Commentary: Patients Don't Want
Protection From Their HMO
By
Karlyn Bowman
Congress
and state legislatures are considering dozens of patient protection
bills that would impose new standards on health plans. The conventional
wisdom in Washington holds that "no one doubts that so-called
patient protection bills are highly popular," as the National
Journal put it last month. But sometimes the conventional wisdom
is wrong, or at least seriously misleading. Carefully reviewing
what people in managed care are actually saying about their coverage
suggests that the great majority are content, and their desire
for change greatly depends on its cost.
People
in traditional fee-for-service care are generally more satisfied
than those in managed-care arrangements. But the differences
are small, and there is little evidence of widespread unhappiness
in either group. A Roper Starch Worldwide survey found that 80%
of managed-care customers in 1996 were satisfied with the quality
of their care, as were 82% of those in fee-for-service care;
77% in managed care were satisfied with the availability of medical
care when they needed it, as were 79% in traditional care.
Last
year, ABC News compared the satisfaction of customers in Health
Maintenance Organizations to those in traditional care. As the
nearby table shows, the poll results were very similar for all
types of service. For example, 83% of patients in HMOs and 87%
in traditional arrangements were satisfied with their ability
to get a doctor's appointment; 81% in HMOs and 90% in traditional
care were satisfied with their ability to see top-flight specialists.
Most tellingly, 78% of those in traditional arrangements said
they would recommend their arrangement--statistically no different
from the 79% of HMO customers who would tout their plan. This
is hardly evidence of widespread dissatisfaction.
The
cost of health care remains a big concern. When Charlton Research
asked respondents to name the country's most important health-care
problem, 60% of respondents mentioned the two related factors
of cost and affordability. Price was a much bigger worry to those
surveyed than lack of choice in insurance plans and restrictions
on choice of doctors.
In
the Roper and ABC surveys, those in managed care were more satisfied
with costs than those in traditional arrangements--62% of the
former and 53% of the latter told Roper their costs were reasonable.
In the ABC survey, 79% of HMO patients and 65% in traditional
arrangements were satisfied with their costs.
Survey
data do not support the belief that managed care is good for
those who are healthy and bad for the sick. One-third of respondents
in the ABC poll said they or someone in their family had experienced
a serious illness or injury while under their current plan. Of
those, 93% in traditional arrangements said they were satisfied
with the medical care they or their families received, but so
were 88% in HMOs.
According
to the polls, Americans continue to believe that the federal
government has an important role to play in health care. Just
14% in a Kaiser Family Foundation/Harvard University survey said
very little or no government regulation was needed for health
plans or health insurance. But the desire for government oversight
conflicts with concerns that government action will increase
costs and with widespread skepticism about current federal government
performance.
Kaiser/Harvard
asked people in December 1997 which of two statements they agreed
with more. One said that new regulations were needed to "protect
consumers from being treated unfairly and not getting the care
they should from managed-care plans"; the other said new
rules weren't worth it because they "would raise the cost
of health insurance too much for everyone." It was nearly
a dead heat between supporters and opponents of regulation, with
44% in favor and 47% opposed.
When
Kaiser/Harvard probed people's reactions to elements of consumer
bills of rights legislation--which would regulate HMOs and other
types of health plans--they found substantial support for them
in the abstract. But this support declined dramatically when
the pollsters asked if the respondents would still favor the
proposals if they resulted in an increase in premium costs, more
government involvement or in employers dropping coverage.
The
overwhelming majority (72%) of those in the Kaiser/Harvard poll
said they favored legislation to protect health-care consumers.
Support dropped dramatically when price tags were attached to
the laws. Only 43% said they would support laws if their premiums
increased by $1-$5 a month. Only 28% would support legislation
that raised premiums $15-$20 a month.
A
compassionate and generous public has not given up on providing
health care for the uninsured. But this is just one goal Americans
want policy makers to work toward; it is not a demand that overwhelms
all other considerations.
So
what explains the popular notion of mass dissatisfaction with
managed-care? Americans don't like big bureaucracies like the
1993 Clinton plan or managed-care conglomerates. Media coverage
also plays a role. The Kaiser Family Foundation looked at broadcast
news coverage of managed care between 1990 and 1997 and found
it overwhelmingly negative--and most people get their news from
television. Beyond this, the occasional horror stories about
bad medical practices in managed care are genuinely unsettling.
Such factors help to explain why surveys about managed care in
general--as opposed to the more relevant questions about respondents'
personal experiences--often produce negative results.
None
of this should suggest that some reforms aren't necessary and
desirable. But if we get the diagnosis wrong, the cure won't
work.
Ms. Bowman
is resident fellow at the American Enterprise Institute.
