Why People Change Their Health Care Providers
Data Bulletin No. 16
May 2000
Marie C. Reed
atients’ ability to be treated by the
same health care provider is often considered a key aspect in the delivery of quality
medical care. In recent years, managed care and other changes in the health care market,
including some plans changing the provider panels, have led to widespread reports of
patients switching their regular providers. This, in turn, has fueled concerns that
continuity of care has been impaired. However, health plans are not the only reason why
people change providers. Providers retire, patients and their families move or a patient
may want a more convenient provider.
Recent surveys by the Center for Studying Health System Change (HSC) show that 13
percent of people with a usual source of care changed providers last year. Nationwide, 85
percent of people identify a doctor, nurse, another health professional or a specific
place other than a hospital emergency room as their usual source of care.
Reasons for Changing Health Care Providers
Over two-fifths of those who changed their usual health care provider did so because of
personal preferences, such as the desire to obtain better quality care (see
Figure 1). Slightly more than 20 percent cited changes in their health insurance as
the reason for switching-for example, they or their employer changed plans. The rest,
nearly 40 percent, gave other reasons, such as physician retirement.
FIGURE 1
REASONS WHY PEOPLE CHANGE HEALTH CARE PROVIDERS |
| REASON FOR CHANGE |
PERCENT |
|
|
| Health Insurance |
22% |
|
|
Provider no longer covered by plan
|
9 |
Changed health insurance plan
|
9 |
Other health insurance reason
|
4 |
|
|
| Personal Preference |
40% |
|
|
Quality
|
23 |
Convenience
|
12 |
Needed a particular doctor
|
5 |
|
|
| Other |
38% |
|
|
Provider no longer available (e.g., retired)
|
24 |
Patient/family moved
|
12 |
Other
|
2 |
|
|
Source: Community Tracking Study Household Survey, 1998-1999
Role of Insurance and Plan Type
Among people with a usual source of care, 13 percent of those who were privately
insured changed providers in the past year, compared with 11 percent for those with
Medicare coverage or who were uninsured. More than 14 percent of people in health
maintenance organizations (HMOs) changed their usual source of care, while only slightly
more than 11 percent of the insured who are not in HMOs did so. Those in HMOs were nearly
twice as likely as those who were not to indicate that their health insurance was the
reason they changed health care providers (see Figure 2).
FIGURE 2
REASONS FOR CHANGING USUAL SOURCE OF CARE AMONG THE INSURED BY HMO STATUS |
| REASON FOR CHANGE |
HMO STATUS |
| |
In HMO |
Not in HMO |
|
|
| Health Insurance |
28% |
15%* |
Provider no longer covered by plan
|
11 |
6* |
Changed health insurance plan
|
13 |
6* |
Other health insurance reason
|
4 |
3 |
|
|
| Personal Preference |
39% |
43%* |
Quality
|
22 |
25 |
Convenience
|
12 |
12 |
Needed a particular doctor
|
5 |
6 |
|
|
| Other |
33% |
42%* |
Provider no longer available (e.g., retired)
|
21 |
27* |
Patient/family moved
|
10 |
13* |
Other
|
2 |
2 |
|
|
Significantly different from those in HMOs at p<.05.
Source: Community
Tracking Study Household Survey, 1998-1999
Rate of Changing Providers Is Stable
Anecdotal evidence suggests that changes in the health care market may have caused
increases in the rate at which people have changed providers in recent years. However, HSC
data show that the rate of changing providers remained the same-13 percent-during two
different survey periods (1996-1997 and 1998-1999).
At the same time, there are changes in the reasons people give for switching providers.
In particular, people are less likely to identify health insurance as the reason than they
were two years ago (see Figure 3).
FIGURE 3b>
Reasons for Changing Health Care Providers
* Significantly different from 1996-97 to 1998-99 at p<.05.
Source:
Community Tracking Study Household Survey, 1996-1997 and 1998-1999.
Implications
Some recent patients’ bill of rights proposals stem from fears that changes in health
plans are forcing people to change providers. In fact, this is the reason given by 11
percent of enrollees in HMOs who changed providers and 6 percent of those not in HMOs.
Even though health plans play an important role in the decision to
change providers, less than one-quarter of the people who change do so because of their
plan. People are much more likely to switch because of personal preferences. This is true
for people in HMOs and those not in HMOs. It appears that insurers are not driving
provider change to the extent they did a few years ago. This may be due to the growing
popularity of preferred provider organizations and point-of-service products and broader
networks of plan physicians, all of which reflect health plan and employer responses to
consumer demands for more choice.
This Data Bulletin presents findings from the Household Survey, a nationally
representative telephone survey of the civilian, non-institutionalized population
conducted as part of the Community Tracking Study. The 1996-1997 survey includes nearly
33,000 families and 60,000 individuals, while the 1998-1999 survey includes approximately
32,000 families and 59,000 individuals.