by Megan Flaherty
June 22, 1998

A new breed of demanding, outspoken healthcare consumer is replacing the more obliging patient of yesteryear.

Experts say this attitude shift can be partly explained by the distinct personalities of different generations of Americans. Baby boomers—who will be the next great wave of healthcare consumers—tend to be more informed, opinionated, and difficult to please than their elders, for example. Overall, research shows that a patient’s age—from senior on down to twentysomething—explains a lot about his or her attitude toward health care.

The mature attitude

Older Americans grew up when healthcare information wasn’t easily accessible. So to many of them, medicine was mysterious and their physician was like a god. "The information highway was still a dirt road, so people deferred to their physicians to make choices," said Steven Steiber, PhD, senior vice president and healthcare practice director at Opinion Research Corp. International in Evanston, Ill.

Even now it would not occur to many seniors to challenge their physicians the way many younger patients do, said Nancy Cirone, MSN, RN, a diabetic educator and education director at Bucks County and Parkview hospitals in Philadelphia. For many seniors—including her own parents—"whatever the physician says to do they do."

Older Americans are generally more satisfied with their health care overall than baby boomers and young adults, although they are the most demanding in terms of the complexity of their illnesses and medications, said Richard L. Kravitz, MD, MSPH, director of the Center for Health Services Research in Primary Care at the University of California, Davis. "They don’t tend to be as consumer-oriented compared to the younger patients and baby boomers."

Older people are the most likely of any adults to have built long-term relationships with their health providers, a good indicator of satisfied patients. A 1998 report by the Center for Studying Health System Change in Washington, D.C., shows that 90 percent of people over 55 have a usual source of care, the highest percentage among all adults. People over 55 are also most likely to have health insurance, which means they have better access to care in the first place. Only 15 percent of those over 55 reported having difficulty getting health care in the past year, the lowest percentage among adults.

Boomer consumers

Baby boomers—now 34 to 52 years old—crave convenience and control, two standards that are difficult to achieve in healthcare, said Mary P. Malone, MS, JD, executive director of consulting services for Press, Ganey Associates in South Bend, Ind. After all, drive-through fast food and ATMs were designed for boomers, and this mentality translates into the healthcare arena, she said. "Boomers won’t stay with health providers who make them wait," Malone said.

In addition to valuing convenience, boomers expect providers to listen to them completely, answer their questions fully, and be receptive to their ideas. They expect them to be willing to discuss health information they pulled off the Internet or to give them details about the drug they just saw on television or in a magazine. "It can be embarrassing for a patient to ask questions about a drug a provider hasn’t heard of," Steiber said.

Boomers have seen amazing progress in medicine; they’ve witnessed the near eradication of polio and childhood diseases. They remember a time when all surgeries were major events, rather than outpatient procedures. But while they appreciate these advances, they are still critical of their own experiences receiving care, Malone said, because "the healthcare industry has emphasized high-tech over high touch." Boomers are now clamoring for both, she said.

Eighty-six percent of this population identifies a usual source of care, and 22 percent reports difficulty obtaining health care in the past year, according to the Center for Studying Health System Change.

Generations X, Y, Z

Young adults won’t reach their peak consumption of health care for many years, so researchers haven’t studied their attitudes in-depth. One thing is clear: They have the highest rate of being uninsured of any generation, said Peter Cunningham, senior researcher at the Center for Studying Health System Change. They are no longer eligible for their parents’ insurance and may take jobs that don’t offer insurance. And some young adults choose not to be insured even if they have the option. "Young adults are generally healthy, so they think they’re going to live forever," Cunningham said.

If they do have insurance, they may face inconsistency in their care providers because they tend to switch jobs a lot and may be forced to switch health plans with every new company. Seventy-six percent of young adults ages 25 to 34 report having a usual source of care, according to the center. And 26 percent—the highest percentage of any adult group—say they have difficulty getting health care.

Of course, many young adults do have insurance. A subgroup of this young adult population is highly educated and Internet-savvy, and has precise ideas about what they want for health care, Kravitz said. They may visit a provider thinking they’ve already diagnosed their problem and requesting a specific test or treatment, Kravitz said. "The extreme example is someone who comes in for headaches and already has a service in mind, like a CT scan or a neurological consultation with an expert."

Across the divide

In fact, receiving a referral to a specialist or getting a medical test authorized are top patient concerns that cut across all age groups, said Ellen Severoni, RN, president of California Health Decisions, a nonprofit public education organization. Severoni says age is important in predicting a patient’s attitudes, but prior experience with the healthcare system carries more weight. "You can work with an older patient with relatively little experience [with health care] or a younger person who unfortunately has a lot of experience," she said.

Steiber agrees that age—along with other demographic variables like sex and income—aren’t always the best predictors of attitude. "Past behavior is the best indicator of future behavior," he said.

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JULY 6

Read part two of
Generations to find out how can you work effectively with seniors, boomers, and Generation Xers.

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