Wednesday, August 03, 2005

National, For-Profit Managed Care Organizations Are the Least Trustworthy

I just learned about a recent article in Health Services Research on trustworthiness of managed care organizations that had some fascinating results. (The full citation is Schlesinger M, Quon N, Wynia M, Cummins D, Grey B. Profit-seeking, corporate control, and the trustworthiness of health care organizations: assessments of health plan performance by their affiliated physicians. Health Services Research 2005; 40: 605-646.)
The investigators used data from the American Medical Association's Socioeconomic Monitoring Survey from 1998. They focused on responses from 1274 physicians who had at least one managed care contract to questions asked about the health plan that enrolled the largest number of patients from the physician's practice. The distribution of responses to some of these questions were striking.
How often do the plan's advertisements create an inaccurate impression of its benefits?
Sometimes 30.7%
Often 18.9%
Always 7.2%
How often are patients often confused about plan benefits?
Sometimes 36.1%
Often 36.0%
Always 11.9%

How often does the plan forces physicians to compromise their standard of care?
Sometimes 23.6%
Often 6.3%
Always 1.3%

Furthermore, in multivariate analysis, for-profit national plans were rated by the physicians as less trustworthy. For the variables listed above, the odds ratios (approximation of the relative risk) for less favorable responses were:
Ads create inaccurate impression of benefits - 1.69
Patients often confused about benefits - 1.71
Plan forces physicians to compromise standard of care - 1.67

In summary, physicians frequently think that managed care plans run advertising that create false impressions of the plans benefits, confuse patients about their benefits, and force physicians to compromise their standard of care. National, for-profit plans are more likely to behave in such untrustworthy fashions than local and not-for-profit plans. Some points in the authors' discussion, couched in the typically cautious language of scholarly journals, merit repeating:
The managed care industry changed dramatically between the mid 1980's and mid-1990's. The ownership of health plans by large, for-profit corporations expanded markedly
Our findings suggest that the managed care backlash that appeared in the mid-1990's may have been a result of this transformation of the industry....
It is essential to recognize that these segments of managed care are growing rapidly because public policies have encouraged that growth.
Many states have enacted a plethora of regulation applied to managed care practice. As yet, little is known about the efficacy of these interventions, although state resources for enforcement are quite limited. Under these circumstances, public policies that encourage a larger role for more trustworthy forms of managed care may prove a more feasible form of intervention....
However, at the moment, we are instead seeing larger and larger for-profit national managed care organizations being formed by mergers. The most recent example is the merger of UnitedHealthGroup and PacifiCare. The important article by Schlesinger and colleagues suggests such mergers do not bode well for doctors or patients.

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