Willingness to recommend a health plan: who is dissatisfied and what don't they like?

To explore the characteristics of individuals who are dissatisfied with their health plan, assess what aspects of the medical care experience are associated with plan dissatisfaction, and examine how this association varies according to plan type.

Retrospective observational study using the 1996 Medical Expenditure Panel Survey.

Unwillingness to recommend a health plan to others was used as a measure of overall plan dissatisfaction. Descriptive statistics were calculated to characterize the dissatisfied population. Logistic regressions and predicted probabilities controlling for personal characteristics were calculated to determine the association between plan or provider attribute and unwillingness to recommend a plan.

We found no personal characteristics that significantly differentiated individuals who reported their family was unwilling to recommend a health plan from those who were willing. The largest predictors of unwillingness to recommend a plan were dissatisfaction with choice of providers and preventive services coverage; in contrast, provider and personal characteristics were not significant predictors of dissatisfaction. We estimated the probability of being unwilling to recommend a health plan was 38% for individuals dissatisfied with the choice of providers and 34% for those dissatisfied with preventive services coverage. Although provider attributes were not found to be predictors of plan dissatisfaction for the entire sample, they were predictors of dissatisfaction for HMO and multiple plan members.

Enrollee dissatisfaction with the choice of providers and preventive services coverage are major predictors of health plan dissatisfaction. Managers concerned about plan satisfaction may want to examine enrollee assessments of these measures.