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Despite fears that managed care prices will rise, employers are buying health care increasingly based on quality concerns and less on cost, a new survey says.

It also showed that most smaller companies still focus on price, while the largest companies have grown more interested in sophisticated quality measurement yardsticks.

The survey, by Bethesda, Md.-based Watson Wyatt Worldwide and the Washington Business Group on Health, found 51% of employers surveyed mentioned cost as a definition of value in choosing a health plan, down from 59% in a similar survey last year.

In contrast, 51% of respondents said they look for quality in their definition of value, up from 45% in 1996.

But as employers recognize the importance of comparing the quality of health care choices, they also are facing their lack of knowledge on complex quality-measurement issues, said Maureen Cotter, a consultant in Watson Wyatt's Southfield, Mich., office who helped organize the study.

"Fewer companies think they are very effective at buying health care," she said.

Whereas 20% of employers in the 1996 survey said they felt

they were "very effective" at buying health care, this year only 12% expressed that level of confidence.

In descending order of significance, companies ranked the following as most important in their definition of "value": access of facilities; cost; medical outcome data; employee satisfaction; utilization data; accreditation; and Health Plan Employer Data & Information Set data.

Large employers were much more likely to consider factors other than cost as important.

For example, large employers used performance standards 88% of the time, while small employers used such standards only 37% of the time.

The study conducted mail-in surveys of 252 companies and in-person interviews with 46 large employers.

Copies of the survey, "Partnering For Value," will be available in early May for $100 each from Watson Wyatt Worldwide by calling 800-243-1349.