CONSUMER SATISFACTION: SURVEY SHOWS MOST HAD NO PROBLEMS
A new survey of consumer experiences with managed care inThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
the Sacramento, CA, area, a region with one of the highest rates
of managed care in the country, shows that the majority of
consumers had no difficulty with their health insurance in the
past year. However, 27% reported some difficulties receiving
treatment. According to the survey, the most commonly reported
difficulties included: delay or denial of care or payment (42%),
including disputes over coverage and disagreement about the scope
of the benefits covered by the plan; limited access to physicians
(32%), including difficulties getting appointments and limited
access to specialists; and concerns about the quality of care
(11%), including perceived problems with inadequate treatment or
facilities. Medicaid recipients reported the most difficulty
with their managed care plans, with 42% citing problems.
Medicare recipients enrolled in managed care experienced the
lowest rate of difficulty (17%). Nearly three-quarters of
consumers with either employee-provided or self-purchased health
insurance reported no difficulties with their managed care plans.
MORE RESOURCES NEEDED?
The survey also found that the majority of consumers did not
know about existing resources to resolve concerns about care.
Only 2% of consumers with difficulties contacted a state or local
agency. Thirty-eight percent contacted their health plans and
37% contacted their doctor. Over a third of consumers (36%)
resolved their difficulties within one month and 13% had their
problem resolved within one to two months. Another 13% took two
months or longer to resolve. Thirty-five percent had not
resolved their differences at the time of the survey. The
majority of consumers said that they would have used an
independent group to resolve their problem had the service been
available. Consumers requested information on consumer rights
(62%), a mechanism for lodging a complaint (66%), referral to
other resources (60%) and help understanding their health plan's
policies (54%). Of the 27% of people who reported a problem
receiving care, 30% said they experienced a financial loss as a
result of the difficulty, 31% said they lost time from work or
school as a result of difficulty and 11% reported a worsening of
a health condition as a result of the difficulty in receiving
Gary Yates, president and CEO of the California Wellness
Foundation, said, "Quality health care has to work for patients.
These results show that while the majority of consumers reported
no problems with their care, we must strive to make the system
work for everyone. We see that even consumers with long-term
continuity and familiarity with managed care have experienced
difficulties." The survey was conducted to provide baseline
information for a multi-year evaluation of a pilot consumer
assistance program, the Health Rights Hotline, a free information
sources for consumers in California's El Dorado, Sacramento,
Placer and Yolo Counties. The program is the largest test of an
independent assistance program for consumers in managed care in
the nation. The survey was funded by the Kaiser Family
Foundation, Sierra Health Foundation and the California Wellness
Foundation. Drew Altman, president of the Kaiser Family
Foundation, said, "At a time when people across the country are
complaining about managed care, this project is trying to find
solutions. It is the leading community-based effort in the
nation giving people concrete help for their health plan
The Survey of Consumer Experiences in Managed Care was
developed and analyzed by the Lewin Group and administered by the
Survey Methods Group, Inc. for the Kaiser Family Foundation, the
California Wellness Foundation and Sierra Health Foundation.
More than 4,000 Sacramento households were contacted by phone in
June and August. The margin of error is +/-3% for most questions
(Kaiser release, 11/19).