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New Study Quantifies How HMO Stereotypes Influence Consumer Ratings of Their Health Care

News Releases
September 8, 2000

Alwyn Cassil: 202/264-3484

ASHINGTON, D.C.– About a quarter of people in privately insured plans incorrectly identify whether or not they are in an HMO, according to a new study from the Center for Studying Health System Change (HSC). Once HSC researchers controlled for the type of plan people reported they are in – which they did with the help of an Insurance Followback Survey – the differences in ratings between those actually enrolled in HMOs and those actually enrolled in other types of plans shrink or disappear. The HSC study quantifies for the first time how negative views about HMOs in general bias consumer ratings of their health care.

"These results strongly imply that negative perceptions about HMOs adversely color how consumers rate their own health care and health providers," said James D. Reschovsky, HSC senior researcher and co-author. "Instead of poll results reflecting people’s experience in using health care, it seems as if people’s beliefs about plan type, driven in part by polls and media coverage, are driving survey results."

The study is based on two linked surveys conducted as part of HSC’s Community Tracking Study. The first, the Household Survey conducted in 1996-1997, is nationally representative and includes 60,000 individuals. The second, the Followback Survey, gathers information about health insurers and their products for those in the Household Survey. The study being released today is based on approximately 18,000 non-elderly individuals with commercial insurance for whom a definitive match to a specific insurance product was made using the Followback Survey data.

Comparisons of the data from the Household and Followback Surveys showed that 13 percent of people who are in an HMO incorrectly thought that they were in another type of plan,

and that 11 percent of people in other types of plans incorrectly thought they were in an HMO. In total, 24 percent of people incorrectly identified their plan type.

"This is sobering when you realize that policy makers are often using surveys that rely on patients to report plan type," said Lee Hargraves, HSC researcher and co-author. "Our study suggests that policy makers should exercise caution in drawing conclusions about differences between HMOs and other kinds of plans from survey data alone, because these data may be skewed."

HSC researchers compared consumer assessments across 10 different measures, reporting four main indicators in the study released today, namely: 1) the percent dissatisfied with family’s health care in general; 2) the percent rating thoroughness of exam during last doctor’s visit as fair to poor; 3) the percent agreeing that their doctor might not refer them to a specialist when needed; and 4) the percent agreeing that their doctor might prescribe unnecessary tests and procedures.

For the first three measures, people who report being in HMOs were more dissatisfied than their counterparts in other kinds of plans – with differences between 3 and 8 percent. But after researchers controlled for the type of plan people thought they were covered by, the differences in ratings between those who actually are in HMOs and those who actually are in others kinds of arrangements either become virtually non-existent or shrink to within two percentage points of one another. For the last measure, there was no difference in plan ratings until plan type beliefs were accounted for, after which HMO members rated their plans better than other types of insurance on this dimension.

HSC researchers also accounted for demographic differences and differences in health status to make sure these differences were not biasing the analysis. The results still held.

"The study does not, in itself, argue for or against efforts to further regulate HMOs," said Paul B. Ginsburg, president of HSC. "But it does underscore the need for clinical data to better understand how HMOs stack up to other kinds of plans."


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The Center for Studying Health System Change Ceased operation on Dec. 31, 2013.