Survey shows dissatisfaction rising in managed care plans

A recent national satisfaction survey by management consulting firm Hewitt Associates reveals that 22 percent of U.S. consumers are dissatisfied with their managed care plans, up from 17 percent in 1997, according to a news release from Hewitt.

Although most people remain satisfied with their health plans, Hewitt's survey results indicate consumer dissatisfaction has increased for all managed care plans health maintenance organizations, preferred provider organizations and point-of-service plans as well as across all geographic regions.

"Since we began surveying employees on managed care in 1996, satisfaction levels have remained relatively stable above 80 percent until this year," said Hewitt Associates consultant Marc Kaiser, in a release.

"So, the good news is the majority of people remain satisfied with their health plans, as well as their individual physicians. However, our survey shows there is growing consumer frustration with health plans' administrative breakdowns and difficulty resolving problems," Kaiser added.

The Hewitt Satisfaction Survey represents the opinions of nearly 150,000 U.S. employees participating in more than 600 managed care plans nationwide.

Sources of dissatisfaction. According to Hewitt's survey findings, poor customer service is the driving force behind people's dissatisfaction.

In fact, more than a third of employees (34 percent) expressed displeasure with their plans' ability to resolve problems, up from 29 percent in 1996.

And 30 percent of employees said they are not satisfied with their plans' timeliness, profes-sionalism or accuracy, a sharp increase from 1996 and 1997 rates of 17 and 24 percent.

Kaiser attributes a large share of people's lack of satisfaction with customer service to industry consolidation.

"As managed care plans have consolidated over the past two years, their integration has been slow," he said. "In most cases, consumers are left to deal with their health plans' operational glitches, technical problems and confusion. Cost pressures on plans also have caused many to cut back on staff and service to stay profitable, which has frustrated many participants."

Cost is another area where people expressed dissatisfaction, with 22 percent saying they are not pleased with how much they have to pay for deductibles and copayments, and 19 percent not happy with how much comes out of their paycheck to enroll in a health plan. Another 18 percent of employees expressed dissatisfaction with their plans' convenience, particularly in the area of scheduling doctor appointments and reaching doctors after hours.

Regional satisfaction differences. Overall, dissatisfaction with managed care has accelerated in all U.S. regions, with the West experiencing the biggest increase.

A quarter of employees in the West (25 percent) said they are not satisfied with their managed care plan, up 7 percentage points since 1997. In the East, 22 percent of employees expressed dissatisfaction with their plans, an increase of 6 percentage points from the previous year. And in the Central region, 21 percent of employees said they aren't satisfied with their plans, up 3 percentage points from 1997.

"We're seeing higher levels of dissatisfaction in every part of the country," Kaiser said.

"However, recent price wars among managed care plans in the West have caused many to cut back on customer and support services, which has led many people in that region to become frustrated," he added.

Satisfaction differences among major U.S. markets. Among the 10 largest U.S. markets, Hewitt's survey reveals employees are least satisfied with their managed care plans in Detroit (35 percent) and Los Angeles (30 percent). Dissatisfaction rates were lowest in Boston (11 percent) and Philadelphia (17 percent).

"Because health plans are administered on a local basis, their performance and customer service are going to vary by market," Kaiser said. "Even if it's a national plan, it will still be administered locally and you will see differences in its performance in markets throughout the country."

Satisfaction differences by plan type. According to Hewitt's survey findings, employee satisfaction is down for every type of managed care plan.

Nationally, point-of-service plan participants expressed the most dissatisfaction at 29 percent, a 7 percentage point increase from a 1997 rate of 22 percent. Health maintenance organizations' dissatisfaction rates rose 4 percentage points to 17 percent in 1998 and preferred provider organizations increased 2 percentage points to 27 percent.

"Because of the way POS plans are structured, participants often have to work their way through complex rules regarding referrals and in-network vs. out-of-network providers, which often leads to frustration and confusion," Kaiser said, citing that 24 percent of point-of-service plan participants expressed dissatisfaction with convenience and ease of use of their health plans.

Hewitt satisfaction survey. The Hewitt Satisfaction Survey is an annual survey conducted among large U.S. employers. It evaluates employees' satisfaction with their overall health plan, including customer service, cost and convenience/ease of use.

Hewitt Associates LLC is a global management consulting firm specializing in human resource solutions.