Does Dissatisfaction with Health Plans Stem from Having No Choices?

Health Affairs

Volumn 17, Issue 5, 1998, Pages 184-194

  Gawande, Atul A ^a   Blendon, Robert J ^b   Brodie, Mollyann ^c   Benson, John M ^e   Levitt, Larry ^e   Hugick, Larry ^d  

^a BRIGHAM AND WOMEN S HOSPITAL   (United States)

^b HARVARD UNIVERSITY   (United States)

^c HENRY J KAISER FAMILY FOUNDATION   (United States)

^d Princeton Survey Research Associates   (United States)

^e NONE

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; ARTICLE; CONSUMER; EPIDEMIOLOGY; HEALTH INSURANCE; HUMAN; MANAGEMENT; MIDDLE AGED; MULTIVARIATE ANALYSIS; ORGANIZATION AND MANAGEMENT; SOCIOECONOMICS; UNITED STATES;

ADULT; CONSUMER PARTICIPATION; CONSUMER SATISFACTION; HEALTH BENEFIT PLANS, EMPLOYEE; HEALTH CARE SURVEYS; HUMANS; MANAGED CARE PROGRAMS; MIDDLE AGED; MULTIVARIATE ANALYSIS; POLICY MAKING; SOCIOECONOMIC FACTORS; UNITED STATES;

EID: 0032163220     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.17.5.184     Document Type: Article

References (20)

1. R.J. Blendon et al., "Understanding the Managed Care Backlash," Health Affairs (July/August 1998): 80-94.
2. A.R. Davies et al., "Consumer Acceptance of Prepaid and Fee-for-Service Medical Care: Results from a Randomized Controlled Trial," Health Services Research 21, no. 3 (1986): 429-452; and K. Davis et al., "Choice Matters: Enrollees' Views of Their Health Plans," Health Affairs (Summer 1995): 99-112.
3. A.R. Davies et al., "Consumer Acceptance of Prepaid and Fee-for-Service Medical Care: Results from a Randomized Controlled Trial," Health Services Research 21, no. 3 (1986): 429-452; and K. Davis et al., "Choice Matters: Enrollees' Views of Their Health Plans," Health Affairs (Summer 1995): 99-112.
4. Further analysis of the Commonwealth Fund survey, however, did find evidence suggesting lower satisfaction in network-model HMOs and PPOs than in group/staff-model HMOs and fee-for-service plans - even after controlling for extent of choice. C. Schoen et al., "Image and Reality: Managed-Care Experiences by Type of Plan," Bulletin of the New York Academy of Medicine (Winter Supplement 1996): 506-531.
5. R. Ullman et al., "Satisfaction and Choice: A View from the Plans," Health Affairs (May/June 1997): 209-217.
6. C. McLaughlin, "Health Care Consumers: Choices and Constraints" (Paper presented at the Robert Wood Johnson Foundation's meeting, "The Power of Choice in the Health Care Marketplace and Its Consequences," Washington, D.C., 19 November 1997); and K. Davis, testimony before the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry, hearing on consumer choice of health insurance plans and providers, Washington, D.C., 25 June 1997.
7. C. McLaughlin, "Health Care Consumers: Choices and Constraints" (Paper presented at the Robert Wood Johnson Foundation's meeting, "The Power of Choice in the Health Care Marketplace and Its Consequences," Washington, D.C., 19 November 1997); and K. Davis, testimony before the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry, hearing on consumer choice of health insurance plans and providers, Washington, D.C., 25 June 1997.
8. Blendon et al., "Understanding the Managed Care Backlash."
9. Ibid. Standard techniques were used in the survey to ensure the representativeness of the sample. To compensate for known biases from different levels of participation by different subgroups of the population, the sample data were weighted in analysis using parameters from the most recently available census data. Also, we employed random-digit dialing, replicate subsamples, callbacks staggered over times of day and days of the week, refusal conversions, and systematic respondent selection within households. For more detailed discussion of our methods and the representativeness of the data, see Blendon et al., "Understanding the Managed Care Backlash."
10. Ibid. Standard techniques were used in the survey to ensure the representativeness of the sample. To compensate for known biases from different levels of participation by different subgroups of the population, the sample data were weighted in analysis using parameters from the most recently available census data. Also, we employed random-digit dialing, replicate subsamples, callbacks staggered over times of day and days of the week, refusal conversions, and systematic respondent selection within households. For more detailed discussion of our methods and the representativeness of the data, see Blendon et al., "Understanding the Managed Care Backlash."
11. Direct estimates of enrollment by plan type find a similar distribution to that shown in Exhibit 1. KPMG Peat Marwick, Health Benefits in 1997 (Arlington, Va.: KPMG Peat Marwick, 1997).
12. We do not include dissatisfaction with one's variety of choices as an independent variable because it could be an effect rather than a cause of discontent.
13. In a separate multivariate analysis of variety, those with an inadequate variety had significantly poorer plan ratings and negative opinions of managed care as well, and having dependent children became an insignificant contributor. Multivariate analysis results are available from the authors at Department of Health Policy and Management, Harvard School of Public Health, Fourth Floor, 677 Huntington Avenue, Boston, Massachusetts 02115.
14. McLaughlin, "Health Care Consumers."
15. J.R. Gabel, P.B. Ginsburg, and K.A. Hunt, "Small Employers and Their Health Benefits, 1988-1996: An Awkward Adolescence," Health Affairs (September/October 1997): 103-110.
16. Foster-Higgins, Annual Survey of Employers (1993), as reported in R. Bergman, "Study: Employers Consider Cost over Quality in Health Purchases," Hospitals and Health Networks (5 March 1994): 54.
17. Foster-Higgins, Annual Survey of Employers (1993), as reported in R. Bergman, "Study: Employers Consider Cost over Quality in Health Purchases," Hospitals and Health Networks (5 March 1994): 54.
18. "Quality Commission: Debates Choices, Appeals Process," Associated Press, 14 August 1997.
19. A. Goldstein, "Panel Outlines Protections for Health Care Consumers; Commission Would Guarantee Patient Choices," Washington Post, 23 October 1997, A1.
20. Advisory Commission on Consumer Protection and Quality in the Health Care Industry, "Consumer Bill of Rights and Responsibilities: Report to the President of the United States" (www.hcqualitycommission.gov/cborr/consbill.htm, November 1997).