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Consumer Choice and the Managed Care Backlash

Published online by Cambridge University Press:  24 February 2021

Alain C. Enthoven ,
Helen H. Schauffler  and
Sara McMenamin
Alain C. Enthoven
Affiliation:
Center for Health Policy, Institute for International Studies, at the Stanford University Graduate School of Business. Stanford University, 1952; Oxford University (Rhodes Scholar), 1954; Massachusetts Institute of Technology, 1956
Helen H. Schauffler
Affiliation:
University of California, Berkeley. Skidmore College, 1973, Harvard University, 1976, Brandeis University, 1989. Health Services Administration at the Harvard University School of Public Health and health care management consultant for Arthur D. Little, Inc. Prof. Schauffler is the King Sweesy and Robert Womack Chair in Medical Research and Public Health at University of California, Berkeley.
Sara McMenamin
Affiliation:
University of California, Berkeley, Johns Hopkins University, 1996, University of California, Berkeley, 1998
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Extract

The backlash against managed care, in general, and Health Maintenance Organizations (“HMOs”), in particular, is a major health policy issue. It has led to the formation of major commissions at the national and state levels, and to a great outpouring of legislative activity. The U.S. Congress has been deadlocked over various versions of a Patients’ Bill of Rights for the past two years. As a nation, we are far from resolving the many problems consumers report experiencing with their HMOs. However, to prescribe an effective solution to the problem, it is important to understand the root causes of the consumer backlash. It is, after all, possible that a Patients’ Bill of Rights will do little if it is not targeted to correct what is really bothering people about HMOs.

Type
Articles
Information
American Journal of Law & Medicine , Volume 27 , Issue 1 , 2001 , pp. 1 - 15
Copyright
Copyright © American Society of Law, Medicine and Ethics and Boston University 2020

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References

1 See generally Blendon, Robert J. et al., Understanding the Managed Care Backlash, Health Aff., July-Aug. 1998, at 80 (discussing the fears of people enrolled in managed care plans as compared to their traditionally insured peers)CrossRefGoogle Scholar; Bodenheimer, Thomas, The HMO Backlash-Righteous or Reactionary, 335 New Eng. J. Med. 1601 (1996) (discussing the substantive issues raised by the backlash against HMOs)CrossRefGoogle ScholarPubMed; Enthoven, Alain C. & Singer, Sara J., The Managed Care Backlash and The Task Force in California, Health Aff. July-Aug. 1998, at 95 (reporting the findings of the California Managed Health Care Improvement Task Force)CrossRefGoogle Scholar; Mechanic, David, Managed Care as a Target of Distrust, 277 JAMA 1810 (1997) (noting the increased public opposition to managed care)CrossRefGoogle Scholar.

2 See Blendon, , supra note 1, at 81Google Scholar; Bodenheimer, , supra note 1, at 1601Google Scholar; Enthoven, & Singer, , supra note 1, at 95Google Scholar.

3 See, e.g., Bipartisan Patient Protection Act of 2001, S. 283, 107th Cong. (2001); Patients’ Bill of Rights Act, S. 6, 107th Cong. (2001); Common Sense Patients’ Bill of Rights Act, H.R. 5628, 106th Cong. (2000); Patients’ Bill of Rights Act, S. 3058, 106th Cong. (2000); Quality Care for the Uninsured Act of 1999 and The Bipartisan Consensus Managed Care Improvement Act of 1999, H.R. 2990, 106th Cong. (1999); Patients’ Bill of Rights Plus Act, S. 1344, 106th Cong. (1999). See also Blendon, , supra note 1, at 81Google Scholar.

4 See Tindall, William N. et al., Paving the Pathway to Managed Care Medicine (visited Feb. 14, 2001) <http://www.acmcm.org/CME/Pathway_Course_l.htm>>Google Scholar.

5 See id.

6 See Davis, Karen & Schoen, Cathy, Assuring Quality, Information, and Choice in Managed Care, 35 Inquiry 104, 104 (Summer 1998)Google Scholar; Collins, Karen Scott et al., The Commonwealth Fund, The Commonwealth Fund Survey of Physician Experiences With Managed Care (visited Jan. 28, 2001) <http://www.cmwf.org/programs/health_care/physrvy.asp> [hereinafter Physician Survey].+[hereinafter+Physician+Survey].>Google Scholar

7 See Physician Survey, supra note 6.

8 For more information about CalPERS, see California Public Employees’ Retirement System (visited Feb. 7, 2001) <http://www.calpers.ca.gov>.

9 See id.

10 For more information about FEHBP, see U.S. Office of Personnel Management, Federal Employees Health Benefits Program (visited Feb. 7, 2001) <http://www.opm.gov/insure/health>>Google Scholar.

11 See Stanford GSB News and Information, Enthoven, Alain C., Managed Care: What Went Wrong? Can It Be Fixed? (visited Feb. 14, 2001) <http://www.gsb.stanford.edu/services/news/enthovenozmunlecture.html> [hereinafter Enthoven Speech]+[hereinafter+Enthoven+Speech]>Google Scholar; see also Enthoven, & Singer, , supra note 1, at 97Google Scholar.

12 See The Kaiser Family Foundation and Health Research and Educational Trust, Employer Health Benefits 1999 Annual Survey 42-54 [hereinafter Employer Health Benefits]; Enthoven Speech, supra note 11; Enthoven & Singer, supra note 1, at 97.

13 See Enthoven Speech, supra note 11.

14 See Enthoven Speech, supra note 11; see also Karen Davis & Cathy Schoen, The Commonwealth Fund, Managed Care, Choice, and Patient Satisfaction (visited Jan. 28, 2001) <http://www.cmwf.org/programs/health_care/satis.asp> (discussing involuntary physician changes for managed care patients) [hereinafter Patient Satisfaction],

15 See Enthoven Speech, supra note 11.

16 See Davis, Karen et al., Choice Matters: Enrollees’ Views of their Health Plans, Health Aff., Summer 1995, at 99, 108-10Google Scholar; Enthoven, & Singer, , supra note 1, at 102-03Google Scholar; Managed Health Care Improvement Task Force, Improving Managed Health Care in California: Findings and Recommendations Vol. 2, 18 (1998)Google Scholar [hereinafter Findings and Recommendations]; Helen H. Schauffler & Lee D. Kemper, California Center for Health Improvement, Survey Brief to the Managed Health Care Improvement Task Force: Task Force Survey Finds 76% of Insured Californians Satisfied, 42% Report Problems 8 (1998) [hereinafter Survey Brief].

17 The establishment of the California Managed Health Care Improvement Task Force was added by 1996 Cal. Stat. 815 § 1 (introduced as A.B. 2343). See Cal. Health & Safety Code § 1342.1 (West 2000). See also Survey Brief, supra note 15, at 1. Section II of this article discusses the survey conducted by the MCTF. For clarity’s sake, individual citations to the MCTF’s report to the governor have been omitted. For more information on the MCTF survey and findings, see generally Findings and Recommendations, supra note 15 (discussing the MCTF survey and findings).

18 See infra Table 1.

19 See infra Table 2.

20 See infra Table 3.

21 See infra Table 4.

22 See Schauffler, Helen H. et al., Health Care Trends and Indicators in California and the United States: A Chartbook from the Kaiser Family Foundation 39, Exhibit 4.7 (2000)Google Scholar.

23 See id. at 39, Exhibit 4.8.

24 See Employer Health Benefits, supra note 12, at 47, Exhibit 5.5.

25 See Patient Satisfaction, supra note 14.

26 See id., Table 4.

27 See id., Table 4.

28 See Davis, , supra note 15, at 109.Google Scholar

29 See id.