HMOs score high on access but low on satisfaction

HMO enrollees are less likely to trust that their physicians will put their medical needs first or refer them to a specialist, a study finds.

By Susan J. Landers, amednews staff. March 27, 2000.

Washington -- Managed care companies haven't been winning any popularity contests in recent years, but a new study suggests that their reputation for setting up roadblocks to patient care may be undeserved.

As Congress wrangled over patients' rights legislation inspired by a common perception that consumers are not well-served by their managed care companies, the Center for Studying Health System Change released a study showing that HMOs differ little from non-HMOs on some important measures of patient care.

However, missing from the analysis is such important information as a comparison of health outcomes and the cost of the care, noted Robert Reischauer, PhD, president of the Urban Institute and former head of the Congressional Budget Office.

"This tells us nothing about what policymakers need," Dr. Reischauer said. "They need health outcomes information. Just measuring how often consumers go to the doctor isn't enough."

Policymakers would also need to know how much money an HMO could save before making any policy decisions, he added.

The study compared HMOs with other types of insurance, such as traditional indemnity plans, on 55 indicators of patient access, service use and satisfaction.

The researchers contacted nearly 36,000 privately insured individuals who were among the respondents to the center's 1996-1997 Community Tracking Study Household Survey.

The findings revealed that HMO patients were more likely to visit their doctors than were patients in traditional insurance plans, although the visits were more often to primary care doctors than specialists.

HMO enrollees were also admitted to hospitals as frequently as were patients in other types of health plans, had just as many inpatient and outpatient surgical procedures, and reported a similar number of unmet medical needs during a one-year period, according to the study.

Cost low; so is satisfaction

Health care also cost less under HMOs, and such preventive care measures as mammography screening, flu shots and smoking cessation advice were provided more often.

Despite all those favorable findings, individuals enrolled in HMO plans reported less satisfaction with their care than did those in other kinds of plans. HMO enrollees were less likely to trust that their physicians would put their medical needs first and refer them to a specialist when needed, the study found.

Patients also reported less satisfaction with such aspects of care as their physicians' listening to them, providing thorough explanations and giving them a thorough exam.

Researchers speculated that the existing "managed care backlash," enhanced by poor media reports, could be responsible for the negative views of enrollees.

But "it may be that the policy debate, which has been fueled by a perception that there are huge differences between HMOs and other forms of insurance coverage, has missed the mark," said John Rother, director of legislation and pubic policy at AARP. "The fact is that neither type of insurance is doing a good job, and both need to improve."

The findings point to a "disconnect" between people's negative views about HMOs and what the data say about their overall experiences, said Janet Corrigan, PhD, director of the Health Services Division at the Institute of Medicine.

"External appeals processes for all forms of health coverage would go a long way to allay people's fears," she said.

The researchers did note that the small differences between the HMOs and other health plans could be the result of diminishing overall differences between the two insurance approaches. Although HMOs are adopting less restrictive practices, care management techniques pioneered by HMOs are being adopted by more traditional plan types, they said.

"Although the overall findings may be welcome news for those worried that HMOs unnecessarily restrict access to care, they raise questions about HMOs' longer-term ability to control costs," said Peter Kemper, PhD, the center's vice president and one of the study's authors.