Health Services Research , vol.35, no.1, Part II (April 2000): 219-237
James D. Reschovsky, Peter Kemper, Ha T. Tu
he type of insurance people have-not just whether it is managed care but the type of managed care-affects their use of services and their assessments of the care they receive. Based on the Community Tracking Study Insurance Followback Survey, a supplement to the Household Survey, the authors found that as people move from indemnity insurance to more managed care products, use of primary care increases modestly, but use of specialists is reduced. Few differences were found in preventive care, hospital use and surgeries. The likelihood of having unmet or delayed care does not vary by insurance type, but enrollees in more managed products are less likely to cite financial barriers and are more likely to perceive problems in provider access, convenience, and organizational factors. Consumer assessments of care-including satisfaction with care and trust in physicians-are generally lower under more managed products, particularly closed-model health maintenance organizations (HMOs).
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