Patients like Managed Care (unless they're sick)

The  Kaiser Family Foundation and Consumer Reports released reports this week showing that most Americans under age 65 report having no major problems with their health plans over the past year.  However, people who are sick, or who are women, or who are enrolled in "restrictive" managed care plans (i.e., HMOs) have substantially more complaints.

The most common complaints were denials of (or delays in) care, difficulty in getting to see a doctor, and billing problems.

62% of patients enrolled in HMOs reported having such problems over the past year, versus only 49% in less restrictive managed care plans (such as PPOs), and only 32% in the old-fashioned (and endangered) indemnity plans.

64% of Americans gave their health plans an A or B grade.  But the sickest 20% in the survey were described as having major problems getting the care they need.

"These results are not good news for consumers," said Peter Lee, President and CEO of the Pacific Business Group on Health.

These results are "good news for consumers," said Susan Pisano, spokesperson for the American Association of Health Plans.

DrRich comments: 

Well, what is it?  Good news or not?

It depends on whether you're a healthy consumer or a sick consumer.  If you're sick, you are likely to be having a problem getting the care you need in a timely manner, from the doctor you'd like to be delivering that care.  And your bills are probably screwed up.  You're so frustrated, and odds are you're considering switching health plans.

If you're healthy, you are probably having no trouble getting the care you need (especially since you don't need any care.)  And because the sick people who tend to drive up your premiums are leaving the plan in utter despair and frustration, your premiums (or rather, those of your employer who is footing the bill) aren't rising as fast as they might.

And for the American Association of Health Plans, which fully realizes that the majority of Americans are healthy at any given time and thus are likely to give their health plans a passing grade, everything is in its place and all's right with the world.  The surveys are showing just what they're supposed to show.

So the latest surveys from Kaiser and Consumer Reports merely confirm what we knew all along.  Everything - at least on the consumer front - is going according to plan.

06/10/2000

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