Does dissatisfaction with health plans stem from having no choices?

Data from a 1997 nationwide telephone survey are used to assess the relationship between choice and public opinion about managed care. We found that only a minority of the working-age population effectively control what health plan they get. Persons without choice were markedly more dissatisfied with their health plan, especially when enrolled in managed care. In multivariate analysis, how respondents rated their health plan depended as much on whether they lacked choice as on whether they were enrolled in managed care. Persons without choice also had more negative opinions about managed care in general. The results suggest that the managed care "backlash" may persist so long as consumers have little control over health insurance decisions.

Understanding the managed care backlash.

This paper examines the depth and breadth of the public backlash against managed care and the reasons for it. We conclude that the backlash is real and influenced by at least two principal factors: (1) A significant proportion of Americans report problems with managed care plans; and (2) the public perceives threatening and dramatic events in managed care that have been experienced by just a few. In addition, public concern is driven by fear that regardless of how well their plans perform today, care might not be available or paid for when they are very sick.

How much does the public know about health reform?

With federal action on major health reform set to take place in 1994, a recent survey of 1,200 adults found major gaps in Americans' understanding of what the problems are or how major legislative proposals would address them. While the public is primarily concerned about how health reform will affect them personally, their current lack of knowledge heightens the impact that political advertising, media coverage, and public education campaigns will have.