Patients' ratings of the quality of care delivered by health plans can be used by consumers, employers, and other plan purchasers to assess and compare the quality of services across plans or by providers to identify areas for improvement. However, patients' sex, education, health, and insurance coverage appear to influence their ratings of managed behavioral health care plans. Thus it may be important to adjust the ratings for patient characteristics when comparing plans, according to a study supported by the Agency for Healthcare Research and Quality (HS09205).
Paul D. Cleary, M.D., Ph.D., of Harvard University, and his colleagues mailed a survey to samples of adult patients in five public assistance and five commercial health insurance plans in four different States to assess patients' experiences with the care they received (for mental illness, personal or family problems, or alcohol or drug dependency) from one of three managed behavioral health care organizations in the previous 12 months. They then analyzed the influence of patient characteristics, health care use, and insurance coverage on patients' ratings.
Older and healthier patients rated their care and health plans more highly than did other patients. Patients with less education and those whose insurance paid all costs of care gave consistently higher plan ratings. Women and frequent care users enrolled in commercial plans gave more positive care ratings than men and less frequent users. Commercial enrollees who reported good mental health rated both their care and their plans more favorably than patients who reported poor or fair mental health. Among public assistance enrollees, mental health status was positively associated with care ratings but not consistently associated with plan ratings. Minority patients in public assistance programs had lower average ratings of care than white patients. After adjusting for enrollee characteristics and coverage, there were no differences between ratings of patients in commercial and public plans.
See "The influence of patient characteristics on ratings of managed behavioral health care," by Matthew J. Carlson, Ph.D., James A. Shaul, M.H.A., Susan V. Eisen, Ph.D., and Dr. Cleary, in the November 2002 Journal of Behavioral Health Services & Research 29(4), pp. 481-489.