthcare providers have contributed to the increasing cost of healthcare, summary of means, by gender and age, November 2008
                                                                                                        • Figure 50: Degree to which respondents believe that healthcare and insurance providers are contributing to the increasing cost of healthcare, November 2006
                                                                                                        • Figure 51: Degree to which healthcare providers have contributed to the increasing cost of healthcare, summary of means, by race/Hispanic origin and household income, November 2008
                                                                                                        • Figure 52: Degree to which healthcare providers have contributed to the increasing cost of healthcare, summary of means, by gender with age, November 2008
                                                                                                    • The Consumer—Who is Responsible for Providing Insurance?

                                                                                                          • Figure 53: Who should have responsibility for providing health insurance, by gender and age, November 2008
                                                                                                          • Figure 54: Who should have responsibility for providing health insurance, by race/Hispanic origin and household income, November 2008
                                                                                                          • Figure 55: Who should have responsibility for providing health insurance, by insured/uninsured, November 2008
                                                                                                          • Figure 56: Who should have responsibility for providing health insurance, by marital status and presence of children, November 2008
                                                                                                          • Figure 57: Who should have responsibility for providing health insurance, by gender with age, November 2008
                                                                                                      • The Consumer—Expectations about Health Insurance in the Future

                                                                                                            • Figure 58: Attitudes towards health insurance, by gender and age, November 2008
                                                                                                            • Figure 59: Attitudes towards health insurance, by race/Hispanic origin and household income, November 2008
                                                                                                            • Figure 60: Attitudes towards insurance, by marital status and presence of children, November 2008
                                                                                                            • Figure 61: Attitudes towards insurance, by gender with age, November 2008
                                                                                                            • Figure 62: Attitudes towards healthcare, 2007 and 2008
                                                                                                        • The Consumer—Historical Comparison of Marketing Channel Used

                                                                                                            • Figure 63: Method of obtaining current medical policy, 2003-08
                                                                                                            • Figure 64: Method of obtaining current medical policy, 2007 and 2008
                                                                                                        • The Consumer—Satisfaction with Employer-provided vs. Individual Policies

                                                                                                            • Figure 65: Degree of satisfaction with employer-provided policies, by employment status, November 2008
                                                                                                            • Figure 66: Importance of attributes when choosing a policy, employer provided policies, by employment status, November 2008
                                                                                                            • Figure 67: Importance of attributes when choosing a policy, for those with individual policies, by employment status, November 2008
                                                                                                        • Cluster Analysis

                                                                                                            • Organizers
                                                                                                              • Who they are
                                                                                                                • Opportunity
                                                                                                                  • The Employed
                                                                                                                    • Who they are
                                                                                                                      • Opportunity
                                                                                                                        • Loners
                                                                                                                          • Who they are
                                                                                                                            • Opportunity
                                                                                                                              • Cluster characteristics
                                                                                                                                • Figure 68: Health insurance clusters, November 2008
                                                                                                                                • Figure 69: Type of health insurance, by health insurance clusters, November 2008
                                                                                                                                • Figure 70: Who should have responsibility for providing health insurance, by health insurance clusters, November 2008
                                                                                                                                • Figure 71: Satisfaction with components of medical plan, by health insurance clusters, November 2008
                                                                                                                                • Figure 72: Importance of components of medical plan in choosing a new plan, by health insurance clusters, November 2008
                                                                                                                                • Figure 73: Level of trust in various medical professionals, by health insurance clusters, November 2008
                                                                                                                                • Figure 74: Degree to which healthcare providers have contributed to the increasing cost of healthcare, by health insurance clusters, November 2008
                                                                                                                              • Cluster demographics
                                                                                                                                • Figure 75: Health insurance clusters, by gender, November 2008
                                                                                                                                • Figure 76: Health insurance clusters, by age, November 2008
                                                                                                                                • Figure 77: Health insurance clusters, by household income, November 2008
                                                                                                                                • Figure 78: Health insurance clusters, by race, November 2008
                                                                                                                                • Figure 79: Health insurance clusters, by Hispanic origin, November 2008
                                                                                                                              • Cluster methodology
                                                                                                                              • Appendix: Trade Associations

                                                                                                                                Companies Covered

                                                                                                                                • American Academy of Family Physicians (AAFP)
                                                                                                                                • American Association of Retired Persons (AARP)
                                                                                                                                • American Medical Association (AMA)
                                                                                                                                • America’s Health Insurance Plans
                                                                                                                                • Blue Cross and Blue Shield Association
                                                                                                                                • Co-operative Group
                                                                                                                                • Eastbridge Consulting Group, Inc
                                                                                                                                • Employee Benefit Research Institute
                                                                                                                                • Greenfield Online
                                                                                                                                • Henry J. Kaiser Family Foundation
                                                                                                                                • Insurance Information Institute Inc.
                                                                                                                                • National Association of Insurance Commissioners (NAIC)
                                                                                                                                • PacifiCare Health Systems, Inc.
                                                                                                                                • PricewaterhouseCoopers
                                                                                                                                • Principal Financial Group, Inc.
                                                                                                                                • Starbucks Corporation
                                                                                                                                • U.S. Securities and Exchange Commission
                                                                                                                                • UnitedHealth Group Incorporated
                                                                                                                                • Walmart Stores (USA)
                                                                                                                                • WellPoint, Inc.

                                                                                                                                Health Insurance - US - April 2009

                                                                                                                                £3,277.28 (Excl.Tax)