More MS news articles for Sep 2001

Patients Equally Satisfied With HMO, PPO Plans

http://www.reutershealth.com/

NEW YORK (Reuters Health) Sept 12 - Healthy patients were equally as satisfied with the care they received from PPOs and HMOs, although those with serious health problems were happier with the service they received in a PPO, according to an annual reader survey conducted by Consumer Reports magazine.

HMOs, or health maintenance organizations, are more restrictive of consumer choice than PPOs, or preferred provider organizations. PPOs typically avoid burdensome requirements that a worker obtain a referral before seeing a specialist and get a plan's approval before beginning treatment.

"The biggest finding is that people were as satisfied in HMOs as in PPOs," said Trudy Lieberman, director of the Center for Consumer Health Choices at the Consumers Union in Yonkers, New York. "This runs contrary to the conventional wisdom that people are not happy in HMOs."

The magazine's managed care survey, first conducted in 1991, asked 83,000 readers to assess their satisfaction with their healthcare plan. The results were published in the October issue.

Overall, 57% of PPO users and 55% of HMO users reported being highly satisfied with their plan. However, of the 14% of patients who reported having a family member with a significant illness, 11% of patients in a PPO reported having trouble getting needed care and seeing doctors compared with 18% of patients in an HMO.

"In general, people in an HMO are as satisfied as those in a PPO, but people in an HMO had more problems getting care among those who had a sick family member," Dr. Donato Vaccaro, the survey's head researcher and a research program leader at Consumer Reports, told Reuters Health.

HMOs traditionally provide less flexibility and choice in exchange for a lower cost, while PPOs allow patients to travel outside the approved network of doctors if they pay part of the bill.

However, that flexibility led to increased billing problems among PPO users.

Nearly one-quarter of the readers reported going outside of the provider's approved network to see an outside doctor, which often leads to billing problems. Nearly 40% of the respondents using PPOs reported having billing problems.

"People have to realize if they go into a PPO, the fact there could be these billing problems are very real," Lieberman said. "You really trade whatever freedom against potential billing problems. If you go out of network, you can be stuck for a huge bill."

The survey also asked members of 44 of the largest HMOs and 11 of the largest PPOs in the country to rank their satisfaction.

The highest-rated HMO plan was Capital District Physicians' Health Plan of New York, with 78% of the members reporting they were highly satisfied and only 2% of those members reporting having trouble getting needed care.

As for PPOs, the survey reported that CareFirst Blue Cross and Blue Shield of Maryland was ranked the highest and Prudential Healthcare was ranked the lowest on consumer satisfaction.

"Many of these rankings have been consistent over several surveys," Lieberman noted. "People should realize if they go into these (poorly-ranked) plans, they may have problems getting issues resolved."