Primary market research conducted in March 2009 on the impact of the economy on young families. Pertinent for health care professionals offering childbirth or pediatric services.

1. Bon Secours Richmond Health System
Market Research ● March 2009
Young Families
and the Economy
Mary Anne Graf
Vice President
Women’s and Children’s Services
Bon Secours Richmond Health System
mary_anne_graf@bshsi.org

2. Ownership and Credit
• This presentation includes comparative data from relevant databases
nationwide. Please credit these databases if you use this information.
• The primary market research in this presentation, starting with slide 9, is
the sole property of Bon Secours Richmond Health System. You may use
this information under the following conditions:
• The information used remains essentially unaltered.
• Bon Secours Richmond Health System Women’s & Children’s Services is
noted as the source.
• Contact information (mary_anne_graf@bshsi.org) is included with the
information.
• The date of the market research is shown (March 2009).
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3. Key to Taking Advantage
of the Down Economy
• Know the market
• National, local
• Within women’s services,
most significant impact
nationally so far is
undoubtedly on young
families
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4. Review of National Trends
See Reference section
at end of presentation
for more information.

5. 5

6. 6

7. 7

8. Healthcare and the Economy: U.S.
Most Affected Least Affected
• Black, Hispanic • Asian
• Single, separated, divorced • Married
• Age 18-39 • Age >60
• Income <$48,000/year • Income >$48,000/year,
• Part-time employment particularly those making
• Poor to fair health >$90,000
• Full-time employed
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9. Young Families and the Economy
Bon Secours
Market Research
Young Families
and the Economy
March 2009

10. The Impact of the Economy: OB
08Q1 Pediatrix reports
1st ever NICU volume
downturn
Many Snowmass May 08
Participants note OB
volumes down ~5-10%
Unstable
economy already
Dec 07:
felt by young
“Recession” All/majority of
families
official US hospitals feel
OB decrease
OB-Neo overlay source: Graf, Health Care Innovations, 2009 ● TeamHCI.com 10

11. Market Research Components
• Comprehensive review of national data re: young families and the
recession from CY07 forward
• US, 2008: 57% of those unemployed were between the ages of 20 and 44 –
prime childbearing age
• In Virginia in Dec 08 alone, 36% of those laid off were between 30 and 44,
and likely another 40% <30
• Bon Secours market research (Mar 09)
• Random phone survey of young families, age 18-44 (N=275)
• At 95% confidence level, the maximum statistical error for the N is +/-
5.9%.
• Highly applicable sample to current childbearing age families: 76% (n=205)
either were currently pregnant or had child age 5 or under to ensure target
population
• Focus groups: Two groups of young mothers who had delivered in the last six
months
• Mirrored national trends, but provided detail on young families
11

12. Bon Secours Research, Young Families and the Economy
Survey Respondents
• Phone survey, land lines only; random calls, purchased lists
• N=275
• Age 18-44
• Male: 112
• Female: 163
• Pregnant or have child age 5 or under: 205
• 92% married
• Insured
• Insurance: 87%
• Medicaid: :8%
• No insurance: 4% (Half of these lost insurance when they were laid
off)
Bon Secours Richmond Health System market research, 2009. All rights reserved.
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13. Bon Secours Research, Young Families and the Economy
Survey Respondents
• Average number of children in
household: 2.1
• Ethnicity
• Non-Hispanic Caucasian: 87%
• African American: 10%
2.1 children
• Asian or Hispanic: 1% each
• Survey: Median family income: $55,000 to $75,000 (skewed
slightly high; average family income nationally for childbearing
demographic is about $50,000)
• Likely due to use of land lines only
• Focus group: Skewed low income
Bon Secours Richmond Health System market research, 2009. All rights reserved.
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14. Bon Secours Research, Young Families and the Economy
Employment in the Recession
• Laid off: 6%
• Income frozen or reduced: 28%
• No impact: 48%...
• All
• 76% personally know someone
who was laid off since recession
start
• 50% personally know someone
who has had their income frozen
or reduced
Bon Secours Richmond Health System market research, 2009. All rights reserved.
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15. Bon Secours Research, Young Families and the Economy
Overall Impact of the Economy
• Specifically related to the economy
• 87% have changed how their family spends money
• 29% have had weight management problems (up or down)
• 40% have trouble sleeping
• 77% changed how they shop for groceries
• 16% started or increased smoking
• 40% acknowledge strained relationship with spouse/partner, and
another 30% say economic concerns have hurt their sex life
• Of the 27 women who were pregnant, 20% felt their pregnancy
negatively interfered with finding a new job
Bon Secours Richmond Health System market research, 2009. All rights reserved.
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16. Bon Secours Research, Young Families and the Economy
Handling Family Health Care
• Limiting health care expenses for the family: 79%
• Fewer visits to doctor: 16%
• Delayed procedures or surgery: 7%
• Difficulty paying for hospitalization: 7%
• Cancelled or delayed annual exam: 6% or mammogram: 3%
• Difficulty paying for medications: 6%
• Delayed medical tests: 5%
• Used free clinic: 3%
Bon Secours Richmond Health System market research, 2009. All rights reserved.
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17. Bon Secours Research, Young Families and the Economy
Plans for Children
• The impact of the economy on plans for
children
• Decided not to have any more children: 15%
• Decided on few children than when economy
was better: 7%
• More careful about using birth control, started
birth control or had sterilization: 8%
• Delayed a pregnancy: 4%
• Of the 10% who considered adoption or
infertility treatments during the last two
years, one out of four stopped because of
the economy
Bon Secours Richmond Health System market research, 2009. All rights reserved.
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18. Bon Secours Research, Young Families and the Economy
Impact on Pregnancy
• Of 27 respondents expecting a baby
• Had planned to move, cannot do now: 15%
• Cannot afford the right foods for pregnancy: 15%
• Had fewer prenatal/doctor visits: 11% or no visits: 7% (total, 18%)
• Could not afford birth control: 7%
• Did not take prenatal classes: 7%
• Biggest concerns:
• Cost of childbirth at the hospital: 22%
• Cost of baby supplies, e.g., diapers, nursery: 22%
• Rising household costs (mortgage, utilities): 22%
• Cost of raising the child: 19%
• Can marriage relationship take the stress? 19%
• Worries about job (self or spouse): 19%
• Cost of prenatal care: 11%
Bon Secours Richmond Health System market research, 2009. All rights reserved.
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19. Bon Secours Research, Young Families and the Economy
Other Stressors
• Supporting adult relatives
• 13% started providing financial support to an adult relative in the last
two year
• 5% have a relative (not immediate family) living with them
• Another 22% consider it likely that a relative will be living with them
soon
• 23% rate their health insurance coverage as worse than two
years ago
• Focus groups: Women don’t have money for the very basics
(diapers, pads) for their first days at home…let alone later
• For these women, breast-feeding is a luxury they cannot afford
Bon Secours Richmond Health System market research, 2009. All rights reserved.
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20. Redefining our picture of “Indigent”
• Today’s ‘uninsured’ or ‘homeless’ could have been making
$200,000+ per year for most of their recent career and today
be unemployed, losing their home, and without insurance
(Cobra doesn’t apply if company dissolves.)
• They will return
• What we do for them
today may well earn
their loyalty to us
for life
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21. References

22. References
• USA Today March 09 research series on Americans, the economy and
health care, March 09 (available online; terrific graphics);
http://www.usatoday.com/money/economy/2009-03-10-well-being-
index_N.htm
• 1 in 5 American workers uninsured, USAToday.com, Mar 24, 09,
http://www.usatoday.com/money/industries/insurance/2009-03-24-health-
insurance_N.htm
• IMS National Prescription Audit; Kaiser Family Foundation, 2009;
searchable online
• Outsourcing Parenthood, Parenting.com,
http://www.parenting.com/article/Mom/Work--Family/Outsourcing-
Parenthood
• Patients skip medicine, doctor visits due to sick economy,
http://www.usatoday.com/news/health/2008-10-22-medical-
financial_N.htm
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23. References
• Recession affects family planning, with abortions and vasectomies up,
http://www.tampabay.com/news/health/article988131.ece
• Roan, Sheri, In an ailing economy, the doctor can wait, Los Angeles
Times, Apr 09, http://www.latimes.com/features/health/la-sci-prevention8-
2009apr08,0,5420195.story
• Shah, Gina, Down Economy Provides Opportunities to Improve Physician
Relations, Healthcare Leaders Media, Apr 2009
• http://Erickson, Baby boomers flock to social networking sites,
http://www.norwichbulletin.com/lifestyles/x1098998426/Baby-boomers-
flock-to-social-networking-sites
• Inside Facebook (Demographics)
http://www.insidefacebook.com/2008/09/18/latest-data-on-us-facebook-
age-and-gender-demographics/
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24. References
• Twitter links businesses to customers,
http://www.denverpost.com/business/ci_12258514
• Malone, Michael, The Twitter Revolution: The brains behind the Web's
hottest networking tool, Wall Street Journal,
http://online.wsj.com/article/SB124000817787330413.html
• www.healthleadersmedia.com/content/230802/topic/WS_HLM2_MAR/Do
wn-Economy-Provides-Opportunities-to-Improve-Physician-
Relations.htmlWheeler and Hirsh, Channel Champions: How leading
companies build new strategies to serve customers, 1999, Jossey-Bass
• Tanner and Johnson, Patients skip medicine, doctor visits due to sick
economy, USA Today, Oct 08,
http://www.usatoday.com/news/health/2008-10-22-medical-
financial_N.htm
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