Choice Matters: Enrollees' Views of Their Health Plans

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 scrutiny by lawmakers intent on balancing the federal budget by sharply reducing their growth rates. Amid these changes, it is critical for health policymakers to know how Americans perceive their health care system and their coverage. The survey reported in this paper is an attempt to fill the information gap. Conducted by The Commonwealth Fund in 1994, the managed care survey examines the experiences with managed care by families who have employer health coverage in Boston, Los Angeles, and Miami. Karen Davis is president of The Commonwealth Fund, the nation s fourth-oldest private foundation. She holds a doctorate in economics from Rice University. Before joining Commonwealth, Davis chaired the Department of Health Policy and Management at the Johns Hopkins School of Hygiene and Public Health. Karen Scott Collins is a senior program officer at Commonwealth; she holds a medical degree from Cornell and a master of public health degree from Johns Hopkins. Cathy Schoen is director of special projects at the University of Massachusetts Labor Relations and Research Center; she holds a master s degree in economics from Boston University. Cynthia Morris is an associate in the office of communications at the Edna McConnell Clark Foundation; she holds a master of public health degree from Columbia University. Abstract: Enroliees' views of their health plans and physicians are important measures of the performance of the health care system. The Commonwealth Fund's 1994 survey of 3,000 adults in fee-for-service and managed care organizations documents enroliees' experiences with choosing a plan and satisfaction with that plan. Fee-for-service enroliees were more satisfied with their plan's access to and quality of care; managed care enroliees were more satisfied with their plan's cost, paperwork, and coverage of preventive care. The survey also found a high rate of involuntary plan changing, limited choice of physicians, and low levels of satisfaction among low-income managed care enroliees.