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Does dissatisfaction with health plans stem from having no choices

Published on Sep 1, 1998in Health Affairs5.71
· DOI :10.1377/hlthaff.17.5.184
Atul A. Gawande59
Estimated H-index: 59
(Kaiser Family Foundation),
Robert J. Blendon46
Estimated H-index: 46
(Kaiser Family Foundation)
+ 3 AuthorsLarry Hugick3
Estimated H-index: 3
(Kaiser Family Foundation)
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Abstract
ABSTRACT: Data from a 1997 nationwide telephone survey are used to assess the relationship between choice and public opinion about managed care. We found that only a minority of the working-age population effectively control what health plan they get. Persons without choice were markedly more dissatisfied with their health plan, especially when enrolled in managed care. In multivariate analysis, how respondents rated their health plan depended as much on whether they lacked choice as on whether they were enrolled in managed care. Persons without choice also had more negative opinions about managed care in general. The results suggest that the managed care “backlash” may persist so long as consumers have little control over health insurance decisions.
  • References (5)
  • Citations (64)
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References5
Newest
Published on Jul 1, 1998in Health Affairs5.71
Robert J. Blendon46
Estimated H-index: 46
,
Mollyann Brodie20
Estimated H-index: 20
+ 4 AuthorsLarry Hugick3
Estimated H-index: 3
PROLOGUE: Managed care has been described with terms as forceful as “revolution.” Given the sweeping implications of such a word, a negative reaction is inevitable on the part of persons and institutions that are affected. For managed care, the “backlash” has taken the form of legislation introduced in nearly every state (more than one thousand bills at last count), aimed at calming consumers' fears of losing control of their health care while trying to retain some of the cost-saving, market-inn...
Published on Sep 1, 1997in Health Affairs5.71
Jon R. Gabel8
Estimated H-index: 8
(KPMG),
Paul B. Ginsburg28
Estimated H-index: 28
,
Kelly A. Hunt7
Estimated H-index: 7
(KPMG)
Limited choice and high out-of-pocket costs for employees in small firms may help to explain the managed care backlash.
Published on May 1, 1997in Health Affairs5.71
Ralph Ullman2
Estimated H-index: 2
,
Jerrold Hill11
Estimated H-index: 11
+ 1 AuthorsRandall K. Spoeri2
Estimated H-index: 2
Communitywide surveys have demonstrated that managed care enrollees tend to express higher satisfaction with their health plan if they have been given the opportunity to make a choice between managed care and fee-for-service plans. This DataWatch shows similar results with plan-specific data, even for enrollees whose plan benefits include coverage for out-of-network services. That is, what matters seems to be choice at the time of enrollment, not at the point of service. Further, in the practica...
Published on Jan 1, 1995in Health Affairs5.71
Karen D. Davis75
Estimated H-index: 75
(Rice University),
Karen Scott Collins3
Estimated H-index: 3
(Rice University)
+ 1 AuthorsCynthia Morris1
Estimated H-index: 1
(Rice University)
Prologue: Despite the failure of government to act on comprehensive health system reform, the US, health care system is undergoing rapid and profound changes. Managed care plans continue to gain a foothold throughout the country. The security of many Americans' health care rises and falls with the fortunes of the U.S. economy, both here and abroad, because health care coverage is inextricably linked to employment status. Public programs such as Medicare and Medicaid are under unprecedented scrut...
Cited By64
Newest
Published on Apr 1, 2019in Health Affairs5.71
Jean Marie Abraham16
Estimated H-index: 16
(UMN: University of Minnesota),
Anne Royalty13
Estimated H-index: 13
(IUPUI: Indiana University – Purdue University Indianapolis),
Coleman Drake2
Estimated H-index: 2
(University of Pittsburgh)
The individual and small-group health insurance markets have experienced considerable changes since the passage of the Affordable Care Act in 2010, affecting access, choice, and affordability for enrollees in these markets. We examined how health plan access, choice, and affordability varied between the individual on-Marketplace, individual off-Marketplace, and small-group markets in 2018. We found relatively similar outcomes across the three markets with respect to deductibles and out-of-pocket...
Kevin F. Erickson3
Estimated H-index: 3
(Rice University),
Yuanchao Zheng4
Estimated H-index: 4
(Stanford University)
+ 3 AuthorsGlenn M. Chertow108
Estimated H-index: 108
(Stanford University)
The Medicare program insures >80% of patients with ESRD in the United States. An emphasis on reducing outpatient dialysis costs has motivated consolidation among dialysis providers, with two for-profit corporations now providing dialysis for >70% of patients. It is unknown whether industry consolidation has affected patients’ ability to choose among competing dialysis providers. We identified patients receiving in-center hemodialysis at the start of 2001 and 2011 from the national ESRD registry ...
Published on May 1, 2016in Health Policy2.08
Daniëlle M.I.D. Duijmelinck4
Estimated H-index: 4
(EUR: Erasmus University Rotterdam),
Wynand P.M.M. van de Ven27
Estimated H-index: 27
(EUR: Erasmus University Rotterdam)
Germany, the Netherlands, and Switzerland have taken steps toward regulated competition on the health insurance market to enhance efficiency and consumer responsiveness. The rationale of giving the consumer a periodic choice of health insurer is that individual risk-bearing insurers are stimulated to effectively purchase and manage the care on behalf of their enrollees. For Europe this is largely a terra incognita, while the United States have at least fifty years of relevant experience. Twenty ...
Published on Jan 1, 2014in Journal of Health Politics Policy and Law1.84
Pamela Nadash1
Estimated H-index: 1
(UMass: University of Massachusetts Amherst),
Rosemarie Day2
Estimated H-index: 2
Published on Dec 1, 2013in BMC Health Services Research1.93
R. Bes3
Estimated H-index: 3
,
S. Wendel4
Estimated H-index: 4
+ 2 AuthorsJudith de Jong12
Estimated H-index: 12
Background In a demand oriented health care system based on managed competition, health insurers have incentives to become prudent buyers of care on behalf of their enrolees. They are allowed to selectively contract care providers. This is supposed to stimulate competition between care providers and both increase the quality of care and contain costs in the health care system. However, health insurers are reluctant to implement selective contracting; they believe their enrolees will not accept t...
Published on Sep 1, 2012in Journal of General Internal Medicine4.61
Alison A. Galbraith16
Estimated H-index: 16
(Harvard University),
Stephen B. Soumerai70
Estimated H-index: 70
(Harvard University)
+ 2 AuthorsTracy A. Lieu57
Estimated H-index: 57
(Harvard University)
Background High-deductible health plans (HDHPs) are an increasingly common strategy to contain health care costs. Individuals with chronic conditions are at particular risk for increased out-of-pocket costs in HDHPs and resulting cost-related underuse of essential health care.
Published on Feb 1, 2012in Health Affairs5.71
Jon Kingsdale4
Estimated H-index: 4
The success of the Small Business Health Options Program (SHOP)—health insurance exchanges targeted at the small-group market and opening for business in January 2014—will depend in large part on persuading small employers and qualified health plans to participate. The most important objective will be offering employers lower-cost health plans than they have now. Other critical objectives will be offering small firms administrative efficiencies and access to choices among high-value plans that a...
Published on Jan 1, 2012
Beth S. Abramson (Antioch University)
The cost of health and mental health care is a growing problem for the United States. Managed care evolved as a way to continue providing quality services in a cost-effective fashion. In the mental health field, some individuals believe managed care reduces the quality of treatment. This exploratory study investigates current sentiments among mental health clinicians regarding managed care’s impact on mental health treatment and looks at how clinicians practice in light of managed care’s guideli...
Published on Apr 1, 2011in Health Affairs5.71
Mark V. Pauly65
Estimated H-index: 65
(UPenn: University of Pennsylvania)
The Affordable Care Act, with its subsidies, demonstrations, commissions, and study groups, embodies a considerable amount of regulatory and policy pressure on markets to improve the quality of health care. However, it is possible that this government-led movement will lead to a lot of talk about quality but not necessarily much improvement. A better strategy may be found through “disruptive innovation,” a market-driven approach that has balanced cost and quality in other industries. An example ...
Published on Apr 1, 2011in Health Services Research2.71
Lieke H. H. M. Boonen7
Estimated H-index: 7
(EUR: Erasmus University Rotterdam),
Bas Donkers23
Estimated H-index: 23
(EUR: Erasmus University Rotterdam),
Frederik T. Schut23
Estimated H-index: 23
(EUR: Erasmus University Rotterdam)
In managed care markets, health insurers bargain over the price and quality of health care services. Selective contracting is an important tool for health insurers in negotiations with health care providers. Empirical research in the United States showed that health insurers using exclusionary provider networks obtain higher discounts than insurers without restrictions on provider choice (Staten, Dunkelberg, and Umbeck 1987; Melnick et al. 1992; Sorensen 2003;). Research on health plan choice in...
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