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Managed Care, Choice, and Patient Satisfaction

Managed care has not lived up to its reputation as a consumer choice revolution. In testimony presented before the newly established President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry, Fund president Karen Davis detailed how most Americans do not have a choice among employer-provided health insurance plans.

Basing her testimony on the report Managed Care, Choice, and Patient Satisfaction, co-authored with Cathy Schoen, director of research and evaluation, and produced jointly by the Fund and the Henry J. Kaiser Family Foundation, Davis described survey results showing that only 2 of 5 working adults ages 18 to 64 are offered two or more plans by their employer.

The 1997 Kaiser/Commonwealth National Health Insurance Survey also found that an equal proportion of working adults have a choice of only one employer-provided plan. The remaining 17 percent of employees are not offered health insurance at all through their employers.

Full-time employees are the most likely to have a choice among plans, and employees of smaller firms and lower-income workers are the least likely to have a choice. Married couples who both work full-time are the most likely to have a choice through a combination of their plans.

Taking into account options through both spouses’ employers, 52 percent of all adults ages 18 to 64 in working families have a choice of two or more plans.

Davis stressed the importance of establishing quality standards for managed care plans, making standardized information available to improve decision-making when choices are available, and addressing the issues of coverage stability and continuity of care.

Facts and Figures
  • Only one-third of survey respondents had a fee-for-service insurance plan that allowed them to go to any doctor.
  • About 57 percent of those with only one plan option work for firms of 100 employees or less, compared with 17 percent who work in firms with 500 or more members.
  • Workers with only one plan option are twice as likely to have incomes below $20,000.
  • Thirty-one percent of workers have changed plans in the last two years; of these, 80 percent changed plans involuntarily.

The full report is not available online at this time.

Publication Details



Managed Care, Choice, and Patient Satisfaction, Karen Davis, Ph.D., and Cathy Schoen, M.S., The Commonwealth Fund, August 1997