« Remember those New Year’s resolutions? It’s time for a checkup | Main | A policy wonk’s delight: The Social Security and Medicare Trustees report »


Findings from a survey of my son and health insurance: Meet the “intransigents”

by Sheryl Coughlin, Research Lead, Deloitte Services LP

The Deloitte Center for Health Solutions has recently spent time researching what young adults know and think about health insurance through our survey of young adults age 19-34*. The results were recently published in the report “Young adults and health insurance: Not invincible—but perhaps convincible." While working on this study, I decided to road test a few ideas on my unsuspecting in-house young adult and oldest of our three boys.

Opening with “What do you think about health insurance?” wasn’t a good start. A pained expression, slightly raised brow, and a quick glance up from the laptop were all I got. “Okay, well…what about a monthly premium?” I then tried. Much better. He quickly converted that to an annual amount which he decided to be a sky-high figure that he couldn’t afford. And to be frank, he had no idea what it would buy. He thought that health insurance sounded like a good idea, but it was clear that he had no real understanding of what it was, let alone how to get or pay for it.

[Note to self: family health literacy campaign = CLEARLY OVERDUE]

As a parent, this is a timely reminder. Annual physicals and school vaccinations mean that all three boys have been in regular contact with the health care system over the years. Perhaps a "failure to launch" on my part, but leaving the family cocoon and on the brink of adulthood, my oldest should have the skills and knowledge to begin to be responsible for managing his own health. And yet, like many of his peers, has a long way to go.

My son represents a subset of the young adult population that emerged in our survey that covers young adults at many different stages of their lives and with differing needs.

For many of the young adults, what matters most to them about health insurance is overall cost and perceived value for money. Those who purchased insurance say they did so to avoid paying medical bills and for the peace of mind it gives them. Those who decided to forgo health insurance say they did so for two reasons: they believe that they cannot afford insurance and they do not see its value.


Those who remain uninsured are an interesting group, and deeper examination shows two distinct sub-groups–- “the interested” and “the intransigents.” “The interested” have clearly considered obtaining health insurance. They visited HealthCare.gov or had done their homework, checked out eligibility for programs such as Medicaid, and sought information from family and friends. But, at the end of the day, many concluded they just couldn’t afford health insurance. Interestingly, this group considers themselves to be "less healthy" than their peers.

In contrast, “the intransigents” didn’t visit any health insurance websites. Affordability is also a key barrier for this group. But in addition, “the intransigents”’ are distinguished by many who are disinterested or disinclined to buy insurance and unconvinced about value for money. And, a small number are basically opposed to insurance and not interested under any circumstances. These look to me like the younger members of the cost-conscious and disengaged "Casual and Cautious" consumer segment – identified in Deloitte’s ongoing consumer segmentation studies.



The challenge for those charged with policy and advocacy, as well as for health care providers and health plans, is how to engage young adults like my oldest son and his “intransigent” peers. Here are some things to consider:

  • They may be young and healthy now, but as they age they will likely require health care just as much as the rest of the population. New low-cost insurance products that include smaller provider networks and direct distribution channels that target the unique coverage needs and interests of this group could go a long way in delivering a product that is affordable. New entrants to the market could disrupt the traditional channels.
  • Friends and family are important sources of information and guidance. Communications, information, and resources targeting these networks may well be as impactful as directly targeting the young adults. Also to keep in mind, mobile-friendly capabilities should be considered as mobile technology is widely used by young adults as a main source of Internet access.
  • Navigating the health care system and health insurance are new experiences for many young adults. Key steps may include developing road-maps and peer-supports to educate young adults and their supporters about health insurance, personal health management and about the health care system – for example, how to find a primary care doctor or how free preventive care works.
  • Peers are influential. Vlogging (video blogging) is increasing in popularity and early-movers are leveraging these to promote products and services. Engaging influential vloggers with a genuine interest in health and wellness may present opportunities for spreading the message about the why's and how’s of health insurance, framed through the vlogger’s thoughts and opinions on health, wellness, beauty, and fitness.
  • Research has found that new health insurance enrollees tend to "go with the crowd" learning from others who have more information and experience. Some suggest that more people may take up insurance if having it was the norm rather than the exception. For example, strategies that reinforce positive social attitudes about having health insurance may encourage people to “join the team” and sign up for coverage.1

At the end of the day, I hope that there will be high-quality, accessible information readily available to those like my oldest son who are just entering this new world of insurance, as well as opportunities for some of the intransigents to turn into "smart shoppers" and get good, affordable coverage.


Sheryl CoughlinSheryl Coughlin is a research lead at the Deloitte Center for Health Solutions, where she leads objective and data-driven research and thought-leadership. Sheryl has deep expertise in health care research, organizational strategy, and performance management in private and public sector health care organizations.


*Deloitte conducted an online survey of 500 randomly selected young adults age 19-34, between April 9, 2014 and April 23, 2014. Respondents were those who were uninsured as of September 30, 2013, and either remained uninsured or had subsequently become insured through various avenues.

 1Katherine Baicker, William J Congdon, and Sendhil Mullainathan. “Health Insurance Coverage and Take-Up: Lessons from Behavioral Economics.” The Millbank Quarterly 90, no. 1 (2012): 107-34.



The comments to this entry are closed.