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Public apprehension over whether managed care will deliver care when it's most needed has not translated into a groundswell of support for federal regulation of managed care plans, according to a survey released last week.
The "Kaiser/Harvard National Survey of Americans' Views on Managed Care" found that only 19% of the respondents to the study said the federal government was the entity they would "most" like to see regulate managed care.
Eighteen percent of respondents supported regulation by state governments, but 34% wanted independent, non-profit organizations.
Although 2% of the respondents volunteered they'd like to see another type of organization regulate such plans, 16% of
the respondents said they didn't want to see anyone regulate the plans.
But the respondents offered a somewhat contradictory answer to a similar question when told: "Some people say the government needs to protect consumers from being treated unfairly and not getting care they should from managed care plans. Others say the additional government regulation isn't worth it because it would raise the cost of health insurance too much for everyone." The survey then asked whether managed care should be regulated.
Even with the cost caveat, 52% of the respondents said government should regulate managed care, while 40% said doing so would cost too much and 8% didn't know.
The survey, undertaken by the Menlo Park, Calif-based Henry J. Kaiser Foundation and Harvard University, was based on the responses of 1,204 adults polled nationwide by telephone between Aug. 22 and Sept. 23. Princeton Survey Research Associates conducted the interviews. The survey did not break out managed care entities into such categories as PPOs and HMOs when asking questions.
The survey also found that most respondents, though concerned about managed care in general, gave their own plans relatively high marks. Not surprisingly, those whose employers provided a choice of plans gave their plans higher marks than those with no choice. In general, though, the public views key aspects of managed care plans more negatively than positively.
Much of the public's apprehension appears to be based on the idea that "horror stories" of managed care plans not covering relatively rare diseases are commonplace occurrences, said Kaiser Foundation President Drew E. Altman as he unveiled the survey at a press conference last week. If the public felt the same way about airplane crashes, the airline industry would have a serious problem, he said.
Nevertheless, Robert J. Blendon, professor of public health and political analysis at Harvard's School of Public Health and the Kennedy School of Government, said there was nothing in the survey to show support for "massive regulation" of managed care plans.
"This is not a call for a new FDA," he said, referring to the federal Food and Drug Administration.
Instead, both Messrs. Altman and Blendon said there appears to be public support for regulation of specific controversial managed care practices, such as so-called drive-through deliveries that require mothers of newborns to leave the hospital within a very short period of time or face the loss of benefits, they said.
The managed care industry itself could call on its members to take a closer look themselves at controversial practices to "lower the temperature" of public concern over perceived managed care excesses, said Mr. Blendon.
In a series of questions about managed care in general, respondents gave managed care negative marks in five of six categories:
61% said managed care had decreased the amount of time doctors spend with patients, 16% said managed care had increased the amount of time spent with patients.
59% said managed care made it harder for sick people to see medical specialists; 25% said managed care made it easier for sick people to see specialists.
55% said managed care had not made much difference in health care costs; 28% said managed care lowered health care costs.
51% said managed care decreased the quality of health care for the sick; 32% said it had increased health care quality for the sick.
46% said managed care made it easier to get preventive services; 31% said managed care made it harder.
45% said managed care decreased the quality of health care for patients; 32% said it increased the quality of health care for patients.
But most respondents enrolled in managed care plans gave their own plans high grades when asked to rate them from "A" to "F," with "A" being the highest grade. But the marks for managed care plans generally trailed those given to traditional coverage.
For example, 22% of the respondents enrolled in managed care plans gave their plans an "A," while 33% of those with traditional coverage gave their plans the same high mark. There was a statistically insignificant difference between those in managed care and those with traditional plans who gave their arrangements a mark of "B"-44% of the managed care enrollees and 43% of those with traditional coverage offered that mark.
The differences grew wider further down the report card, with 22% of the managed care enrollees giving their plans "C's" compared with 15% of those with traditional coverage, 8% of the managed care enrollees giving their plans "D's" compared with 4% of those with traditional coverage. Two percent of the managed care enrollees gave their plans a failing grade of "F," a grade none of the respondents with traditional coverage gave their arrangements.
Sharp differences in satisfaction arose among respondents enrolled in employer-provided managed care plans based on whether they had a choice of plans.
Nearly three out of 10 respondents-29%-who had a choice of plans gave their plans an "A," while 18% of those with no choice gave their plans an "A." Forty-seven percent of those with a choice gave their plans a "B," compared with 41% of those with no choice. Of those with a choice, 16% gave their plans "C's," a grade given by 28% of those with no choice. Six percent of the respondents with a choice of plan gave their plans "D's," compared with 8% of those with no choice, and only 1% of those with a choice failed their plans, compared with 3% with no choice giving their plans an "F."
In addition, 39% of those with a choice of plans said they "trust their health plan to do the 'right thing' just about always," a perception shared by only 31% of those with no choice.
Single copies of the "Kaiser/Harvard National Survey of Americans' Views on Managed Care" are free and can be ordered by calling 800-656-4533, or by writing the Henry J. Kaiser Foundation, 2400 Sand Hill Road, Menlo Park, Calif. 94025.