Yale Researchers Find Wide Gap in Satisfaction Between Sick and Healthy Patients Under Managed Care

Managed care patients with chronic illnesses are twice as likely to report dissatisfaction with their care than healthier patients, while both types of patients are equally satisfied with fee-for-service plans, Yale researchers say.

Consequently, chronically ill patients may be less able to share in the benefits and be more vulnerable to the difficulties of managed care than their healthier counterparts, said Benjamin Druss, M.D., assistant professor of psychiatry and public health at Yale School of Medicine.

“Managed care relies less on cost-sharing incentives for patients and more on provider incentives and clinical practice constraints to contain costs,” said Druss. “Because these mechanisms are less visible to healthy than to sicker enrollees, the general population tends to report fairly high levels of satisfaction under managed care. Only when enrollees become seriously ill do they directly experience the rationing mechanisms that are more common under managed care.”

Published in the January/February issue of Health Affairs, the study analyzed results from a health and satisfaction survey returned by more than 16,000 employees of three major U.S. corporations.

Respondents were asked about health care delivery, plan administration and overall satisfaction. Patients surveyed had chronic illnesses ranging from hypertension, back pain, arthritis, peptic ulcer disease, emphysema/asthma, diabetes, history of heart attack and cancer. These are some of the most prevalent and costly disorders for adults treated under managed care. Researchers compared people with chronic illnesses to enrollees without a serious medical condition.

“With the waning of traditional indemnity insurance, chronically ill patients are increasingly covered under some form of managed care,” said Druss. “Understanding the experiences of chronically ill patients may offer regulators and other members of a covered population a useful window for evaluating plans.”

Druss’ research team included Mark Schlesinger and Tracey Thomas of the School of Epidemiology and Public Health at Yale School of Medicine, and Harris Allen, a health care performance consultant. The study was partly supported by grants from the Robert Wood Johnson Foundation and the Donaghue Medical Foundation.

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Karen N. Peart: karen.peart@yale.edu, 203-432-1326