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Health Care Costs and Financing

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Even a small amount of choice in health plans might improve public confidence in health insurance

Compared with working-age people who are able to choose their own health plans, workers who do not have plan choice are substantially more dissatisfied with their coverage. This is especially true when they are enrolled in managed care. People without a choice also have more negative opinions about managed care in general, according to a 1997 survey that was supported in part by the Agency for Health Care Policy and Research (National Research Service Award training grant T32 HS00020).

Regulations that loosen managed care restrictions may not improve satisfaction unless they include measures to increase choice, notes lead author Atul A. Gawande, M.D., of the Harvard School of Public Health. The researchers analyzed responses from a random sample of 778 working-age people who responded to a telephone survey to assess the relationship between health plan choice and public opinion about managed care. Among insured respondents, 42 percent said that they were given no choice of health plan when they enrolled in their current plan. Even among those given a choice, one in five complained of not having enough plans to choose from. Overall, 63 percent of respondents had no choice of plan, had an insufficient variety of plans, or were forced to change plans.

Among respondents with plan choices, 29 percent had two options, and 34 percent had three plans to choose from. Almost 40 percent of those not given a plan choice gave their plan a "C" (average), "D" (poor), or "F" (failing) grade—nearly double the proportion of those with plan choice who gave similar ratings. Half of those in managed care without choice gave their plan low grades compared with 29 percent of those in traditional fee-for-service insurance who had no choice. Those with two choices gave their health plan much better grades than people who had only one choice. However, having more than two choices did not significantly improve health plan grades. The authors conclude that increasing choice even slightly may help to restore public confidence in health insurance and health care.

For more details, see "Does dissatisfaction with health plans stem from having no choices?" by Dr. Gawande, Robert J. Blendon, Sc.D., Mollyann Brodie, Ph.D., and others, in Health Affairs 17(5), pp. 184-194, 1998.

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