Public opinion about managed care has turned around radically from once-tolerant, hopeful attitudes in the early 1990s to the current disappointment, anger and a “crisis of confidence,” declared Russ Newman, Ph.D., J.D., speaking to 350 psychologists at a Practice Directorate event during the APA convention in San Francisco in mid-August.
Citing surveys, polls and studies by the Washington Post, New York Times, Los Angeles Times, Harris and Gallup polls and various consulting groups, Newman noted that even the public’s belief that managed care has been effective in solving the cost problem in health care is beginning to change. “Consumers’ financial stake in health care is rising in an increasingly ineffectual system over which they have no control,” the head of the Practice Directorate declared.
He continued: “The more experience the public has had with managed care, the more negative public opinion has become. As people’s understanding of managed care increased so, too, has their recognition of problems with our health care system.”
Newman’s facts and figures revealed that a 1991 Towers-Perrin survey of 1,000 employees found that participants were at least as satisfied with managed care as with traditional indemnity plans. The employees particularly liked the low out-of-pocket expenses and, in a second survey by Gallup later that year, they also affirmed that they preferred to choose their own doctors, believing that the care they received from HMO-affiliated doctors was equal to care from their own doctors.
But by 1997, a Harvard/Harris poll found after analyzing 25 public opinion surveys during the preceding three years that consumer dissatisfaction with health care was distinctly rising. By then, Harris found that 54% of Americans believed managed care would harm the quality of care they received.
Also, they had lost confidence that managed care could help contain costs. In 1996, 59% thought managed care would help restrain rising costs, while by 1997, the figures dropped to 51%. As a further signal of public disenchantment, a Harvard/Kaiser Family Foundation study in late 1997 disclosed that 51% felt managed care had lowered the quality of healthcare; 55% thought managed care made little difference in checking costs; and 64% favored passing a law allowing patients to sue health plans for malpractice that would parallel their right to sue providers.
Newman drew the conclusions that consumer priorities which earlier focused on costs and low out-of-pocket expense have yielded to a priority concern for quality treatment and access to care. He also suggested that the public animosity a few years ago that doctors were ripping them off has transferred to the managed care industry.
Newman quoted from other publications, one of which said that although HMOs are winning the battle of the marketplace, they are faltering badly in their attempt to gain the confidence of Americans, fearful that managed care is eroding the quality of health care. He quoted a New York Times article that “the anger Americans feel about the soaring health care costs of the 1980s has turned emphatically against organizations that are most responsible for halting the rising costs. We have gone from dissatisfaction with one system to dissatisfaction of another.”