Kaiser Family Foundation/Harvard University National Survey of Americans’ Views on Consumer Protection in Managed Care – News Release

Kaiser/Harvard National Survey of Americans’ Views On Consumer Protection In Managed Care

Public Supports Broad Range Of Proposals For Federal Consumer Protection In Managed Care, But Potential Consequences Raised By Critics Also Hit Home

Embargoed for release until: 9:30 a.m. ET, Wednesday, January 21, 1998

For further information contact: Matt James or Tina Hoff

Access to Specialists Public’s Number One Consumer Protection Priority

Washington, DC — As the debate over regulation of the health care market takes shape, a new survey by the Kaiser Family Foundation and Harvard University finds that significant majorities of Americans favor the key measures intended to protect consumers in the President’s “Consumer Bill of Rights” and in legislative proposals before the Congress. Close to half of Americans — 48 percent — report that they personally, or someone they know, have experienced at least one of the problems addressed by the proposed regulations, including needing more information about health plans (29%), difficulty getting permission to see a medical specialist (24%), problems getting a plan to pay an emergency room bill (19%), and being unable to file an appeal to an independent agency for a denied claim (17%).

However, some of the arguments already being voiced against Federal regulation by its critics — that it will result in higher insurance premiums, too much government involvement in health care, and will cause employers to drop coverage — worry many people and weaken support.

“The consumer protection measures being proposed are modest steps that address some of the problems people are having in managed care,” said Drew E. Altman, Ph.D., President, Kaiser Family Foundation. “But, support may fall if the public comes to see them as part of a larger government health reform plan that could result in employers dropping coverage or higher health insurance premiums.”

Among the arguments against regulation made by critics, Americans respond most strongly to the possibility of some employers dropping health care coverage. Hearing that a measure might increase the cost of health insurance or might get the government “too involved” in health care also results in a drop in support, although majorities still support legislation on four out of six of the proposed requirements for health plans: providing more information, allowing direct access to gynecologists, paying for emergency room visits, and allowing independent appeals.

Public Favors Consumer Protections, But Consequences Raised By Critics Register

Would you favor a law requiring health plans to … Would you still favor such a law if you heard it might result in … An increase
in insurance premiums Government too involved Employers dropping coverage Provide more informationabout how health plans operate 92% 58% 55% 54% Allow denied claims to be appealedto independent reviewer 88% 63% 51% 49% Allow a woman to see a gynecologist without pre-approval 82% 63% 51% 48% Provide greater access to medical specialists 81% 58% 47% 46% Pay for emergency room visits 79% 62% 52% 48% Allow patients to sue for malpractice 64% 48% 38% 36%

When asked which among six consumer protection proposals they would give the greatest priority, requiring health plans to provide greater access to medical specialists, including gynecologists, was the public’s top priority. It is named by 37 percent of Americans, followed by, laws mandating that plans pay for emergency room visits (18%) and provide more information about benefits and policy (18%). The right to sue health plans directly for malpractice ranked last among these proposals with just 8 percent of Americans naming this as the most important one.

The “Bill of Rights”

Three quarters of the public (72%) support passing into law the “Consumer Bill of Rights,” proposed by a Presidential advisory commission at the end of last year and endorsed by the President; 17 percent oppose. After hearing of the potential consequences raised by critics, support for the “Bill of Rights”declines. The support declines the most when the effect is believed to have a greater magnitude. When presented with the possibility of premium increases: 43 percent would still favor it if their premium increase were small, $1-5 per month (43% would oppose), but drops to 28 percent if their increase were larger, $15-20 per month (57% would oppose). About half (48%) would still favor the “Bill of Rights” if it meant the government were “somewhat more” involved (38% would oppose), and 45 percent if the government were involved “a lot more” (40% would oppose). Support declines markedly if people believe employers would drop coverage: 20 percent would favor if passing it if it meant only a “small number of employers” dropped coverage (65% would oppose), and 13 percent if a “large number of employers” dropped coverage (73% would oppose).

“If the public sees the debate as being about an abstract consumer bill of rights, support will not be sustained in the face of possible negative consequences,” said Robert J. Blendon, Sc.D., Professor of Health Policy and Political Analysis, Harvard University. “But, if it is framed around the specific concerns people have the public will stay on board.”

Yet, as the debate over the new “Bill of Rights” starts, many Americans are confused about what it is actually proposed to do. Just 15 percent are aware that its primary purpose is to recommend practices health insurance plans should follow to ensure patients are treated fairly and get the care they need. Close to a quarter (22%) wrongly believe it calls for universal health coverage, and 9 percent think it would tell doctors how to treat certain medical conditions. Twenty-one percent (21%) think it does all three. A third (33%) are simply unsure what it is about. Most Americans do not think the “Bill of Rights” is the same as President Clinton’s previous health reform plan. Just 7 percent believe it is very similar to the Clinton plan, 27 percent consider it a “scaled-down version,” and 24 percent say it is a different proposal that calls for more modest changes. But, many — 42 percent — can’t say how it compares, if at all.

Regulation: Who Should Do It?

As compared to how effective Americans perceive regulation to be in protecting consumers in other areas — including, automobile safety, food safety, airline safety, and protections against environmental hazards — current government action in the area of health insurance ranks last. A majority (53%) say the government has not been effective in protecting the interests of health care consumers (34% say “somewhat effective” and 7% say “very effective”). By comparison, 82 percent say auto safety regulation has been effective (53% say “somewhat effective” and 29% say “very effective”).

When asked who should protect managed care consumers, a majority (57%) of Americans think the primary responsibility should rest with a non-government independent organization; a quarter (23%) think the government should serve this function, and 15 percent say it is the managed care industry itself. However, when specific agencies such as the Securities and Exchange Commission or the Federal Aviation Administration are given as examples, half (51%) would favor establishing a new independent regulatory agency to oversee the health insurance industry; 43 percent say creating such an agency would expand government’s role too much and increase health care costs.

A question about a telephone hotline for health care consumers to call to get help with problems underscores Americans’ skepticism about the government. While 70 percent of Americans say it is “very important” to have such a service, just 43 percent say it is “very important” if the government were responsible for setting up the hotline.


The Kaiser/Harvard National Survey of Americans’ Views on Consumer Protections in Managed Care is a product of the Kaiser-Harvard Program on the Public and Health/Social Policy. It was designed and analyzed by researchers at the Kaiser Family Foundation and Harvard University. The survey was conducted by telephone by Princeton Survey Research Associates with 1,204 adults (age 18 or older) nationwide between December 12-30, 1997. Additional questions were asked as part of a national omnibus telephone survey of 1,012 adults (age 18 or older) conducted January 8-12, 1998. The margin of sampling error for both national samples are plus or minus 3 percent. The margin of sampling error may be higher for some of the sub-sets in this analysis.

The Kaiser Family Foundation, based in Menlo Park, California, is a non-profit, independentnational health care philanthropy and is not associated with Kaiser Permanente or KaiserIndustries. The Foundation’s work is focused on four main areas: health policy, reproductive health, and HIV in the United States, and health and development in South Africa.

Copies of the questionnaire and top line data for the findings reported in this release available by calling the Kaiser Family Foundation’s publication request line at 1-800-656-4533 (Ask for #1356). Also available is the top line data from the Kaiser Family Foundation/Harvard 1997 National Survey of Americans on Managed Care (Ask for #1328). These documents are also available on the Kaiser Family Foundation website at http://www.kff.org.

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