Managed health care raises access concerns for state residents
By Susan Trulove
Spectrum Volume 21 Issue 07 - October 8, 1998
As governments and businesses turn to health-insurance plans based on managed care as a way to control costs, Virginians covered by such policies are divided on whether the quality of care is the same as with traditional plans, and are unhappy about limited access to medical care with such insurance.
The seventh annual Quality of Life in Virginia Survey, conducted by the Center for Survey Research, found that of the 60 percent of insured Virginians who have managed-care insurance, 83 percent are satisfied with the plan, although only 49 percent agree that "Managed-care health plans provide the same quality of medical care as other typical medical insurance."
"The response reflects the contentious nature of the issue," said James Bohland, a faculty member in urban affairs and planning. Questions on managed health care were added to the 1998 survey for research being done by Bohland and Karen Roberto, director of the University Center on Gerontology.
Responses to the question, "Managed-care plans limit a person's choices for medical care," were less ambivalent; 78 percent agreed with the statement. "It's not surprising that access to desired services, rather than quality, is seen as the real disadvantage of managed care," Bohland said.
Bohland said 60-percent coverage by managed-health-care plans is higher than he expected. Forty percent of those covered by managed care have been in such plans from more than five years.
A main thrust of the research by Bohland and Roberto is to determine public opinion on using a managed-health-care approach with Medicare and Medicaid. "I was particularly interested in responses by age group, and in Medicare versus Medicaid. Medicare is viewed as sacred, but people might be more willing to experiment with Medicaid."
In fact, more people agreed that "The federal government Medicare program should be a managed-care insurance program" than Bohland expected--44 percent. As predicted, those under 40 were more willing than those 40 and over; 43 percent of those under 40 years old agreed and 37 percent disagreed, compared to 36 percent of older Virginians who agreed and 50 percent who disagreed.
As predicted, more people are willing for Medicaid to be a managed-care insurance program--57 percent agreed and 32 percent disagreed.
Eighteen percent of those questioned had medical coverage from Medicaid or Medicare--26 percent of those over 40 years of age. Eighty-one percent had medical insurance paid for by their employer or themselves, down from 89 percent last year.
Another new question addressed the perceived quality of nursing homes. A repeat question indicated that 51 percent of Virginians worry they will have to care for a sick relative, compared to 47 percent last year. But only 40 percent rate their local nursing homes as good or excellent, and 24 percent elected not to answer or did not feel knowledgeable enough to respond to the new question. Roberto said "many citizens are unsure or unaware of nursing-home standards."
Related to care for the elderly, 51 percent of Virginians think there is not enough public spending on social services for the elderly. It was 45 percent last year.
Additional health-related questions in the annual survey were repeated from the previous six years.
Ninety-three percent of Virginians are satisfied with their own physical health--up from 87 percent in 1997.
Forty-six percent of the respondents say they "often" or "sometimes" worry that someone in their family might have a serious illness "not fully covered" by insurance. This is up from 41 percent last year, when the question asked respondents if they worried that someone in their family might have a serious illness that was "uninsured."
While 88 percent of Virginians report they are satisfied with the quality of their medical care and 77 percent rate health-care facilities in their community as excellent or good, 23 percent are not satisfied with the cost of medical care. That is better than last year, when 30 percent were unhappy about cost.
The Virginia Tech center found that 74 percent of Virginians continue to think that national limits should be set on what doctors' charge and 72 percent continue to want a national health care policy.
37 percent of Virginians think there is not enough public spending on health-care services, while 45 percent think it's about right.
Virginians continue to favor physician-assisted suicide, with 63 percent agreeing with the statement, "Doctors should be allowed to end a patient's life when the patient is terminally ill." However, 22 percent strongly disagreed.
Surveyors completed 726 interviews to provide a representative sample of adult respondents in households across Virginia with a margin of error of plus-or-minus 3.8 percent.