Most Give Their Health Plans Passing Grades
June 7, 2000 -- Americans are generally satisfied with their health insurance plans. But the hassles of dealing with strict managed care plans left many of them feeling stressed and lacking care they think they need, according to a "report card" survey released Wednesday by the Kaiser Family Foundation and Consumer Reports magazine.
The first national survey to quantify how many people are having problems reports "one of every two Americans is having problems with their health insurance plan," Larry Levitt, MPP, a Kaiser analyst, tells WebMD. "That suggests that the momentum behind the patients' rights debate [in Congress] is grounded in real patient experiences, not just in anecdotes. We also found that most of the problems are relatively minor, not horror stories."
The Kaiser Family Foundation is an independent health care research institute based in Denver, Colo. It is not affiliated with Kaiser-Permanente, a major HMO based in California.
The Kaiser survey polled a nationally representative sample of 2,500 people between 18 and 64 who had some kind of health insurance other than Medicare. The survey found that most people -- 83% -- who have had contact with their plan in the last year had positive experiences. Even among those who had problems with their plan, 71% reported recent experiences as being positive. Also, most people seemed satisfied with their plan overall -- 65% gave their plan a grade of A or B.
However, those with "strict" managed care plans that limit choices, like HMOs, gave their plans lower grades than those in "loose" managed care plans. Loose plans got an A or B from 70% of those surveyed, while strict plans got high grades from just 53%. Among those in traditional fee-for-service health care plans, 74% gave a thumbs up.
The most common problems reported by the 51% of total respondents who had trouble with their plan involved delays or denials of coverage or care (32%), difficulty seeing a physician (27%), and billing or payment problems (23%). Most of the problems were resolved with only minor consequences, but 62% of the people who experienced problems said it caused them stress, according to the report. In general, people reported dealing with their health insurance plans caused them stress similar to doing their taxes and dealing with their auto mechanic.
Many of the reported problems were on the order of, "You go to the emergency room and your plan doesn't want to pay the bill, so you make a few calls and it gets paid," Levitt says. "It's ripe for dinner table conversation; it annoys people, but it's not changing lives."
"The disturbing news was that one out of five people are having serious problems, when a treatment costs money out of pocket, when delays in treatment lead to worsening of health problems," he tells WebMD. "People have to take time from daily activities to deal with problems, and then the problem doesn't resolve itself. Those are the problems we need to focus on, both to prevent them and to make sure they get resolved."