Survey Shows Low Confidence In Hmos Americans Want Rules Enacted To Improve Treatment, Protect Patient Rights

Americans in health maintenance organizations and other types of “managed care” have far less confidence in their medical plans than those with traditional insurance, according to a new study.

Sponsored by the Henry J. Kaiser Family Foundation and Harvard University, the study found that 44 percent of Americans in relatively restrictive health plans believe it is very likely their treatment would be covered if they became seriously ill, compared with 69 percent in “fee-for-service” arrangements.

The national survey of 1,200 adults is the first attempt to probe not just whether people believe the health care system is working overall but to gauge how much people with different kinds of insurance trust their own care.

It found that Americans with all kinds of insurance hold managed care companies in low esteem, ranking them below nurses, doctors, hospitals and drug manufacturers. Three-fifths of the people surveyed said that managed care had caused doctors to spend less time with their patients and had made it harder for sick patients to get specialized care.

And only one-fourth said they believe managed care - HMOs and an assortment of other arrangements that restrict how much and what kind of treatment patients receive - had accomplished one of its chief objectives: constraining medical costs. When asked who gets any of the money that managed care has saved, nearly three-fourths said they believed the savings increase companies’ profits, while only half said they help make care more affordable.

“People are worried managed-care companies care more about costs than about them,” said Drew E. Altman, president of the Kaiser Family Foundation, a non-profit agency that sponsors health care research.

The portrait of Americans’ attitudes painted by the survey has particular relevance, because it comes during an intensifying political debate over what role government should play in regulating health insurance to try to improve the quality of patients’ care.

Congress, state legislatures and a presidential commission are assessing a variety of measures that would prescribe coverage for certain ailments, guarantee patients more information about treatment and health plans and give consumers more leverage if they are dissatisfied with their care.

The findings suggest substantial public support for such regulation. Slightly more than half the people surveyed said government should create more protections for patients, even if those protections make insurance more expensive. But there appears to be uncertainty as to whether such regulation should come from the federal government, states or other organizations.

“This is a call for political entrepreneurship,” said Robert J. Blendon, professor of health policy at Harvard University. “People at different levels have a crack at doing this.”

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