Key Policy Area 3 - Managed Care and Markets
anaged care is increasingly regulated, in part because of consumer concerns
about how cost-containment techniques affect quality. HSC research has tracked
the extent of such techniques and examined how they may be affecting care delivery
and consumer and physician perceptions of quality. Contrary to the anecdotes,
HSC researchers have found few differences in access and use of services among
types of managed care plans and between managed care and indemnity insurance.
At the same time, HSC found that negative perceptions about HMOs taint people’s
ratings of their health care.
Drawing on successive rounds of site visits, HSC has tracked the evolution of
managed care and helped policy makers to understand implications of the consumer
backlash that is now dismantling the original vision. In the future, HSC will
document whether consumer satisfaction improves as plans relax care management
and whether physicians have less trouble obtaining needed services for patients—or
more problems, as may be the case for hospital services.
Burgeoning health care information on the Internet, the rising tide of aging baby
boomers who promise to be far more demanding consumers and other factors portend
a new age of consumerism in health care. It is interesting to note that HSC research
has found that consumers are not all that knowledgeable about how their health
plans work. HSC surveys will continue to track how consumer access to information
may affect patient-physician interactions and, from doctors’ perspective, the
cost and quality of care.
Market changes—including instability in health plan provider networks, consolidation
among providers and insurers and the loosening of managed care—could lead to a
range of policy responses or a decision to back away from regulation. For example,
greater market consolidation of plans or hospitals may lead to antitrust actions
or attempts to limit rate increases. On the other hand, some aspects of proposed
federal patient protection legislation may be moot as plans move to provide better
access to specialists and discard preauthorization requirements.
Related Publications by HSC Staff
Health Affairs, Vol. 20, No. 2 March/April 2001 Do Consumers Know How Their Health Plan Works?
by Peter J. Cunningham, Charles Denk and Michael Sinclair Issue Brief No. 35 February 2001
Back to the Future? New Cost and Access Challenges Emerge: Initial Findings from HSC’s Recent Site Visits
by Cara S. Lesser and Paul B. Ginsburg Issue Brief No. 30 September 2000
Health Care Perceptions and Experiences: It’s Not Whether You Are in an HMO, It’s Whether You Think You Are
by James D. Reschovsky and J. Lee Hargraves
|
"We have been through a lot, and we're not any closer to a long-term
resolution of the system's fundamental problems," says Paul Ginsburg,
president of a Washington, D.C., think tank called the Center for Studying
Health Systems Change.
—The Wall Street Journal, February 21, 2001 |
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