If managed care is to meet its promise of providing broad access to affordable, quality health care, plans must be required to meet minimum quality standards. In addition, consumers must have choice and the information necessary to make informed selections among plans.
In a new report, Assuring Quality, Information, and Choice in Managed Care
, Commonwealth Fund President Karen Davis warned that managed care is falling short in these areas, creating doubt that the system will be able to deliver on its promise. In the absence of quality standards, employee choice among plans, or access to comparative information, competition among health plans will be based only on price. Evidence from studies supported by The Commonwealth Fund over the past five years show clear signs that poor quality and barriers to care are significant problems in the managed care marketplace, especially in newer forms of managed care plans.
Quality problems identified by both patients and physicians have included: lack of access to needed care; inadequate physician capacity and time spent with patients; long waiting time for appointments; lack of access to specialists, emergency care, and women's health care; and lack of access to care for those with serious or chronic illnesses, and for minorities and low income families. Managed care plans score higher on preventive care, decreased out-of-pocket costs, and reduced paperwork.
Davis recommended the following steps to ensure quality and stability in health care: first, plans must meet minimum quality standards and be accredited by an approved private body. Second, members of managed care plans must have the right to external appeal of denial of care; access to needed primary, specialist, and emergency care; access to reproductive health care that is responsive to women's preferences; choice among quality health plans; and public access to accurate information about quality and patient experiences in individual plans. Davis also contended that managed care plans must institute financial rewards rather than penalties for providing high-quality care. Facts and Figures
- While 40% of physicians with a majority of patients in managed care were dissatisfied with the amount of time they could spend with patients, only 18% of physicians with no managed care patients were dissatisfied.
- Of those patients in managed care, 17% rated the quality of doctors as fair or poor, and 25% rated their choice of doctors as fair or poor. Of those insured under fee-for-service, 4% rated quality of doctors fair or poor, and 5% rated their choice of doctors fair or poor.
- Only 52% of adults ages 18-64 in working families have a choice of health plans; those in managed care without choice of plans were least satisfied on quality measures, compared with those who had a choice of plans.
- Both physicians and patients rated group and staff model health maintenance organizations (HMOs) better than other managed care plans, with over a fourth of network/mixed model HMO and preferred provider organization (PPO) enrollees rating their plan as fair or poor, compared to 14% for group/staff model HMOs. Patient ratings were also higher in nonprofit plans, with 22% of for-profit enrollees rating their plan as fair or poor, compared to 15% for nonprofit plans.
Karen Scott Collins, Cathy Schoen, and David R. Sandman, The Commonwealth Fund Survey of Physicians' Experiences with Managed Care
, The Commonwealth Fund, March 1997.
Karen Davis, Karen Scott Collins, Cathy Schoen, and Cynthia Morris, ""Choice Matters: Enrollees' Views of Their Health Plans,"" Health Affairs
, Summer 1995.
Karen Davis and Cathy Schoen, Managed Care, Choice, and Patient Satisfaction
, The Commonwealth Fund, August 1997.
Cathy Schoen and Pamela Davidson, ""Image and Reality: Managed Care Experiences by Type of Plan,"" Bulletin of the New York Academy of Medicine
, Winter Supplement, 73:506531, 1996.
Preliminary data from The Kaiser/Commonwealth Fund National Health Insurance Survey
, 1997, Louis Harris and Associates, Inc.
The full report is not available at this time.