Public Opinion About Health Care - Satisfaction With Health Insurance Plans

Harris Interactive and other researchers report increasingly negative public attitudes about managed care. In fact, the April 2003 Harris Poll that asked Americans how well they thought different industries were serving their customers found the health insurance industry and managed care plans at the bottom of the list. Just 40% of respondents felt health insurance companies were doing a good job, and 30% credited managed care plans with a job well done. The Harris Poll researchers distinguish the growing dissatisfaction with the concept of managed care from how consumers feel personally about their own plans. The researchers contend that the personal experiences of most Americans are not as awful as the accounts described in the media (Humphrey Taylor, "Supermarkets, Food Companies, Hospitals, and Banks Top the List of Industries Doing Good Job for Their Consumers," The Harris Poll, Harris Interactive, May 28, 2003).

FIGURE 9.8

In contrast to public opinion and many media reports, many people are quite satisfied with their health plans. In "Satisfaction with Own Health Insurance Remarkably Stable"(Health Care News, Harris Interactive, vol. 4, issue 5, March 29, 2004), Humphrey Taylor and Robert Leitman observed that for the fifth consecutive year the majority of the insured public continues to report high levels of satisfaction with their health plans. In 2004 about two-thirds of health plan members gave their plans high marks—As and Bs.

In 2004 more than three-quarters of adults with health insurance (76%) said they would "probably" or "definitely" recommend their plan to a family member or friend who was healthy, and more than two-thirds (68%) said they would likely recommend their plan to a family member or friend suffering from a serious or chronic illness. (See Table 9.2 and Table 9.3.) Persons insured by employers or unions were even more likely to recommend their health plans. Nearly 80% would "probably" or "definitely" recommend their plan to a healthy family member or friend, and 70% would likely recommend their plan to a family member or friend suffering from a serious or chronic illness. (See Table 9.4 and Table 9.5.)

According to Taylor and Leitman in the Harris Interactive survey, overall consumer dissatisfaction with health plans has not substantially changed from 2001 to 2004. Slightly more Medicare recipients (29%) gave their health plan low grades in 2004 than in 2001 (24%), and there was a comparable increase in the percentage of Medicare recipients who would not recommend their plans to their healthy friends.

More Medicaid beneficiaries are dissatisfied than persons enrolled in Medicare or employer-sponsored health plans. According to Taylor and Leitman, some 18% of Medicaid recipients awarded their health plan a failing

FIGURE 9.9

grade (D or F) compared to 12% of persons with employer-provided plans, 15% of Medicare beneficiaries, and 11% of persons who purchased private insurance. Dissatisfaction with Medicaid has also increased in recent years—33% of recipients reported in 2004 that they would not recommend it to friends or family members who have serious or chronic illnesses, compared to 24% in 2001.

Are Members of For-Profit HMOs Less Satisfied with Care Than Members of Nonprofit HMOs?

During the 1980s just one-quarter of all HMO members were enrolled in for-profit HMOs. However, conversion of many not-for-profit plans resulted in a dramatic shift, and by the late 1990s nearly two-thirds of HMO members were enrolled in for-profit plans. Some industry observers worried that large, for-profit health plan owners might jeopardize the quality of care delivered by denying members needed services to save money. Investigators Ha Tu and James Reschovsky at the Center for Studying Health System Change in Washington, D.C., looked at the relationship between members' assessments of their care and the profit status of their HMOs to find out if profit status affected members' perceptions of the quality of health care they received.

The investigators examined data from more than thirteen thousand HMO members and published the results of their analysis in the New England Journal of Medicine (vol. 346, no. 17, April 25, 2002). They found that slightly

TABLE 9.2

Public opinion on recommending a health plan to a healthy relative or friend, 1998–2004
WOULD YOU DEFINITELY, PROBABLY, PROBABLY NOT OR DEFINITELY NOT RECOMMEND YOUR HEALTH CARE PLAN TO A FAMILY MEMBER OR FRIEND WHO IS BASICALLY HEALTHY?
Base: Insured adults
	1998 %	1999 %	2000 %	2001 %	2002 %	2004 %
SOURCE: "Table 2-A. Recommending Health Plan to a Healthy Relative or Friend: 1998–2004," in Health Care News: Satisfaction with Own Health Insurance Remarkably Stable, vol. 4, no. 5, Harris Interactive, March 29, 2004, http://www.harrisinteractive.com/news/newsletters/healthnews/HI_HealthCareNews2004Vol4_Iss05.pdf (accessed September 13, 2004), © 2004, Harris Interactive Inc. All rights reserved. Reproduced with permission in 2004.
Definitely recommend	39	31	41	34	40	41
Probably recommend	40	44	37	39	36	35
Probably not recommend	12	13	11	16	10	11
Definitely not recommend	7	8	6	7	8	7
Not sure/refused	3	5	4	4	5	6

TABLE 9.3

Public opinion on recommending a health plan to a sick relative or friend, 1998–2004
WOULD YOU DEFINITELY, PROBABLY, PROBABLY NOT OR DEFINITELY NOT RECOMMEND YOUR HEALTH CARE PLAN TO A FAMILY MEMBER OR FRIEND WHO HAS A SERIOUS OR CHRONIC ILLNESS?
Base: Insured adults
	1998 %	1999 %	2000 %	2001 %	2002 %	2004 %
SOURCE: "Table 3-A. Recommending Health Plan to a Sick Relative or Friend: 1998–2004," in Health Care News: Satisfaction with Own Health Insurance Remarkably Stable, vol. 4, no. 5, Harris Interactive, March 29, 2004, http://www.harrisinteractive.com/news/newsletters/healthnews/HI_HealthCareNews2004Vol4_Iss05.pdf (accessed September 13, 2004). © 2004, Harris Interactive Inc. All rights reserved. Reproduced with permission in 2004.
Definitely recommend	34	28	38	34	38	37
Probably recommend	34	38	30	33	29	31
Probably not recommend	16	13	13	14	15	14
Definitely not recommend	13	14	12	11	11	10
Not sure/refused	3	7	6	6	7	8

TABLE 9.4

Public opinion on recommending an employer-provided health plan to a healthy relative or friend, 1998–2004
WOULD YOU DEFINITELY, PROBABLY, PROBABLY NOT OR DEFINITELY NOT RECOMMEND YOUR HEALTH CARE PLAN TO A FAMILY MEMBER OR FRIEND WHO IS BASICALLY HEALTHY?
Base: Adults insured by employers or unions
	Currently insured through work, union
	1999 %	2000 %	2001 %	2002 %	2004 %
SOURCE: "Table 2-B. Recommending Health Plan to a Healthy Relative or Friend: 1998–2004 Employer-Provided Plans," in Health Care News: Satisfaction with Own Health Insurance Remarkably Stable, vol. 4, no. 5, Harris Interactive, March 29, 2004, http://www.harrisinteractive.com/news/newsletters/healthnews/HI_HealthCareNews2004Vol4_Iss05.pdf (accessed September 13, 2004). © 2004, Harris Interactive Inc. All rights reserved. Reproduced with permission in 2004.
Definitely recommend	26	42	33	40	40
Probably recommend	53	40	42	37	39
Probably not recommend	12	9	17	11	11
Definitely not recommend	8	6	6	7	6
Not sure/refused	2	3	3	4	4

more members of nonprofit HMOs were very satisfied with their care (64%) than members of for-profit plans (58.1%). In the for-profit HMOs, sick members reported greater dissatisfaction than healthy members, with sick members reporting more delays in receiving care, unmet needs, organizational or administrative obstacles to receiving treatment, and higher out-of-pocket expenses. In nonprofit HMOs, the only difference between sick and healthy members was that sick members expressed greater confidence that they would be referred for care when necessary.

The investigators speculated that while there may have been significant differences in the operation of for-profit and nonprofit plans in the past, in recent years all

TABLE 9.5

Public opinion on recommending an employer-provided health plan to a sick relative or friend, 1998–2004
WOULD YOU DEFINITELY, PROBABLY, PROBABLY NOT OR DEFINITELY NOT RECOMMEND YOUR HEALTH CARE PLAN TO A FAMILY MEMBER OR FRIEND WHO HAS A SERIOUS OR CHRONIC ILLNESS?
Base: Adults insured by employers or unions
	Currently insured through work, union
	1999 %	2000 %	2001 %	2002 %	2004 %
SOURCE: "Table 3-B. Recommending Health Plan to a Sick Relative or Friend: 1998–2004 Employer-Provided Plans," in Health Care News: Satisfaction with Own Health Insurance Remarkably Stable, vol. 4, no. 5, Harris Interactive, March 29, 2004, http://www.harrisinteractive.com/news/newsletters/healthnews/HI_HealthCareNews2004Vol4_Iss05.pdf (accessed September 13, 2004). © 2004, Harris Interactive Inc. All rights reserved. Reproduced with permission in 2004.
Definitely recommend	24	36	32	38	36
Probably recommend	44	33	35	30	34
Probably not recommend	14	13	15	15	14
Definitely not recommend	14	12	11	11	9
Not sure/refused	4	6	6	6	6

plans have been subjected to comparable market pressures and economic constraints, rendering the plans nearly indistinguishable from one another in terms of quality and health service delivery.