Managed Care Gets Good, But Slipping, Grades

September 4, 2001 ( - Although nearly half (48%) of Americans had some kind of problem with their health plan in the last year, roughly two-thirds give their plans an "A" or "B", according to a survey by the Kaiser Family Foundation and Harvard School of Public Health.

While survey respondents were generally positive, they were increasingly negative about managed care programs, with the percentage saying managed care plans do a “bad job” serving consumers almost doubling between 1997 (21%) and 2001 (39%).

Those in “strict” managed care plans, those with many of the elements found in HMOs, were less satisfied than those in “loose” managed care plans, or traditional plans.

Diminishing Impact

Two-thirds (67%) of all adults believe that during the past few years, HMOs and other managed care plans have decreased the time doctors spend with patients, up from 61% two years ago. More than half (54%) believe managed care has decreased the quality of health care for the sick, also slightly higher than the 50% in April 1999.

Six in ten (59%) believe that managed care has not made much difference to health costs (55% in April 1999), and about half (51%) of Americans believe that there is not enough regulation of HMOs and managed care.

Common Problems

The survey found that the most common problems were:

  • delays (1%) or denials (12%) of coverage or care (together reported by 13% of all people
  • and 28% of people with problems)
  • difficulty seeing a physician (10% of all people; 22% of people with problems)
  • billing and payment problems (13% of all people; 27% of people with problems)

Less common were problems related to communication or customer service difficulties, reported by just 8% of all people; 16% of people with problems.

Nearly a quarter (24%) reported a problem that resulted in paying more for care, with more than half of those reporting a “major” effect. Other costs cited were:

  • 21% – a problem that resulted in lost time from life activities
  • 14% – a problem that resulted in a decline in their health

About half of those with private insurance are still very (24%) or somewhat (32%) concerned that if they become sick, their health plan will be more concerned about saving money than providing the best treatment.