Managed care's nagging headache with public perception isn't getting better.
But while a majority of people are concerned about the quality of care under health plans, they support targeted consumer protections rather than sweeping government regulation, according to a new national survey by the Kaiser Family Foundation and Harvard University.
The study, released last week, found most insured Americans think their health plans are doing a good job regardless of whether they're in traditional or managed-care plans.
At the same time, a majority of respondents believe managed care has eroded healthcare quality. And a majority of people in managed care-some 55%-are anxious they won't get the best medical treatment when they're sick because managed-care plans focus on saving money.
The irony is that even people satisfied with their own healthcare believe that managed care is doing bad things to others.
"People seem to generalize from anecdotal reports in the news about problems with managed care. When asked about specific examples taken from news stories about the problems some people have reported . . . with managed care, the public's perception is that these are fairly common occurrences," the survey found.
For example, two-thirds of respondents believe HMOs often or sometimes hold back on a child's cancer treatment.
The telephone survey of 1,204 adults nationwide was conducted in August and September.
In a surprising finding given the intense media attention on managed care, a sizable number of respondents-some 28%-said they never heard of managed care, and an additional 26% said they've heard about it but aren't sure what it means.
Some 72% of the respondents said cost reductions achieved by managed care mostly benefit insurers' profits, while 56% said the reductions also help employers, and 49% said they also help individuals. Nevertheless, 55% said managed care hasn't affected healthcare costs very much.
As for the regulation of managed care, 52% said the government should protect healthcare consumers, but 40% said such intervention isn't worth the increased costs.
"This doesn't show a call for massive regulation. There are four or five things that really bother people," said Robert Blendon, professor of health policy at Harvard University.
Republican leaders who oppose comprehensive patient-rights legislation already are using the specter of increased government regulation and increased costs to mobilize opposition to such bills.
In a memo to their Republican colleagues, Senate Majority Leader Trent Lott (R-Miss.) and House Majority Leader Dick Armey (R-Texas) warned that legislation to regulate healthcare quality is "a way to implement the defeated Clinton health plan" (See related story, p. 82).
The GOP leaders also are asking some of the same groups that helped them defeat the Clinton plan to again join the fight.
An internal memo of the Health Insurance Association of America circulating in Washington said Lott told insurance and business groups that "we are in a war and need to start fighting like we're in a war."
The HIAA was instrumental in the controversial advertising campaign featuring the fictional yuppie couple Harry and Louise that savaged the Clinton health bill.
Lott also told the groups to "get off your butts, get off your wallets," the HIAA memo said.
The public is divided over whether plans should be regulated by the federal or state governments or by an independent organization. Sixteen percent said managed-care plans should not be regulated at all.
Even the industry itself is split about the level of governmental regulation needed in the field (See stories, p. 36).
"Managed care is winning in the healthcare marketplace, but it is in danger of losing the battle for public opinion," said Drew Altman, president of the Kaiser Family Foundation. The foundation is not affiliated with Kaiser Permanente, the country's largest HMO.
-With Eric Weissenstein