Public perceptions of cost containment strategies: Mixed signals for managed care

Health Affairs

Volumn 23, Issue SUPPL. 2, 2004, Pages

  Schur, Claudia L ^a   Berk, Marc L ^a   Yegian, Jill M ^b  

^a UNIVERSITY OF CHICAGO   (United States)

^b California HealthCare Foundation   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; AGED; ARTICLE; CONSUMER; FEMALE; HEALTH CARE COST; HEALTH CARE DELIVERY; HEALTH CARE UTILIZATION; HEALTH INSURANCE; HUMAN; MALE; MANAGED CARE;

EID: 17144394786     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.W4.516     Document Type: Article

References (25)

1. In 2002 health spending grew 5.7 percentage points faster than the overall economy, as measured by growth of the gross domestic product (GDP) - the total value of goods and services produced in the United States. The health care share of GDP increased to 14.1 percent in 2001 and 14.9 percent in 2002 after nearly a decade in the 13.1-13.4 percent range. See Centers for Medicare and Medicaid Services, "Highlights - National Health Expenditures, 2002," 17 September 2004, cms.hhs.gov/statistics/nhe/historical/ highlights.asp (6 October 2004).
2. J. Gabel et al., "Health Benefits in 2004: Four Years of Double-Digit Premium Increases Take Their Toll on Coverage," Health Affairs 23, no. 5 (2004): 200-209.
3. C. Connolly, "Medicare Premiums to Rise by 17.5 Percent," Washington Post, 7 September 2004.
4. See D.A. Draper and G. Claxton, "Managed Care Redux: Health Plans Shift Responsibilities to Consumers," Issue Brief, Findings from HSC no. 79 (Washington: HSC, March 2004). Also, see B.C. Strunk, P.B. Ginsburg, and J.R. Gabel, "Tracking Health Care Costs," Health Affairs, 26 September 2001, content .healthaffairs.org/cgi/content/abstract/hlthaff.w1.39 (6 October 2004). These authors cite the strengthening of providers' bargaining power vis-à-vis health plans in opening up provider networks as a major factor in cost increases.
5. See D.A. Draper and G. Claxton, "Managed Care Redux: Health Plans Shift Responsibilities to Consumers," Issue Brief, Findings from HSC no. 79 (Washington: HSC, March 2004). Also, see B.C. Strunk, P.B. Ginsburg, and J.R. Gabel, "Tracking Health Care Costs," Health Affairs, 26 September 2001, content .healthaffairs.org/cgi/content/abstract/hlthaff.w1.39 (6 October 2004). These authors cite the strengthening of providers' bargaining power vis-à-vis health plans in opening up provider networks as a major factor in cost increases.
6. M.L. Berk and A.C. Monheit, "The Concentration of Health Care Expenditures, Revisited," Health Affairs 20, no. 2 (2001): 9-18; and M.L. Berk, A.C. Monheit, and M. Hagan, "How the U.S. Spends Its Health Care Dollar: 1929-1980," Health Affairs 7, no. 4 (1988): 46-60.
7. M.L. Berk and A.C. Monheit, "The Concentration of Health Care Expenditures, Revisited," Health Affairs 20, no. 2 (2001): 9-18; and M.L. Berk, A.C. Monheit, and M. Hagan, "How the U.S. Spends Its Health Care Dollar: 1929-1980," Health Affairs 7, no. 4 (1988): 46-60.
8. G.P. Mays, G. Claxton, and J. White, "Managed Care Rebound? Recent Changes in Health Plans' Cost Containment Strategies," Health Affairs, 11 August 2004, content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.427 (6 October 2004).
9. K. Levit et al., "Health Spending Rebound Continues in 2002," Health Affairs 23, no. 1 (2004): 147-159.
10. J. Lundy, B. Finder, and G. Claxton, Trends and Indicators in the Changing Health Care Marketplace, 2004 Update, April 2004, www.kff.org/ insurance/7031/index.cfm (6 October 2004).
11. Data were provided by the Roper Center for Public Opinion Research, University of Connecticut. Data for 1994 come from a survey by NBC News conducted by Blum and Weprin Associates, 5-8 June 1994, and are based on telephone interviews with a national sample of 1,501 adults. Data for 2002 come from a survey by the Democratic Leadership Council conducted by Schoen and Berland Associates, 12-15 July 2002, and are based on telephone interviews with a national sample of 800 adults who are likely voters.
12. S. Trude and J.M. Grossman, "Patient Cost-Sharing Innovations: Promises and Pitfalls," Issue Brief, Finding from HSC no. 75 (Washington: HSC, January 2004); and Draper and Claxton, "Managed Care Redux."
13. S. Trude and J.M. Grossman, "Patient Cost-Sharing Innovations: Promises and Pitfalls," Issue Brief, Finding from HSC no. 75 (Washington: HSC, January 2004); and Draper and Claxton, "Managed Care Redux."
14. See T.C. Buchmueller, T Gilmer, and K. Harris, "Health Plan Disenrollment in a Choice-Based Medicaid Managed Care Program" (Unpublished manuscript, June 2003, revised January 2004); A. Gawande et al., "Does Dissatisfaction with Health Plans Stem from Having No Choices?" Health Affairs 17, no. 5 (1998): 184-194; and C. Schur and M. Berk, "Choice of Health Plan: Implications for Access and Satisfaction," Health Care Financing Review 20, no. 1 (1998): 29-43.
15. See T.C. Buchmueller, T Gilmer, and K. Harris, "Health Plan Disenrollment in a Choice-Based Medicaid Managed Care Program" (Unpublished manuscript, June 2003, revised January 2004); A. Gawande et al., "Does Dissatisfaction with Health Plans Stem from Having No Choices?" Health Affairs 17, no. 5 (1998): 184-194; and C. Schur and M. Berk, "Choice of Health Plan: Implications for Access and Satisfaction," Health Care Financing Review 20, no. 1 (1998): 29-43.
16. See T.C. Buchmueller, T Gilmer, and K. Harris, "Health Plan Disenrollment in a Choice-Based Medicaid Managed Care Program" (Unpublished manuscript, June 2003, revised January 2004); A. Gawande et al., "Does Dissatisfaction with Health Plans Stem from Having No Choices?" Health Affairs 17, no. 5 (1998): 184-194; and C. Schur and M. Berk, "Choice of Health Plan: Implications for Access and Satisfaction," Health Care Financing Review 20, no. 1 (1998): 29-43.
17. A copy of the questionnaire is available from Claudia Schur, schur-claudia@norc.org.
18. Other surveys have found a somewhat higher willingness to increase cost sharing in exchange for fewer restrictive practices related to use of services. It is difficult, however, to make direct comparisons because of different approaches to questioning (such as asking about different restrictions or different cost-sharing requirements) as well as different time periods. For example, the 2000 Community Tracking Survey household component found that 57 percent of respondents would be willing to accept a limited choice of physicians and hospitals in exchange for lower out-of-pocket costs. HSC, Annual Report: Navigating a Changing Health System, 2004, www.hschange.org/CONTENT/452/report1. html (6 October 2004). In a 1994 survey, about two-thirds of respondents said that they would mind not at all or a little if they had to accept certain restrictions in order to pay less for health care. C.L. Schur and E. Dorosh, "Attitudes toward Cost Containment Features of Managed Care: Differences among Patient Subgroups," American Journal of Managed Care 4, no. 10 (1998): 1385-1391.
19. Other surveys have found a somewhat higher willingness to increase cost sharing in exchange for fewer restrictive practices related to use of services. It is difficult, however, to make direct comparisons because of different approaches to questioning (such as asking about different restrictions or different cost-sharing requirements) as well as different time periods. For example, the 2000 Community Tracking Survey household component found that 57 percent of respondents would be willing to accept a limited choice of physicians and hospitals in exchange for lower out-of-pocket costs. HSC, Annual Report: Navigating a Changing Health System, 2004, www.hschange.org/CONTENT/452/report1. html (6 October 2004). In a 1994 survey, about two-thirds of respondents said that they would mind not at all or a little if they had to accept certain restrictions in order to pay less for health care. C.L. Schur and E. Dorosh, "Attitudes toward Cost Containment Features of Managed Care: Differences among Patient Subgroups," American Journal of Managed Care 4, no. 10 (1998): 1385-1391.
20. In a review of peer-reviewed literature, Robert Miller and Hal Luft find that both health maintenance organization (HMO) and non-HMO plans provide roughly comparable quality of care, although HMO enrollees report worse results on many access measures and lower levels of satisfaction compared to non-HMO enrollees. R.H. Miller and H.S. Luft, "HMO Plan Performance Update: An Analysis of the Literature, 1997-2001," Health Affairs 21, no. 4 (2002): 63-86.
21. In a series of surveys conducted by Harris Interactive between 1995 and 2000, the proportion of adults who said that managed care will harm the quality of medical care rose from 39 percent in 1995 to 51 percent in 2000, and the proportion who said that managed care would help contain health care costs fell from 59 percent to 34 percent in that same period. See Harris Interactive, "While Managed Care Is Still Unpopular, Hostility Has Declined," Health Care News, 21 October 2002, www.harrisinteractive.com/news/ newsletters/healthnews/HI_HealthCareNews2002Vol2_Iss20.pdf (28 October 2004).
22. Many of these approaches are discussed in Trude and Grossman, "Patient Cost-Sharing Innovations"; and Draper and Claxton, "Managed Care Redux. " See also J.C. Robinson, "Reinvention of Health Insurance in the Consumer Era," Journal of the American Medical Association 291, no. 5 (2004): 1880-1886.
23. Many of these approaches are discussed in Trude and Grossman, "Patient Cost-Sharing Innovations"; and Draper and Claxton, "Managed Care Redux. " See also J.C. Robinson, "Reinvention of Health Insurance in the Consumer Era," Journal of the American Medical Association 291, no. 5 (2004): 1880-1886.
24. Many of these approaches are discussed in Trude and Grossman, "Patient Cost-Sharing Innovations"; and Draper and Claxton, "Managed Care Redux. " See also J.C. Robinson, "Reinvention of Health Insurance in the Consumer Era," Journal of the American Medical Association 291, no. 5 (2004): 1880-1886.
25. J.C. Robinson and J.M. Yegian, "Medical Management after Managed Care," Health Affairs, 19 May 2004, content.healthaffairs.org/cgi/content/ abstract/hlthaff.w4.269 (6 October 2004).