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Consumers perceive quality differences across health systems and factor these differences into health plan choices

Report cards on health plan performance often do not reflect how individuals value specific health plan features that could affect their plan choices. A recent survey of how employees value various plan features found that the employees did not perceive differences in provider quality across options but did perceive differences in access to specialists and premiums.

The survey involved employees (who were unmarried and had no dependents) of 24 self-insured employers in Minnesota who were offered 15 care plans by a coalition of the employers. The employees were asked to rate attributes related to quality, convenience (of hours and location), and premiums for five plans on a 1 to 10 scale, with 10 being most important.

The study was supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00046), and led by Katherine Harris, M.A.E., Ph.D., of RAND. After inclusion of employee personal characteristics, the addition of one doctor in care system 2 (indicating greater access to care) increased the probability of choosing care system 2 by 0.09 percent. A one-point increase in the importance of low monthly premiums increased the probability of choosing care system 2 by 0.30. However, controlling for provider and service quality increased this estimated effect to 1.22 percent, which was roughly equivalent to relocating care system 2 a mile closer to an average employee.

Changes in the importance of access to specialists had a slightly larger effect on care system choice probabilities than changes in the importance of premiums and other dimensions of provider and service quality. The results suggest that consumers do recognize quality differences across health systems, and that they take these differences into account when making enrollment choices. This finding reinforces the value of collecting and disseminating plan performance measures to consumers.

See "Measuring consumer perceptions of quality differences among competing health plans," by Dr. Harris, Jennifer Schultz, Ph.D., and Robert Feldman, Ph.D., in the Journal of Health Economics 21, pp. 1-17, 2002.

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