As Health Care Costs Take a Toll, Some Changes Win Broad Backing

Most people with coverage, 80 percent, also say their plan tends to pay their medical expenses without much problem. However, a substantial number, 32 percent, say their plan has at some point refused to pay for all or part of a treatment that they thought should have been fully covered. That concern peaks, at 38 percent, among people who say they're in PPOs, preferred provider organizations, which have grown to be the most popular form of private health insurance. Among Americans with private insurance, 45 percent now report being in PPOs, up from 29 percent in 1995.

Serious Illness -- Some might speculate that it's easy to be satisfied as long as you haven't had serious medical problems. Instead, satisfaction runs as high -- and top-level satisfaction even higher -- among people who've experienced a serious illness or injury or a chronic, ongoing illness under their current health plan.

Among such people, 90 percent say they're satisfied with the quality of care they received during that time, and 60 percent are very satisfied with that care. Similarly, 87 percent in these cases are satisfied with their health insurance coverage during that time, and again more, 56 percent, are very satisfied with the coverage they received.

High-level satisfaction with care and coverage alike in these cases peaks among people who report having traditional health insurance coverage, with no restrictions on which doctors they can see; it's lowest among people who say they're in HMOs. In traditional plans, 71 percent are very satisfied with the care they received; in HMOs, it's 49 percent. (Self-reported participation in traditional plans has declined from 43 percent of privately insured Americans in 1995 to 24 percent now. Employers surveyed by Kaiser and the Health Research and Educational Trust report fewer people in traditional plans than this poll finds, and more in PPOs; how people use or perceive their plans may be a factor.)

HMOs --There are other notable differences between people who say they're in HMOs and those who say they're in other types of plans. Generally, overall satisfaction with HMOs is as high, but top-level satisfaction is substantially lower.

People in HMOs are as likely as other insured Americans to rate their coverage positively overall (87 percent do so), as well as their quality of care (93 percent). But just 25 percent in HMOs rate their coverage as excellent, compared with a high of 40 percent of people in traditional plans; and 47 percent in HMOs rate their quality of care as excellent, compared with about six in 10 in traditional plans, PPOs and Medicare alike.

Similarly, 48 percent in HMOs are very satisfied with the quality of their communication with their doctors, compared with 70 percent in traditional plans; 47 percent in HMOs are very satisfied with their ability to get a doctor's appointment when they want one, compared with 65 percent in traditional plans; 38 percent in HMOs are very satisfied with their ability to see top specialists, compared with 63 percent in traditional plans; and 35 percent in HMOs are very satisfied with their ability to get the most sophisticated treatments, compared with 51 percent in traditional plans.

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