Attitudes toward cost-containment features of managed care: differences among patient subgroups

To analyze the extent to which personal characteristics and circumstances affect attitudes toward cost-containment aspects of managed care.

A national probability sample component of the 1994 Robert Wood Johnson Foundation National Access to Care Survey.

Telephone and in-person survey follow-up of 3480 persons who completed the 1993 National Health Interview Survey. Findings on respondents' attitudes toward three principal cost-saving features of managed care are reported. These features are choosing physicians from insurance company lists (LIST), accessing specialists through referrals only (SPECIALIST), and seeing a nurse sometimes instead of a physician (NURSE). Data were categorized and analyzed by different population subgroups.

Respondents were divided almost equally in terms of how much they minded healthcare features of managed care, with approximately one third minding a lot, one third minding a little, and one third minding not at all. However, slightly more people minded LIST (42%) and NURSE (39%) features a lot. The respondent subgroups with the lowest proportion "minding a lot" were the uninsured poor and those already in managed care. Those groups minding the most were the elderly, those in fee-for-service plans, persons in poor health, and those with ischemic heart disease.

Acceptance of managed care cost-containment features varies by consumer characteristics. Those who have the most to gain financially by cost-containment features and the least to lose in terms of their access to care mind the managed care features the least. Persons who object most strongly are those who are not financially constrained and who are in poor health.