A rising call for quality health care

Public opinion polls spanning the last several years reveal growing recognition of a broken health-care system. Gone are the days when health-care consumers are satisfied by cheaper health care. Today?s consumer, increasingly concerned about the need for quality in the wake of managed care, supports specific remedies for the serious problems with the current health-care system. This significant evolution on the part of consumers gives organized psychology a crucial ally in the quest for health-system reform.

The history of this shifting public opinion is instructive. In 1991, a Towers-Perrin survey of 1,000 employees, for example, showed that people were at least as satisfied, some even more satisfied, with managed-care plans as with traditional fee-for-service plans. Not coincidentally, those surveyed identified low out-of-pocket expense as the most important factor in choosing a health plan. Numerous additional polls reflected a similar general level of consumer satisfaction with managed care until 1995. Then, a new finding began to emerge. A Harvard-Harris poll in the summer of 1995 revealed that ?sick people? who paid less for managed-health coverage had a harder time getting treatment than patients with more expensive traditional plans.

About the same time, the debate over ?drive-thru deliveries??limiting hospital stays for mothers and their newborns?began. This battle, described by the Associated Press as ?the first sign of rebellion over managed-care insurance policies,? led to the first consumer-protection laws in New Jersey and Maryland, as well as several congressional proposals. More to the point, the media exposure of a significant problem caused by managed care marked the beginning of a shift in public opinion culminating in the majority believing that managed care is injurious. A July 1997 Harvard-Harris analysis of 25 public opinion surveys from the preceding three years substantiated that consumer dissatisfaction with managed care clearly had risen during the period. In August 1997, a Louis Harris poll found 54 percent of the public believing that the trend toward managed care was harmful, an increase from 43 percent the year before. And 51 percent of consumers in a November 1997 Kaiser Family Foundation?Harvard survey believed that managed care has lowered the quality of health care in this country.

Now, the public wants solutions. According to an April 1998 poll by the APA Practice Directorate, 86 percent of respondents favor legislation that would provide concrete remedies for the escalating problems in health care. These remedies include ensuring access to a specialist and guaranteeing patient choice of doctor outside a health plan at reasonable cost.

Further, 77 percent of participants in the APA poll specifically support changing federal law to allow patients to hold managed care companies accountable for negligent treatment. Importantly, the public expressed a willingness to pay more for such protections. APA?s poll found that 78 percent would still support these legislative provisions if they resulted in an increase of up to $4 per month in health-care premiums for the consumer.

The growing negative public opinion about managed care underscores an important point. The managed-care industry has frequently dismissed adverse public reaction as consumers simply needing time to adjust to a new system. In other words, the public?s concerns should dissipate as time and experience with the changing health-care system increase. In reality, however, as poll results indicate, the more time and experience people have with managed care, the more negative their opinion of it.

Increasingly, the Practice Directorate is joining forces with key health consumer groups such as the Center for Patient Advocacy and Families USA to advocate for necessary changes. There are, however, significant counterforces working against consumers? and providers? collective call for adequate managed-care quality standards. For example, in late June, the House Republican leadership?s Task Force on Health Care announced a patient-rights proposal that lacks various provisions that APA and its health consumer organization allies consider fundamental to meaningful reform. Around the same time the GOP proposal was unveiled, the trade group representing the managed-care industry launched a large-scale advertising blitz aimed at forestalling comprehensive managed-care regulation.

Such steps may temporarily curtail a substantial legislative response to the public?s growing demands for solutions to problems in health care. Ultimately, however, members of Congress cannot afford to ignore widespread constituent dissatisfaction with the ill effects of managed-care cost containment. As this issue takes center stage in the political debate this election year, the APA Practice Directorate is joining with consumers to sound the rising call for quality care in the nation?s ailing health-delivery system.