Center for Studying Health System Change

Managed Care Backlash Ebbs as Consumer Confidence in Health Care Inches Up

People in Poor Health Remain Much Less Likely to Trust Health Care System

News Release
Aug. 7, 2002

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ASHINGTON, D.C.—Privately insured consumers’ confidence in the health care system increased slightly between 1997 and 2001, signaling that people have noticed the easing of managed care restrictions, according to a national tracking study issued today by the Center for Studying Health System Change (HSC).

"In response to the managed care backlash, many health plans have included more providers in their networks and eased restrictions on care, and consumers have noticed the changes," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded exclusively by The Robert Wood Johnson Foundation.

But Ginsburg cautioned that "increased choice and fewer care restrictions come at a cost, and consumers may become more anxious as they are asked to shoulder more costs. Instead of worrying about managed care plans denying needed care, consumers may soon worry more about how they will afford needed care."

The study’s findings are detailed in a new HSC Tracking Report—Who Do You Trust? Americans’ Perspectives on Health Care, 1997-2001. Based on results from HSC’s Community Tracking Study Household Survey, a nationally representative survey involving about 60,000 people in 33,000 families, key findings include:

• The percentage of Americans who trust their doctor to put their needs first increased from 91.6 percent in 1997 to 92.9 percent in 2001.
• The percentage of Americans who think their doctor may not refer them to a specialist when needed declined from 14.3 percent in 1997 to 13.3 percent in 2001.
• The percentage of people in health maintenance organizations (HMOs) who worried about getting specialty referrals declined from 18 percent in 1997 to 16 percent in 2001. However, HMO enrollees continued to be less trusting than people enrolled in other types of health plans, with the proportion of people in non-HMOs worried about getting referrals remaining constant at about 10 percent between 1997 and 2001.

Despite signs of increased overall consumer confidence, the study found people’s trust of the health care system varied significantly depending on their health. People in poorer health are likely to interact more frequently with the health care system, creating more opportunities for them to have problems.

About half of consumers in fair to poor health—those most likely to need and use medical care—believed health plans strongly influenced medical decision-making in 2001, compared with 43 percent of people in good health. Twenty percent of people in fair to poor health worried about getting needed specialty referrals in 2001, compared with nearly 13 percent of people in good health.

"We didn’t find an increase in trust in the health care system among people in fair to poor health. It’s clear that people in poorer health are less trusting of the health care system, and recent marketplace changes have not eased their concerns," said Marie C. Reed, M.H.S., an HSC health research analyst who co-authored the study with HSC Senior Researcher Sally Trude, Ph.D.

The study also found about 45 percent of all privately insured Americans in 2001 continued to believe their doctors were strongly influenced by health insurance company rules when making decisions about their care. In 2001, nearly half of people enrolled in HMOs believed their health plan strongly influenced their doctors’ decisions, compared with less than 40 percent of people in other types of plans. Over time, however, HMO members’ concerns about health plan influence in medical decision-making declined slightly.

Americans’ satisfaction with their choice of primary care physicians in their health plan increased between 1997 and 2001, while satisfaction with their choice of specialists remained about the same. Finally, fewer people reported changing plans and health care providers.

Gail Shearer, director of health policy analysis, Consumers Union, www.consumersunion.org
"The study shows that people in poorer health consistently have less trust in the health care system. These are the people who know best what does and doesn’t work because they count more on the system than healthier people. What good is a health care system that works well only when you don’t need it?"

Karen Ignagni, president and CEO, American Association of Health Plans, www.aahp.org
"Health plans are working side-by-side with physicians to promote evidence-based medicine, preventive care and chronic disease management. As we move away from the divisive debate of the late 1990s, we would expect to see this collaboration reflected in polls and surveys. Health plans are working hard to inform their members and the general public about the added value we bring to the health care system through these innovative approaches that improve health care quality while ensuring access and affordability."

Jack C. Ebeler, president, Alliance of Community Health Plans, www.achp.org
"Marginal improvements in consumer confidence are not enough. Striving for excellence in quality, cost, access and service is not enough. Confidence and trust are ultimately about values. Health plans and providers must demonstrate that the values that motivate their decisions reflect—and support—the health care values of the patients, families and communities that they serve."

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded exclusively by The Robert Wood Johnson Foundation and affiliated with Mathematica Policy Research, Inc.