Yale Bulletin and Calendar

January 28, 2000

Volume 28, Number 18

Study: Chronically ill give
low ratings to managed care

Managed care patients with chronic illnesses are twice as likely to report dissatisfaction with their care than healthier patients, yet both types of patients are equally satisfied with fee-for-service plans, Yale researchers say.

Consequently, chronically ill patients may be less able to share in the benefits and be more vulnerable to the difficulties of managed care than their healthier counterparts, says Dr. Benjamin Druss, assistant professor of psychiatry and public health at the School of Medicine.

Published in the January/February issue of Health Affairs, the study analyzed results from a health and satisfaction survey returned by more than 16,000 employees of three major U.S. corporations. Researchers compared the views of people with chronic illnesses to enrollees without a serious medical condition.

"Managed care relies less on cost-sharing incentives for patients and more on provider incentives and clinical practice constraints to contain costs," says Druss. "Because these mechanisms are less visible to healthy than to sicker enrollees, the general population tends to report fairly high levels of satisfaction under managed care. Only when enrollees become seriously ill do they directly experience the rationing mechanisms that are more common under managed care."

He adds, "Understanding the experiences of chronically ill patients may offer regulators and other members of a covered population a useful window for evaluating plans."

Druss' research team included Mark Schlesinger and Tracey Thomas of the Department of Epidemiology and Public Health, and Harris Allen, a health care performance consultant. The study was partly supported by grants from the Robert Wood Johnson Foundation and the Donaghue Medical Foundation.

-- By Karen Peart

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