2024 Consumer Engagement in Health Care Survey

 The Employee Benefit Research Institute (EBRI) and Greenwald Research published top findings today from the 2024 Consumer Engagement in Health Care Survey (CEHCS). The new research report found that most health insurance enrollees do understand premium and deductible options, but not prescription drug copays or maximum out-of-pocket limits. The survey also found that more than six in ten enrollees have used smart health technology either currently or in the past. However, two-thirds of the enrollees wished the data generated by this technology could be shared with their doctor and six in ten with their health insurance company.

The CEHCS is a survey of privately insured adults that has been conducted annually since 2005. The survey provides reliable national data on the growth of high deductible health plans (HDHP), consumer driven health plans (CDHP) and health savings accounts (HSA) - and the impact on the behavior and attitudes of health care consumers. The 2024 survey of 2,011 individuals was conducted from Oct. 24 to Nov. 25, 2024 and included respondents from ages 21 to 64 years old.

“Simply, I believe we see, via the new survey results, that health insurance enrollees are taking the minimum time to make their health plan decisions. More education is needed. While they are definitely taking advantage of new tech opportunities to make informed decisions, they also seem to need additional input from their health care providing team,” explained Paul Fronstin, Ph.D., director, Health Benefits Research, EBRI.

Key findings in the 2024 survey include:
• Health Plan Knowledge is Often Lacking - Most enrollees understand premiums and deductibles, but not prescription drug copays or maximum out-of-pocket limits. Eighty-six percent understood that premiums are the amount paid for health insurance, regardless of using care, and 82% understood that the deductible is the amount you have to pay out-of-pocket before your plan begins to pay for care. HDHP enrollees were more likely than traditional plan enrollees to answer these questions correctly.

Confusion was noted among most surveyed regarding prescription co-pays. Only about one in four enrollees correctly know that the amount is not the same for all groups of prescriptions. There also is confusion about out-of-pocket maximums. When it comes to knowledge about HSAs and HDHPs, enrollees are more likely to understand HSAs, though overall knowledge remains low (32% correctly answered at least 3 out of 4 statements vs. 22% of traditional plan enrollees).

• Satisfaction with Various Aspects of Health Care Is High, Out-of-Pocket Costs Drives Satisfaction Down - While nearly two-thirds of the enrollees were extremely or very satisfied with their health care, only 10% were not too or not at all satisfied. Satisfaction with the choice of doctors and the quality of health care received were also high, with seven in 10 being extremely or very satisfied. To the degree that enrollees are not satisfied with their health plan, it appears to be driven by costs. Fourteen percent of the enrollees were not too or not at all satisfied with the cost paid out-of-pocket for prescription drugs and 21% were not satisfied with the cost paid out-of-pocket for other health care.

• Smart Health Tech is Popular, but Enrollees Want Data Sharing with Health Providers - Sixty-two percent of enrollees have used smart health technology, such as an application for the phone, wearable device or other technology that includes the ability to sense or track activity for the purposes of managing health, either currently or in the past. Over four in ten enrollees currently use smart health technology, and HDHP enrollees are more likely to use it than traditional plan enrollees. Just over one-third of enrollees have never used smart health technology. Three-quarters agree that smart health technology has made it easier to access care, but two-thirds wish their data could be shared with their doctor and six in ten with their health insurance company.

• Health Savings Accounts Used in a Variety of Ways - Over one-half (56%) of individuals reported opening their HSA to save on taxes. Similarly, 53% opened their HSA to save for future health care expenses and 52% to take advantage of employer contributions. While 36% viewed the account as an investment account, 19% viewed the account as a checking account. Most (66%) viewed the HSA as a savings account. Two-thirds are using the account to pay out-of-pocket expenses incurred this year or in the near term. Only 39% are using it to save for health care expenses in retirement and 38% are using it to minimize taxes or to reduce taxable income.

• Open Enrollment - Most enrollees spent less than two hours deciding on their health plan during open enrollment. One-half spent less than one hour and three in ten spent less than 30 minutes. One-half of enrollees report using annual employee benefits guides to help them decide. Just over one-half of HDHP enrollees used the same resource (down from nearly two in three last year). HDHP enrollees are more likely to use their employee benefits online portal than traditional plan owners. Enrollees were also highly satisfied with various aspects of the open enrollment process. About 90% were satisfied with the overall process -- the time they had to select a plan, materials provided, paperwork, and the person presenting the information during open enrollment.

• Sources of Health Coverage - Most people with private health insurance reported getting their coverage through their own job (61%) or through a spouse’s job (20%). Only 19% said they get it directly either from a health insurance carrier (11%) or from a government exchange (8%). Few individuals with private health insurance said they have had their plan for less than one year (10%). One-half reported having had it for 1 to 2 years (23%) or 3 to 4 years (28%).

Enrollment in HSA-eligible health plans and health reimbursement arrangements appear to have leveled off. Enrollment in health plans with high deductibles that were not eligible to be paired with an HSA continued to fall, reaching 8% in 2024, after having reached 15% in 2020. One-half (53%) of traditional plan enrollees were offered an HDHP in 2024.

“Though satisfaction with open enrollment is high, there is an opportunity for employers to better educate their employees on their plan choices. The bottom line here is that health plan knowledge is generally low and employees do not spend much time making these decisions,” said Sara Rubinstein, director, Healthcare, Greenwald Research.

To view the 2024 CEHCS summary report, visit https://www.ebri.org/health/ebri-greenwald-consumer-engagement-health-care-survey.

Healthy diet during pregnancy supports the child's motor development

The study also found that a healthier maternal diet in early pregnancy was associated with better motor development in the child, especially in gross motor skills at 5–6 years of age. A similar association was found between maternal fish consumption and the child's fine and gross motor skills. A healthy diet includes versatile foods, such as vegetables, fruit, rye bread and fish, which provide vitamins and minerals that are important for a child's development. Fish is also an important source of unsaturated fats, especially omega-3 fatty acids, which are needed for fetal brain development.

"It is likely that targeting prenatal nutrition guidance to mothers who are with overweight or obesity before pregnancy would benefit the mothers themselves, for example, by curbing excessive weight gain during pregnancy, while supporting their children's future motor development,” says Professor Kirsi Laitinen, who leads the Early Nutrition and Health Research Group at the University of Turku.

Plant-rich, low saturated-fat diet associated with reduced psoriasis severity

 

Peer-Reviewed Publication

King's College London

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A diet of fruits and vegetables, whole grains, low-fat dairy foods and lean meats, low in salt and sugar, is associated with reduced psoriasis severity, new research finds.

The new study by researchers at King's College London, published in the British Journal of Nutrition, has found significant associations between diet quality and the severity of psoriasis. The findings provide novel insights into how dietary patterns may be related to psoriasis severity in non-Mediterranean populations.

Psoriasis is a long-lasting inflammatory skin disease which causes flaky patches of skin that form scales. It affects millions worldwide and is believed to be caused by a problem with the immune system.

The research analysed data from 257 adults with psoriasis who had completed an online survey. Participants' adherence to various diet quality scores, including the Mediterranean Diet Score, the Dietary Approaches to Stop Hypertension (DASH) score, and the Healthy Plant-based Diet Index, was assessed using a food frequency questionnaire. Psoriasis severity was self-assessed using a validated questionnaire.

Key findings from the study indicate that individuals with very low adherence to the DASH diet index and the Healthy Plant-based Diet Index were significantly more likely to report higher psoriasis severity.

Further analysis of the different elements of the DASH dietary pattern revealed that greater red and processed meat intake was associated with more severe psoriasis even when body mass index (BMI) was considered. Fruits, nuts and legume intakes were also associated with less severe psoriasis, but this relationship was not independent of BMI.

The study was published as part of the Asking People with Psoriasis about Lifestyle and Eating (APPLE) project and funded by the Psoriasis Association.

"Our findings point to the potential benefits of dietary interventions in improving patient outcomes," said Sylvia Zanesco, PhD student from the Department of Nutritional Sciences at King’s College London who led the research. "Given the impact of psoriasis on physical and psychological well-being, incorporating dietary assessments into routine care could offer patients additional support in managing their condition."

The DASH dietary pattern was originally designed to lower blood pressure and emphasises fruits, vegetables, whole grains, low-fat dairy foods and lean meats while limiting salt, sugar, and saturated fats. A high Healthy Plant-based Diet Index characterises a dietary pattern rich in healthy plant foods including fruits and vegetables, whole grains, nuts and seeds, legumes and plant oils rich in unsaturated fats, as well as being low in animal foods and unhealthy plant foods such as sugary foods and drinks and refined starches.

The study accounted for several confounding factors, including age, sex, smoking status, alcohol, energy intake, and mental health, ensuring a comprehensive analysis of dietary patterns that are independently associated with psoriasis severity.

Emphasising the broader implications of the findings, Professor Wendy Hall, Professor of Nutritional Sciences at King’s College London and senior author of the study, said: "This research brings much-needed evidence that there may be a role for dietary advice, alongside standard clinical care, in managing symptoms of psoriasis. Our next steps will be to explore whether diets rich in healthy plant foods can reduce symptoms of psoriasis in a controlled clinical trial."

The findings of the study contribute to the growing body of evidence supporting dietary modification as a complementary strategy in psoriasis management to potentially alleviate disease severity and improve patients' quality of life.

Dr Thivi Maruthappu, a consultant dermatologist and key investigator on the study, said: “People with psoriasis often ask about how the food they eat affects their skin, and whether changing their diet helps; this research brings us closer to answering these important questions.”

Fitness apps fuelling disordered eating

 With New Year resolutions in full swing and health tracking apps at our fingertips, new research reveals concerning links between health and fitness apps and disordered eating, body image concerns and excessive exercise.

“Diet and fitness apps are marketed as tools to improve health, however they may also have unintended negative consequences, such as creating pressure to meet goals, concerns about body image as well as provoking feelings of guilt if goals aren’t achieved,” says Ms Isabella Anderberg in the College of Education, Psychology and Social Work.

“Whilst there is evidence that these tools can be effective in increasing physical activity, we’re interested in understanding whether these apps might actually be harmful for some users.”

The use of diet and fitness apps is common among young adults, with an estimated 311 million people using health apps, such as MyFitnessPal, to track their meals, calories, and exercise.

Flinders University researchers reviewed 38 studies to examine the links between the use of diet and fitness apps and the risk of users becoming obsessive about weight loss, body image, calorie counting, and excessive exercise.

The research found that those who use health and fitness apps regularly were more likely to have problematic habits related to food and exercise.

“We found that young adults who use diet and fitness apps have greater disordered eating symptoms, such as harmful or restrictive diets, and have negative thoughts about body image when compared to those that don’t use them,” says Ms Anderberg.

“The focus on dietary restriction and weight-loss in these apps may feed into restrictive or excessive behaviours raising concerns for those people who have pre-existing concerns about their weight or body image.

“While some users reported positive experiences such as increased awareness and motivation, the broader implications for mental health need careful consideration, especially among vulnerable populations like adolescents,” she says.

The research also highlights the responsibility that app developers have when designing health and fitness apps to consider the psychological impacts of these tools.

Senior author, Professor Ivanka Prichard, says that as more people turn to apps for guidance in their wellness journeys, they should ensure that they are prioritising mental health alongside fitness goals.

“Our findings highlight the importance of promoting healthy body image and exercise behaviours among young adults, and of being aware of the potential risks associated with the use of diet and fitness apps and for users to approach them with a focus on improving their health,” says Professor Prichard.

“In a growing world of technology, studies like this are important in shaping future research to provide the best health and self-management information via apps to the wider population,” Professor Prichard adds.

The research team noted that more research is needed to understand the benefits and risks related to using health and fitness apps.

“As self-monitoring technology evolves and new diet and fitness apps are released, it is crucial that research continues to explore potential benefits and any unintended consequences connected to their use,” concludes Ms Anderberg.

The article, “The link between the use of diet and fitness monitoring apps, body image and disordered eating symptomology: A systematic review” by Isabella Anderberg, Eva Kemps and Ivanka Prichard was published in Body Image journal. DOI: 10.1016/j.bodyim.2024.101836

Leisure-time physical activity is key for type 2 diabetes risk reduction

 

Physically demanding work is not enough to stay healthyFacebook

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Researchers have found that engaging in moderate to vigorous physical activity during leisure time, regardless of occupational physical activity, is associated with a reduced risk of type 2 diabetes. A combination of sedentary leisure-time activity and demanding occupational activity may increase the risk. Findings from a novel study, appearing in the American Journal of Preventive Medicine, published by Elsevier, add to the body of knowledge that simple lifestyle changes, like recreational physical activity, can make a big difference and can contribute to the global prevention of type 2 diabetes.

The prevalence of type 2 diabetes has more than doubled worldwide over the past decade, making it a major public health burden and a societal challenge.

First author Anna Stage, MSc, Center for Clinical Research and Prevention, Frederiksberg and Bispebjerg Hospital, Denmark, says, "The World Health Organization (WHO) states that physical activity contributes to preventing and managing noncommunicable diseases such as cardiovascular diseases and type 2 diabetes. The current WHO physical activity guidelines do not distinguish in which domains (e.g., work or leisure time) the recommended physical activity takes place. Our findings revealed that while leisure-time physical activity demonstrated a significant protective effect on type 2 diabetes incidence regardless of occupational physical activity level, no similar benefits were observed for occupational physical activity, suggesting that the 'Physical Activity Health Paradox,' which refers to the contrasting associations of physical activity during leisure time and occupational physical activity with cardiovascular disease, may also apply to type 2 diabetes. Currently the evidence is inconsistent and scarce."

This register-based study utilized data from 5,866 working adults aged 30-60 in the Inter99 cohort in Denmark. Assessment of type 2 diabetes status and date of diagnosis were based on the Danish Diabetes Register covering prevalent and incident diabetes from January 1, 1996 to June 30, 2020. In addition to undergoing a physical examination, participants answered a questionnaire about their levels of occupational physical activity and leisure-time physical activity. Data were analyzed in 2024, taking relevant variables into account.

The main findings of the research are:

• Strenuous physical activity at work could be associated with incident type 2 diabetes, however, this was not a statistically significant finding.
• Physical activity during leisure time with moderate to vigorous intensity was associated with a significantly lower risk of type 2 diabetes.
• Sedentary leisure-time activity, such as watching TV or reading, combined with a job that requires any kind of physical activity, was significantly associated with an increased risk of type 2 diabetes.
• Moderate to vigorous intensity physical activity during leisure time combined with any level of occupational physical activity was protective for incident type 2 diabetes.

Stage points out, "It is noteworthy that the WHO recommendations on physical activity do not distinguish between work and leisure time, hence sending a potentially misleading message that daily physical activity accrued during work hours is sufficient to comply with current activity guidelines. However, our findings along with those of others underscore that leisure-time, not occupational, moderate to vigorous physical activity seems to reduce the risk of incident type 2 diabetes, other noncommunicable diseases, and all-cause mortality."

‘Healthy’ vitamin B12 levels not enough to ward off neuro decline

 Meeting the minimum requirement for vitamin B12, needed to make DNA, red blood cells and nerve tissue, may not actually be enough – particularly if you are older. It may even put you at risk for cognitive impairment.

A new study, led by UC San Francisco researchers, found that older, healthy volunteers, with lower concentrations of B12, but still in the normal range, showed signs of neurological and cognitive deficiency. These levels were associated with more damage to the brain’s white matter – the nerve fibers that enable communication between areas of the brain – and test scores associated with slower cognitive and visual processing speeds, compared to those with higher B12.

The study published in Annals of Neurology on Feb. 10.

The researchers led by senior author Ari J. Green, MD, of the UCSF Departments of Neurology and Ophthalmology and the Weill Institute for Neurosciences, said that the results raise questions about current B12 requirements and suggest the recommendations need updating. 

“Previous studies that defined healthy amounts of B12 may have missed subtle functional manifestations of high or low levels that can affect people without causing overt symptoms,” said Green, noting that clear deficiencies of the vitamin are commonly associated with a type of anemia. “Revisiting the definition of B12 deficiency to incorporate functional biomarkers could lead to earlier intervention and prevention of cognitive decline.”

Lower B12 correlates with slower processing speeds, brain lesions

In the study, researchers enrolled 231 healthy participants without dementia or mild cognitive impairment, whose average age was 71. They were recruited through the Brain Aging Network for Cognitive Health (BrANCH) study at UCSF. 

Their blood B12 amounts averaged 414.8 pmol/L, well above the U.S. minimum of 148 pmol/L. Adjusted for factors like age, sex, education and cardiovascular risks, researchers looked at the biologically active component of B12, which provides a more accurate measure of the amount of the vitamin that the body can utilize. In cognitive testing, participants with lower active B12 were found to have slower processing speed, relating to subtle cognitive decline. Its impact was amplified by older age. They also showed significant delays responding to visual stimuli, indicating slower visual processing speeds and general slower brain conductivity. 

MRIs revealed a higher volume of lesions in the participants’ white matter, which may be associated with cognitive decline, dementia or stroke. 

While the study volunteers were older adults, who may have a specific vulnerability to lower levels of B12, co-first author Alexandra Beaudry-Richard, MSc, said that these lower levels could “impact cognition to a greater extent than what we previously thought, and may affect a much larger proportion of the population than we realize.” Beaudry-Richard is currently completing her doctorate in research and medicine at the UCSF Department of Neurology and the Department of Microbiology and Immunology at the University of Ottawa.

“In addition to redefining B12 deficiency, clinicians should consider supplementation in older patients with neurological symptoms even if their levels are within normal limits,” she said. “Ultimately, we need to invest in more research about the underlying biology of B12 insufficiency, since it may be a preventable cause of cognitive decline.”

For more information:

https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/

Higher consumption of highly processed foods, fast food = higher-risk of urinary incontinence

 Higher consumption of highly processed ready-made foods and fast food increased the risk for experiencing symptoms of stress and urgency urinary incontinence. Higher consumption of fruits and an overall higher quality diet decreased the risk for stress urinary incontinence. 

The prevalence of pelvic floor disorders increases as women approach their menopausal years. Estrogen deprivation during menopause, natural aging, reproductive history, and factors increasing intra-abdominal pressure may lead to structural and functional failure in the pelvic floor. In addition, lifestyle choices such as quality of nutrition and eating behaviour may have a significant effect on the mechanisms of pelvic floor disorders. 

“Eating behaviour has been minimally studied as a potential risk factor for pelvic floor disorders,” says doctoral researcher Mari Kuutti from the Faculty of Sport and Health Sciences of the University of Jyväskylä. “We studied how disordered eating can affect the onset of the symptoms.”  

Disordered eating includes overeating, restrictive eating as well as alternating between the two behaviours. 

“We found that women who reported disordered eating were more likely to experience the symptoms of pelvic floor disorders than were women who had reported normal eating,” Kuutti says. 

The disorders studied were stress urinary incontinence, urgency urinary incontinence, fecal incontinence, and constipation and defecation difficulties. 

Pelvic floor disorders are common  

Over half of the participants of the study had symptoms of pelvic floor disorders. Most common was stress urinary incontinence. The study revealed that eating behaviour and consuming some dietary items were associated with onset of the symptoms of pelvic floor disorders. 

“We studied the potential negative and positive associations of common Finnish food items with the symptoms of pelvic floor disorders,” Kuutti says. 

“For example, higher consumption of highly processed ready-made foods and fast food increased the risk for experiencing the symptoms of stress and urgency urinary incontinence. Higher consumption of fruits and overall higher quality diet decreased the risk for stress urinary incontinence.” 

As a preventive measure, the eating behaviour of women at risk for these symptoms should be assessed, and guidance towards healthy eating patterns should be provided. 

The research is part of the ERMA study, the participants of which included over 1,000 women between the ages of 47 and 55 living in the Jyväskylä region. Participants self-reported their eating behaviour as along with demographic factors (age, body mass index, education, physical workload, and physical activity) and gynecological factors (gestations, parity, menopausal status, and hysterectomy) through questionnaires.