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Adieu to "Patients' Bill of Rights"?
The Commonwealth Fund
November 10, 2004
Many Americans would abide by a medical "gatekeeper," take less costly drugs and consent to prior approval by their insurer for new or expensive medical procedures if those steps would reduce their health insurance costs, a new study reports. Only 30% of those surveyed said they believed that managed care can keep health care costs down without hurting patients' health. Yet many consumers indicated a willingness to accept a higher deductible or a higher premium in exchange for fewer restrictions on their use of health care services.
The survey was conducted by the National Opinion Research Center (NORC) at the University of Chicago and funded by the California HealthCare Foundation. It was posted on the Web Wednesday by the policy journal Health Affairs.
The findings run counter to past public support for so-called patients' bill of rights legislation, which dominated Capitol Hill for years. Such bills would have given patients a right to internal and external, independent reviews when their health plan denies coverage for a treatment and expanded patients' rights to sue their insurers in federal and state courts if they felt they had received poor medical care.
The bills also would have expanded patients' access to an array of services, including specialty care, emergency room treatment at any hospital, clinical trials and temporary continued care when a doctor leaves a health plan network. With health care costs on the rise, however, many lawmakers in both parties are loathe to pass any bill that could drive up costs-a fear with any legislation that requires insurers to cover a specific service or treatment or gives providers and patients more flexibility in choosing medical care.
The NORC study found that more than two-thirds of respondents expressed concerns about how much their families must pay for health care. Only 27% to 35% of respondents, respectively, said they would be willing to accept a higher deductible or a higher premium in exchange for fewer restrictions on their use of health care services, researchers found.
"The managed care backlash is easing up, probably because consumers are feeling the pinch of rising costs themselves," said Claudia Schur, a principal research scientist with NORC. But support for managed care practices depended on each consumer's health care experience and needs. "As a result, we may see more plan offerings where consumers who want choice can pay for it, while those willing to accept limits on their care can pay less," Schur said.
Other highlights of the study include:
· Slightly more than half of respondents reported that they spent less than $500 out of pocket on medical expenses (excluding insurance premiums) during the previous year. Twelve percent said they spent between $2,000 and $5,000 and 4% spent more than $5,000
· Overall, 54% of respondents said they thought requiring substitution of less costly drugs was a good or very good idea, 52% felt the same way about referral for specialist care and 43% expressed support for prior approval
· The uninsured, who often cannot afford medical care, were the most open to restrictive practices that contain cost
· Relatively young and healthy people, who tend to have less experience with health care and more experience with managed care, were more supportive of common cost containment practices, such as requiring a referral before visiting a specialist.
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