Health Plan Problems?

Ruzanna Harutyunyan's picture
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Having problems with your health plan? If you speak up about it — or move on to another plan — you are a very unusual consumer, according to a new study.

The vast majority of people do not complain formally about problems with their health plans, even if those problems have significant consequences, such as costing them thousands of dollars out of pocket or denying them essential care, say health policy experts Brian Elbel, Ph.D., of New York University and Mark Schlesinger, Ph.D., of Yale University.

It is even rarer for consumers to leave their health plan in response to problems, the researchers report in the September issue of The Milbank Quarterly.

This silent majority, according to Elbel and Schlesinger, are less likely to have protection against a particular plan’s shortfalls and often are unable to identify the worst plans.

Without this critical information, consumers cannot exert much influence on the health plan market and a choice between plans “would have only a modest influence on quality of care,” said Elbel.

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If consumers had better access to complaint and health plan exit information, “it would be interesting to them, because it would be information that they can understand,” said Judith Hibbard, Dr.P.H., an expert in public reporting of health data at the University of Oregon. “People are more motivated to avoid a potentially negative experience than actively seek the best plan.”

The researchers analyzed formal complaints and exits from health plans using information from a 2002 telephone survey of 5,000 consumers. They discovered that consumers who encountered a problem with their care were eight to 10 times more likely to contact their plan about the problem rather than switch plans.

But fewer than 40 percent of those surveyed complained to their plan about a problem, even when that plan cost an individual $1,000 or more out of pocket or led to a serious health problem. Fewer than 15 percent of these consumers switched plans in response to such serious problems.

Even patients who might have been more “empowered” than others — those who were more capable of complaining and more knowledgeable about why the problem occurred — were mostly silent, Elbel and Schlesinger found.

Most of the problems that vexed consumers enough to blame the health plan had to do with health care costs and paperwork — not quality of care. The problems did not cost very much or affect health in any way, which means that the “signal” of a seriously flawed health plan could be buried in a flurry of trivial complaints, the researchers concluded.

“If many consumers complain about minor annoyances or switch health plans whenever they are inconvenienced by paperwork, plans that cause more serious harms may prove difficult to detect,” Elbel said.

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