Consumer satisfaction with HMOs has dropped significantly during the past two years but continues to run slightly above approval rates for PPOs and fee-for-service health plans, according to a new study.
The number of those "completely satisfied" and "very satisfied" with health plans of all types edged up slightly during the two-year period, the study found.
The conclusions are contained in a national study of more than 160,000 households by Lincoln, Neb.-based National Research Corp., a provider of healthcare marketing research and performance assessment.
The study takes a look beneath the surface of consumer satisfaction data. Several recent studies have reported satisfaction with managed-care plans in the high 80% to 90% range. However, greater differentiation of satisfaction data is needed if health plans are to find opportunities to improve.
Even when consumers are given the option to choose "completely satisfied" as well as "very satisfied" on the measurement scale, overall satisfaction with health plans shows little change in the past two years. The percentage of enrollees who are completely or very satisfied with their health plans edged up to 56.3% in 1996 from 55.9% in 1994.
However, larger changes start to appear when the plan data are broken into categories: fee-for-service, HMO, PPO and Medicare.
Medicare plans have shown the greatest increase in satisfaction, followed by slight increases in satisfaction in fee-for-service and PPO plans.
However, HMO enrollees who reported being satisfied with their plans dropped to 58.3% in 1996 from 63.6% in 1994.
Despite the decline, the level of satisfaction expressed by HMO enrollees is slightly higher than those of fee-for-service and PPO plans. But the drop in HMO satisfaction suggests the differences among various types of plans may be leveling out.
The study is the sixth in a series conducted since 1987 to measure national satisfaction as well as satisfaction within the top 109 metropolitan markets. When surveying such a large sample, the study has a margin of error of 0.2% at a 95% confidence level. Thus, even small changes in percentages can be statistically significant.
The growth of managed care has been spectacular. Two-thirds of households nationally are enrolled in managed-care plans, compared with about 39% in 1994. HMOs have experienced a 10 percentage-point increase in enrollment, but PPOs have jumped to 28.3% of U.S. households enrolled in 1996 from 11.8% in 1994.
Overall, the survey found that respondents reported being slightly more satisfied with their health plans. Almost two out of 10 respondents believe their plan's overall performance has improved in the past 12 months. The improvement, however, tends to fall into the category of "somewhat better" rather than "much better."
One in 10 health plan enrollees across the nation said their plan's performance has worsened in the past year.
More than eight of 10 respondents said they would be likely to recommend their plan to family and friends. However, almost two of 10 enrollees say they may switch plans at their next opportunity.
The survey divides the reasons for satisfaction into four categories: administrative aspects; benefits/costs; access to physicians; and perceived quality of medical care.
Satisfaction with quality of care and outcomes has decreased significantly in the past two years, and the greatest declines came among HMO enrollees.
Satisfaction with quality of care among all health plans dropped more than 11 percentage points to 59% in 1996 from 70.4 in 1994.
One reason for discontent is referrals. One-fourth of HMO enrollees say referral to a specialist they want to see has been a problem, compared with less than half as many in other health plans.
Additionally, 15% of HMO enrollees say they have had difficulty receiving care they believe necessary, and 20% say they have faced delays in care while waiting for insurance approval. Far fewer enrollees of other types of plans cited such difficulties.
HMOs perform higher than other health plans in administrative and cost areas. These include the time it takes to fill out claim forms and paperwork, the amount paid out of pocket and the part of the premium that enrollees pay.
Complaint resolution shows progress. The level of complaints is down significantly from 1994, when 26.7% of health plan enrollees had a complaint. Now the number is 17.7%.
PPOs had the highest level of complaints, and Medicare had the lowest.
Jensen is senior vice president of Lincoln, Neb.-based National Research Corp.