During his presidential campaign, George W. Bush received a great deal of support for promising to reduce government meddling in private matters. Nonetheless, Americans would appear to welcome government involvement to reform Health Maintenance Organizations (HMOs). In September 2001, a Gallup poll* asked "How important is it that Congress pass new laws this year designed to address and reform . . . patient relations with HMOs and similar healthcare providers?" Eighty-nine percent said government involvement is "very" or "somewhat" important.
The desire for reform of HMOs is probably related to the overall lack of confidence Americans have in these organizations. Gallup's annual poll of confidence in institutions finds HMOs at the bottom of this year's list**, as they have been each year since 1999. Only 13% of Americans say they have a "great deal" or "quite a lot" of confidence in HMOs, which is down from an already low 17% in June 1999 when they were first measured.
By comparison, 38% of Americans have that amount of confidence in the medical system more generally, and 79% express that level of confidence in the military, typically the highest item on the list. This year's poll saw a drop in confidence in big business, which at 20% is the next lowest after Wall Street and HMOs.
Americans' persistent lack of confidence in managed care is another factor indicating increasingly troubled waters for an already overburdened industry. Managed care was initially supported as a means of controlling healthcare costs -- but today, premium increases are outstripping the inflation rate once again. The June 2 issue of Medical Economics reported that more than 700 large and mid-size companies expect their health insurance costs to jump 13% to 14% annually over the next five years. That leaves employers disenchanted and looking for new ways to control costs.
In addition, publicity surrounding denial-of-care issues damaged the public's impression of the quality of service provided by HMOs -- indeed, some theorists who were actively involved in the original conception of managed care, including Dr. Paul Ellwood who coined the term "Health Maintenance Organization," now say their vision has been distorted and are looking for new approaches.
Escalating costs and abysmal levels of consumer trust over the last decade have generated a climate that is ripe for change, and the aging of the baby boomers only intensifies the sense of urgency. Expect increased attention on the development of a new round of healthcare reform in the near future.
*Results are based on telephone interviews with 1,004 national adults, aged 18 and older, conducted Sept. 7-11 2001. For results based on the total sample of national adults, one can say with 95% confidence that the maximum margin of sampling error is ±3%.
**Results are based on telephone interviews with 1,020 national adults, aged 18 and older, conducted June 21-23 2002. For results based on the total sample of national adults, one can say with 95% confidence that the maximum margin of sampling error is ±3%.