MANAGED CARE: NEW SURVEY SHOWS PUBLIC CONCERN
"While HMOs are winning the battle in the marketplace, theyThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
are faltering badly in their attempts to gain the confidence of
Americans fearful that managed care is eroding the quality of the
nation's health care system," the Los Angeles Times reports. The
findings are based on a survey released yesterday by the Kaiser
Family Foundation. Drew Altman, president of Kaiser, said, "The
overall image of managed care is decidedly more negative than
positive." He said that Americans "are concerned that managed
care is more concerned with cutting costs than about them"
The study found that although a majority of Americans grade
their health plan a "B" or better, they remain concerned about
key aspects of managed care. A majority of people (55%) in
managed care plans expressed concern that if they were sick their
"health plan would be more concerned about saving money than
about what is the best medical treatment." Thirty-four percent
of respondents in traditional insurance plans felt the same way.
Half (51%) of respondents said that managed care has decreased
the quality of care for people who are sick, while 32% believe
the quality of care has increased under managed care. Sixty-one
percent believe that the amount of time doctors spend with
patients has decreased under managed care, and 59% of respondents
believe that managed care plans have made it harder for people
who are sick to see medical specialists. However, the Kaiser
survey found that people seem to generalize from anecdotal
reports in the media about managed care. For example, 66% of
respondents said that an HMO holding back on a child's cancer
treatment is something that happens "often" or "sometimes" after
being presented with a news story on the subject. Preventive
care was the one area in which managed care came out on top.
Forty-six percent of respondents say managed care has made it
easier to get services such as immunizations, health screenings
and physical exams.
Although many people believe that managed care holds
financial benefits for employers (56%) and individuals (49%), the
majority or respondents (72%) believe that the insurance
companies "reap the rewards in the form of greater profits."
Fifty-five percent of Americans do not believe that managed care
has had a significant impact on the overall cost of health care
in America; 28% say that it has helped reduce overall costs. A
slight majority (52%) of Americans said the government should
regulate managed care; however, they were divided on who should
actually do it, with 19% saying the federal government should do
the regulation and 18% saying state governments. Thirty-four
percent said that an independent organization should regulate the
industry. Forty percent said that a government intervention is
not worth the increased costs that could result. The poll was
conducted for the Kaiser Family Foundation and Harvard University
School of Public Health by Princeton Survey Research Associates.
The survey of 1,204 adults was conducted August 22 to September
23; it has a +/- 3 percent margin of error (Kaiser release,
The Boston Globe reports that Robert Blendon of the Harvard
School of Public Health and a co-author of the survey, said,
"What we really have going on here is an anti-insurance company
backlash." He added, "It looks like people are generally happy,
but they fear if they're very sick they will be denied care, and
they want a timely appeals process for very serious things"
(Knox, 11/6). The Washington Post reports that the findings are
particularly relevant because they come "amid an intensifying
political debate over what role government should play in
regulating health insurance." Noting the division over who
should be regulating managed care, Blendon said, "This is a call
for political entrepreneurship. People at different levels have
a crack at doing this" (Goldstein, 11/6). However, the Los
Angeles Times reports that the study suggests that "the managed-
care industry may be able to kill or weaken reform efforts by
arguing that the regulation will raise medical costs and taxes."
Susan Pisano, a spokesperson for the American Association of
Health Plans, said, "There doesn't seem to be a consensus here
about what it is people want to have happen."
The researchers were surprised that people in California do
not have a significantly different attitude toward managed care
than people in the rest of the country. They had anticipated
that because Kaiser Permanente "pioneered" managed care in
California more than 50 years ago, and because 90% of
Californians are enrolled in managed care, Californians would be
more favorable toward managed care than respondents in other
states. Blendon said, "I look at California's results and say,
'They're not getting used to it.' In the state with the longest
experience with HMOs and managed care, people are still very
anxious about what happens to them when they're sick" (11/6).
According to Adrienne Mitchem, legislative counsel for the
Consumers Union, the poll shows that this is the best time for
Congress to move to ensure consumers receive the health care
services that they have contracted to receive. Mitchem said,
"Until this consumer protection is guaranteed, consumers will
continue to suffer from a crisis of confidence about whether
their managed care coverage will deliver services when they are
sick." Mitchem also said that although most consumers gave their
plans a "B", the real "question should be how do the sick grade
their managed care coverage" (Consumers Union release, 11/5).