Impacts of managed care patient protection laws on health services utilization and patient satisfaction with care

Health Services Research, June, 2005 by Frank A. Sloan, John R. Rattliff, Mark A. Hall

RESULTS

Health Services Utilization

Patient protection laws generally had no statistically significant effects on utilization of health services (Table 2). Exceptions were for hospital utilization and emergency room visits. For hospital use, there was a positive and statistically significant at better than the 0.05 level for the year in which the law took effect. For the postperiod and for enforcement, there were no effects. For emergency room visits, the joint F-test was statistically significant at better than the 0.03 level, but the net effect of the laws on emergency room utilization was practically nil. Overall, signs on the legal parameter estimates were mixed, but parameter estimates had large associated standard errors.

The vast majority of control variables had plausible and statistically significant effects on utilization. Persons in better physical or mental health had lower rates of utilization, while older persons had higher rates. More-educated and higher-income persons also had higher rates of utilization, except for emergency room visits. Blacks and Hispanics had higher rates of hospital and emergency room use, but lower rates of office visits, outpatient surgeries, and visits to mental health providers and other specialists, holding other factors constant. Females had consistently higher levels of utilization than did males.

Patient Trust and Satisfaction with Care

None of the patient protection legal variables had statistically significant effects on patient trust or satisfaction with care (Table 3). For the postenactment period, statistical significance was gauged by a Wald test. By itself, the level of state agency enforcement had a negative impact on patient satisfaction with choice of specialist. But when tested jointly with the binary variable for postenactment, which had a larger but insignificant positive effect, the joint effect was not significant. Most of the other parameter estimates for the laws were positive, suggesting improved patient satisfaction and trust. But these parameter estimates had large associated standard errors.

In contrast to the patient protection laws, the vast majority of other explanatory variables were statistically significant at conventional levels. Persons in good physical and mental health, females, and higher-income persons tended to report higher levels of satisfaction. Blacks, Hispanics, and persons interviewed in Spanish tended to be less satisfied. Patterns by education were mixed. More-educated persons tended to be more satisfied with their last visit and had greater trust in their doctors, but they were less satisfied with their choice of physician. Older persons tended to be more satisfied with their care. In the analysis of subgroups (Table 4), patient protection laws postenactment and enforcement level had a jointly significant positive effect on trust of physician among low-income persons. At the observational means, low-income persons had a higher level of trust after patient-protection laws were implemented. Coefficients on the other patient-protection law variables were not statistically significant for any of the subgroups; nor did year-of-interview have significant effects. Most other independent variables were statistically significant. Signs on the parameter estimates for the control variables were consistent across the three subgroups and corresponded to the total-sample results in Table 3.