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Surveys Debunk Negative Images of Managed Care

Nancy Tarleton Landis

The perception that health plan members are increasingly dissatisfied with their care is not supported by fact, a recent survey suggests. "Deteriorating public perceptions of managed care are media-driven, or physician-driven, not experience-driven," Harris Poll chair Humphrey Taylor wrote in a summary of the results.

Of 929 adults with health insurance who responded to a Harris telephone survey in December 2000, nearly 70% gave their plans a grade of A (34%) or B (35%). Eight percent gave a grade of D and 2%, F.

In addition, 78% would recommend their plan to healthy friends and 68% would recommend it to friends with serious or chronic illnesses.

The findings are similar to those from surveys in 1998 and 1999. For respondents with employer-provided insurance, satisfaction increased; 34% of this group gave their plans an A in December 2000, compared with 26% in summer 1999.

When asked about the best source of health insurance, 51% of all respondents said employers should continue to be the main source, 19% chose government, and 24% said it would be best for workers to select and purchase their insurance directly from insurance companies.

The idea that physicians are spending less time with their patients because of managed care was examined in a study published in the New England Journal of Medicine.1 The authors found that the amount of time spent with patients had actually increased slightly. In 1989, the National Ambulatory Medical Care Survey (NAMCS) and an annual survey by the American Medical Association (AMA) showed average visit lengths of 16.3 and 20.4 minutes, respectively. In both surveys the source of data was reports by the physician or office staff.

From 1989 to 1998, the surveys showed an upward trend in the duration of office visits. The time physicians spent with patients increased an average of 1.1 minutes in the AMA study. According to the NAMCS, visit length was 2.0 minutes longer in 1998 than in 1989 but decreased about 1 minute between 1995 and 1998.

The NAMCS indicated that the number of prepaid visits (i.e., patients are enrolled in an HMO or covered by a capitated insurance plan) more than doubled in the study period. The length of prepaid visits increased by 2.5 minutes. Visits that were not prepaid also increased significantly in number, and their length increased by 2.1 minutes. Nonprepaid visits were longer than prepaid visits throughout the study period, but by 1998 the difference was smaller.

The authors could not identify changes in service that would have lengthened office visits but speculated that physicians may be spending more time explaining their decisions about treatment. As health plans compete for members, patient satisfaction is increasingly important, and physicians may be excluded from health plan networks if their patients are dissatisfied. With that in mind, "physicians may perceive that they are providing patients with less time than they need, despite spending as much time with them as they have spent in the past, or more," the authors suggested.

  1. Mechanic D, McAlpine DD, Rosenthal M. Are patients' office visits with physicians getting shorter? N Engl J Med. 2001; 344:198-204.