The Managed Care Conundrum

Today, 85 percent of workers participating in a health plan are in some form of managed care. As recently as 1992, only 48 percent were in what today is commonly known as managed care. The 1998 HCS reveals that this change in how Americans' health care is provided is a source of great confusion to almost all. Not only are Americans confused about the type of care they receive, their confusion begins with the very term managed care.

Those in Managed Care Don't Understand What They Have

  • The majority of people in managed care plans think they have never been in managed care (56 percent). Americans in PPO-type plans are more likely than individuals in HMO-type plans to report they have never been enrolled in managed care (63 percent v. 44 percent).
  • Six percent of Americans with traditional fee-for-service health insurance think they are currently enrolled in managed care. One in 8 report they were previously enrolled in managed care (13 percent).

Americans Think Health Care as "Managed Care" Is OK

  • A majority of Americans rate managed care excellent, very good, or good for the quality of care available (52 percent). Slightly fewer give high ratings to managed care for choice of doctors (45 percent) or hospitals (47 percent) and access to specialists (46 percent). Two in 5 give managed care similar high marks for preventive care (42 percent).
  • Cost and access to experimental treatments receive the lowest ratings, with just more than one-third indicating that health care cost under managed care is excellent, very good, or good (37 percent), and 1 in 5 rating access to experimental treatments that high (22 percent).
  • No more than 1 in 7 rate most aspects of managed care as poor. The only exception is access to experimental treatments, which one-quarter believe is poor under managed care (25 percent).

Plan Type Affects Opinions on Care and Access

  • Three in 5 HMO-type participants rate the quality of care available in managed care highly (61 percent). Significantly fewer PPO-type participants and traditional insurance participants rate quality that high (52 percent and 51 percent, respectively).
  • HMO-type plan participants rate the choice of hospitals higher than PPO-type participants (54 percent v. 41 percent). HMO-type enrollees also rate access to preventive care higher than others (52 percent v. 42 percent of all Americans).
  • Americans indicate they base their opinions of managed care on personal experience (28 percent), what they have heard from family and friends (23 percent), or what they have seen or heard in the media (29 percent). HMO-type participants are more likely to report that their managed care opinions are based on personal experience (43 percent).

Source: 1998 Health Confidence Survey.

Note: Plan type is categorized by the number of managed care plan design features (out of a total of four) a respondent reports as describing his or her health plan. Individuals enrolled in plans with all four plan design features are considered to be in "HMO-type" managed care plans; individuals enrolled in plans with at least one of these features are considered to be in "PPO-type" managed care plans; and individuals enrolled in plans with none of the four features are considered to be in "traditional" fee-for-service insurance plans. All respondents older than age 65 are considered to be Medicare participants.