Health Insurance Fourth Edition – Michael A Morrisey

Note: CPI = Consumer Price Index; ESHI = employer-sponsored health insurance. Managed Care Backlash The managed care backlash was said to consist of physicians and patients complaining about the nature of the restrictions that managed care plans imposed. A plethora of cartoons and late-night comedy bits about managed care pinpointed the popular antagonism. This intuition was supported by consumer survey work by Blendon and colleagues (1998) and media criticism of managed care reported by Brodie, Brady, and Altman (1998). We should look at these concerns carefully, however.

Physician opposition was said to revolve around the difficulty in admitting patients to hospitals and keeping them there as long as physicians thought prudent. There were concerns about limited drug formularies, limitations on which specialists were covered, and allegations (largely unproven) that managed care plans prevented physicians from discussing some treatment options with patients.

However, as we saw in chapter 9, though utilization management (UM) techniques did reduce hospital days, there is little evidence that it had a large impact on quality of care and very little evidence that ambulatory UM tools had any impact on services in those days. Quality of care has not been measured fully, however, and it may be that providers came to abide by UM protocols even as they objected to them. However, it is also the case that physician incomes were reduced as a result of managed care (Hadley and Mitchell 1999).

It is conceivable that the physician backlash arose, at least in part, because of this. Patients’ concerns were similar to those of physicians with respect to perceived access. In addition, patients were worried about access to what they perceived to be quality care. Judging the quality of a physician, hospital, or other medical care provider is difficult.

The concern with managed care was that the limited panel of providers that makes managed care successful on the price front locked patients into providers who may not be right for them in either a clinical or an interpersonal sense. Marquis, Rogowski, and Escarce (2004) examined the decline in private health maintenance organization (HMO) enrollment in metropolitan areas between 1998 and 2001. In this study, they broadly defined HMO enrollment to include both HMO and point-of-service (POS) plan enrollment.

They found only modest declines in HMO enrollment over this period (to 44.9 percent from 47.7 percent) and little association between these declines and measures that might be indicators of having a greater local choice of insurance options. They “conjecture[d] that backlash either represented the views and perceptions of physicians and the media while consumers were generally satisfied .

. . or that consumers exercised ‘voice’ and health plans responded very quickly to avoid losing market share” (Marquis, Rogowski, and Escarce 2004, 387). However, the decline in HMO (and POS) enrollment has been more substantial since 2001. Exhibit 11.2 shows a decline of 25 percent between 1996 and 2013, just prior to the Affordable Care Act (ACA).

Editorial Board for Graduate Studies Karen M. Volmar, JD, FACHE, Chair University of North Carolina at Chapel Hill Lee W. Bewley, PhD, FACHE University of Louisville Nancy Borkowski, DBA, FACHE University of Alabama at Birmingham Renady Hightower, PhD George Mason University Meenakshi Malhotra, FACHE Upstate University Hospital Sandra S. Murdock, DrPH, FACHE Texas Woman’s University Laura-Kathryn Neal, DM, FACHE DeVry University Jonas Nguh, PhD, RN, FACHE Walden University Neel H. Pathak, DSc, FACHE Johns Hopkins Hospital OceanofPDF.com HEALTH INSURANCE Fourth Edition Michael A.

Morrisey ACHE Learn, Chicago, Illinois Association of University Programs in Health Administration, Washington, DC OceanofPDF.com Your board, staff, or clients may also benefit from this book’s insight. For information on quantity discounts, contact ACHE Learn at (312) 424-9400 This publication is intended to provide accurate and authoritative information in regard to the subject matter covered. It is sold, or otherwise provided, with the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought.

The statements and opinions contained in this book are strictly those of the author and do not represent the official positions of the American College of Healthcare Executives, the Foundation of the American College of Healthcare Executives, or the Association of University Programs in Health Administration. Copyright © 2026 by the Foundation of the American College of Healthcare Executives.

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