Access v. Cost
For consumers, managed care is a choice between limited access to providers and premium costs; the greater the access, the higher the premium; the more limited the choice of providers, the lower the premium. In the late nineties, the so-called "managed care backlash" occurred when cost increases moderated, and consumers demanded access to any provider.
This spawned the "open access" HMO model, tiered benefit plans, and the explosion of PPOs. Now, with costs once more on a double-digit inflation path, there appears to be more willingness on the part of consumers to trade access for lower cost.
The Center for the Study of Health System Change released a national report entitled "More Americans Willing to Limit Physician-Hospital Choice for Lower Medical Costs".
The Center reported that "Between 2001 and 2003, the proportion of working-age Americans with employer health coverage willing to trade broad choice of providers for lower out-of-pocket costs increased from 55 percent to 59 percent—after the rate had been stable since 1997…"
However, the population appears to be polarized on the access-cost issue. Again quoting the Center; ""Americans are deeply divided over the trade-off between unfettered choice of physicians and hospitals and lowering their out-of-pocket health costs," said Ha T. Tu, M.P.A., an HSC health researcher and study author. "Substantial minorities feel intensely about this hot-button issue: 20 percent were strongly willing to limit provider choice, while 21 percent were strongly unwilling."
There were many indicators of preference, or perhaps drivers of preference, for one or the other. For example,
--lower income people were more likely to accept limits on access in return for lower costs
--chronically ill individuals with employer coverage were almost as likely as the general population to accept limited access for lower costs (56% v. 59%)
What does this mean for you?
If you are an employer, this is a clear indication of the advisability of offering multiple options to insured populations, as different groups feel very strongly about these issues.
For insurers, even more demand for flexible benefit programs.