Consumers Lack Understanding Of HMOs, Survey Finds

A majority of states allow women in health maintenance organizations--or HMOs--direct access to an OB/GYN, provide consumers with an independent appeals process and have bans on gag clauses. What does all that mean? If you're not sure, you're not alone.

A mere 30 percent of almost 11,000 consumers correctly identified four basic managed care features, according to a March 12 study by the Center for Studying Health System Change (HSC), a non-partisan research group that looks at the nation's health care system. The study examined what consumers know about health plans, including whether a person must choose from a network of doctors and whether a health plan pays any of the cost of out-of-network care.

The study, Do Consumers Know How Their Health Plan Works? , also found many people believe their own health plan is more restrictive than it really is, specifically in getting appointments with a specialist like a dermatologist or a chiropractor.Lead study author Peter Cunningham says the overall 30 percent finding is "surprising" because it's so high. "It's surprising in terms of how few people really understood basic features of health plans today...such as whether a health plan has a network of [physicians] and whether a patient can go outside the network," he says.

Why do consumers find the managed care concept still difficult to understand and navigate? Researchers said it's hard to say, but consumers need more than just someone handing them a brochure.

"Since most people get insurance coverage through an employer, one source [for information] would be employers. Consumers have to be educated about plans and understand why it's important to know about plans. Research shows that simply supplying people with more information won't enable consumers to make better choices," Cunningham says.

Improving what people know about health plans may also improve their health. The HSC study found people who believed their plans were more restrictive were slightly more likely to delay care. "That could cause delays in getting health care because a patient believes the primary care physician needs to refer him to a specialist, and that person may not [seek specialty care] on their own," says Cunningham.

Industry officials agree that plans must step up efforts to inform consumers. At the same time, consumers need to take advantage of what's already out there, says the Association of Health Plan's Susan Pisano."It has been true from time immemorial that most of us don't read carefully or understand our health benefits. Plans have been struggling with this in trying to identify best ways to help people use plans successfully. One plan has a seminar they give for new members on how to use the plan and they find it highly successful for those who do attend. Unfortunately, they can't get many people to go," Pisano says.

The general public's misunderstandings about managed care don't surprise the industry all that much. The health care system "has denigrated managed care to patients, [to the extent] that people who are covered don't know how good their managed care plans or managed care is in general. Politicians have been encouraged to run against managed care, and that's creating less trust in health care and a lack of appreciation for what managed care is doing," Pisano told Stateline.org.

Tags: Health