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

Fourth, plans may have changed practices across the board, both in states with and without these laws, and in advance of these laws being enacted. This might have been done out of anticipation that these enactments were becoming widespread, or because the general public and political discussion leading up to these laws may have been sufficient for health plans to change their practices even without being compelled to do so, realizing the level of dissatisfaction that existed. There are strong indications elsewhere that this in fact occurred (Hall 2004a, b).

However, if anticipatory or nondifferentiated changes were the main reason for finding no legal effects, we likely would have seen secular changes in these outcome measures over time. In fact, one report based on all three rounds of the CTS found that consumer confidence in the health care system and trust in physicians rose slightly between 1997 and 2001 (Reed and Trude 2002). The authors suggested that this improvement may have reflected the patient protection laws and a loosening of health plan restrictions. But these were descriptive findings rather than from multivariate analysis. Controlling for other factors, we found no statistically significant trends in trust or satisfaction

We did find changes over time in some of the utilization variables, however. Hospitals stays decreased, and outpatient surgeries increased, in the most recent (2000-2001) survey round. This pattern cannot easily be explained in relation to patient protection laws, but the two changes are more easily understood as being in reaction to each other. The absence of any net changes in utilization, either overall, or in reaction to patient protection laws, may explain why patients have not changed their views about the health care system.

A fifth explanation for lack of effects is that people's perceptions of health plans may differ from the plans' actual structure and behavior (Cunningham et al. 2001). Thus, health plans may have changed their practices, but enrollees may either lack knowledge of these changes or misperceive their nature. Moreover, even to the extent that people perceived changes, this may not have affected the attitudes that we measured because they relate more to experiences with physicians or other care providers than with health plans directly. Although health insurance affects provider behavior, many other factors do as well, so changes in managed care may be swamped by other, counteracting effects (for instance, reduced payment rates), or may be insignificant in view of the more fundamental features of treatment relationships.

Whatever the explanation, it does not appear that these laws, in and of themselves, have affected medical care delivery as experienced by patients. It remains to be seen whether these laws have had any great effect on the conditions of medical practice, as experienced by physicians.