Americans fed up with managed care, survey finds

The anger Americans felt about the soaring health-care costs of the 1980s has turned emphatically against the organizations that are most responsible for halting the rising costs, new surveys of public attitudes are showing.

"We've gone from dissatisfaction with one system to dissatisfaction with another system," said Robert Leitman, executive vice president of Louis Harris and Associates.In a survey published last week Harris reports that in August, 54 percent of Americans believed the trend toward managed care is harmful for them, an increase from 43 percent a year earlier. "There is definitely a trend toward accelerating levels of dissatisfaction," Leitman said.

In another survey, published this month in the journal Health Affairs, Harris, the Pew Charitable Trust and the Harvard School of Public Health report that physicians are as dissatisfied as consumers.

Fifty-five percent of 2,000 physicians surveyed in 1995 said the health-care system was deteriorating overall, and most sharply in communities with well-entrenched managed-care organizations.

These and other recent surveys show the public indignation that is fanning the firestorm in Congress and in most states' legislatures to regulate the organizations and the hospitals that use the disciplines of the marketplace to hold down costs and raise profits.

New and pending laws assure patients quick and easy access to specialists, for example, allow them more time in hospitals after surgery and prohibit organizations from offering doctors financial incentives to limit the care. In response, three big health-care organizations joined two consumer groups last week in supporting stiffer regulations.

The American Association of Health Plans, whose members include most health-maintenance organizations, says most surveys show considerable consumer satisfaction but that it drops while consumers are in the throes of shifting from the old, fee-for-service care, which they and their doctors controlled, to managed care.

"We would expect people not to be satisfied in their first year," said Susan Pisano, the group's spokeswoman. She said consumers become more satisfied as they become acclimated to managed care.

The latest Harris poll of 1,007 adults interviewed Aug. 20 to 26 found a tie, 44 percent vs. 44 percent, in response to the question of whether the trend toward managed care was a good or bad thing.

In a similar poll two years ago, 59 percent liked the trend and 28 percent did not. "This is the first time," the Harris report said, that neither a majority nor a plurality thought managed care "was a good thing."