On The Agenda
N 1998, HSC RESEARCHERS ARE CONTINUING TO WORK ON analyses that will provide decision makers with answers to the following kinds of questions:
- How is primary care physicians' scope of care changing under managed care? To what extent are they providing care historically delivered by specialists? Are they comfortable with these changes?
- Does the type of insurance coverage affect consumer satisfaction and perceived quality? Are people in HMOs more or less satisfied with their overall care, and how do they perceive its quality as opposed to those covered under traditional insurance? Does patient trust in physicians differ by insurance type?
- What are physicians' perceptions of their ability to provide high-quality care? What kinds of factors influence physicians' perceptions with respect to quality, in terms of individual attributes, type of practice and market-level variables such as the extent of managed care?
- What is the impact of managed care regulation on local markets? How are these initiatives seen either as protecting consumers or as a backlash against managed care? How are they perceived to affect costs, network strategies and care management techniques?
- How has managed care affected physicians' provision of charity care? Are safety nets fraying? Are doctors taking on more of the charity care burden? Are providers more responsive to patient needs due to increased competition for Medicaid business?
- How are Blue Cross-Blue Shield plans redefining their roles and transforming their local market positions? As traditional insurers of the last resort, and in some markets the last bastion of fee-for-service medicine, how are plans restructuring to compete in a managed care environment? What happens to hard-to-insure people as the Blues convert from nonprofit to for-profit organizations?
SECOND-ROUND DATA
HSC has embarked on its second round of data collection, which will continue through 1998 and part of 1999. Site visits are underway, and field work on the Household and Physician Surveys will begin this summer. (There will be no employer survey in this round.) With baseline data from the first round, researchers will start to track changes in access, delivery, costs, perceived quality and dynamics of health system change.
Analyses of this information will help HSC gain a richer understanding of how the "big picture" in health care is changing and the effects of those changes on consumers. This information will help to inform public and private decision makers as they consider legislative alternatives, select health plans for their employees and grapple with how to address problems of the uninsured and many other health-related issues of national import, as well as those unfolding on the local level.
