Consumer Satisfaction with a Managed Health Care Plan

This study estimates the effects of four categories of variables hypothesized to influence patient satisfaction with a managed care health benefits plan. Ordinal probit is used to include the full spectrum of information available on the satisfaction measure. Results indicate that personal experience, expectations, and judgments about services covered influence overall satisfaction with the plan. Individual differences have little effect on satisfaction. Knowledge of consumers' perceptions of how they fare when covered by managed care health benefits plans is a missing link in the search for an answer to whether these health care plans will solve the nation's health care woes. Managed care, in general, describes insurance plans based on networks of providers (Miller and Luft 1994). In this study, managed care means a plan in which consumers must choose a primary care physician from a network. To obtain medical services, consumers must first see their chosen primary care physician. This medical professional acts as a gatekeeper to further medical services. Steele (1992) summarized the role of the consumer in shaping health services to meet the needs of both providers and consumers: In order to provide health services which are responsive to consumers' needs, those organizations whose role it is to purchase, provide, or assess health services have a duty to carry out consumer appraisal work. Consumers are experts. They are experts on their own priorities, their own needs, and their own experiences, and they should be consulted as should any other expert group (37). This study examines consumer satisfaction with managed care. It recognizes the importance of the consumer in shaping the provision of quality medical care and uses those views to make suggestions as to how managed care plans can be improved to meet the needs of consumers. LITERATURE REVIEW Several researchers have considered the concept of patient satisfaction. After reviewing some of the earlier (pre-1975) literature in the area of patient satisfaction in general, Luft (1981) characterized satisfaction as being related to access, availability of resources, continuity of care, information transfer, humaneness, and quality. Higgens et al. (1991) suggest ten dimensions of quality that are specific to Health Maintenance Organizations (HMOs): reliability, responsiveness, competence, access, courtesy, communication, credibility, security, knowing the customer, and tangibles, such as written communications and billing procedures. Researchers who empirically examined consumer satisfaction with health care in general have suggested that satisfaction is influenced by aspects of care that are specific to the health care experience (Abramowitz, Cote, and Berry 1987; Cleary and McNeil 1988; de Ruyter and Scholl 1994; Doering 1983; Meterko, Nelson, and Rubin 1990; Russell 1990; Strasser, Aharony, and Greenberger 1993; Ware and Snyder 1975; Woodside, Frey, and Daly 1980) and that consumers are able to form summary measures of their satisfaction based on their satisfaction with components of care (Aharony and Strasser 1993; Luft 1981; Strasser, Aharony, and Greenberger 1993). Quality of care, access to care, availability of resources, and continuity of care accounted for 72 percent of the variance in satisfaction in a study by Ware and Snyder (1975), while Russell (1990) found that quality of care and accessibility accounted for 64 percent of the variance in satisfaction. Ward (1990) focused on age as an input into satisfaction with HMOs. The se findings indicate that age, increases in acceptance of providers other than the primary care physician, ability to see the primary care physician, and familiarity with the plan all positively influence consumer satisfaction with HMO services. Some researchers have focused specifically on the process of health care delivery (distinct from the physical outcome) as being a major influence on consumer perceptions of satisfaction with medical services (Buller and Buller 1987; Street and Wiemann 1987; Woolley, Kane, Hughes, and Wright 1978). …