Gender differences in managed care patient satisfaction and quality perceptions

Patient Satisfaction in Quality of Managed Care

Aspect to be compared

Gender and Patient

Satisfaction in Managed Care, etc.

Stakeholder Perceptions of Quality in Managed Care Plans

Two Steps to Enhance Managed Care Quality

Author(s)/Date

Emily Weisman, MS

Martha Romans

Jacobs Institute of Women's Health

Washington, DC

Carolyn M. Clancy, MD

Paul L. Grimaldi, Ph.D.

To determine what the differences are and what variables might affect women patients' perceptions of the quality of managed care

To find out what attributes three different health care stakeholders, physicians, employers and consumers, value most in determining their assessments of the quality of managed care health plans

To explain the ramifications of two developments in managed care: the new application form for MCOs to become Medicare risk contractors, and the National Committee for Quality Assurance plan to begin performance-based accreditation.

Hypotheses

Determining what the differences between men's and women's perceptions of the quality of health care may mean to the outcome of care; hypothesis was that the differences were minor despite women's different patterns of visiting doctors.

The three stakeholder groups view quality differently; consumers want good care and good customer service; physicians want autonomy; employers want value at low cost and good work ethics and so on. Knowing the nature and extent of these differences would help managed care organizations better serve each group.

That the two steps enumerated will cause an increase in health care costs.

First, although the mean gender

Differences in satisfaction are small, identifying the top and bottom performing plans for women could be useful information for consumers, purchasers, and health plans.... "Second, gender-stratified analyses of the predictors of satisfaction levels are useful for identifying mutable health plan characteristics that are associated with women's satisfaction and can be the focus of quality improvement efforts within health plans.

Third, the study suggests ways in which consumer satisfaction tools may be modified to improve sensitivity to women's health care."

Stakeholders of different groups perceive the attributes of MCO plans differently; the implications of this are that it is incumbent on designers of health plans to be careful to design them with those features most important to the consumers to gain greater acceptance.

The new MCO application form and the performance-based accreditation plan will cause health care costs to rise dramatically.

Authors' suggestions for further study (if any)

Is for-profit health service contradictory to good care or a perception of good care by women?

Additional study of care structure quality and perceptions of stakeholders.

Outline: Comparison of Studies

I. General subject area

A. Gender and Patient Satisfaction in Managed Care: definition

B. Stakeholder Perceptions of Quality in Managed Care Plans: definition

C. Two Steps to Enhance Managed Care Quality: definition of steps

II. Comparison of methodologies

A. Aggregate data

B. Focus groups, mail survey

C. Compiling published information

III. Literature review critique

B. As a tool to construct format of focus groups

IV. Compare probable reliability of findings

A. Assess amount of information in A and B. articles; assess source of information in C.

V. Assess need for further study

A. Should similar studies be carried out in a for-profit setting?

B. Is there a way to address the preferences/perceptions of all three stakeholder groups to serve all equally well?

C. Is there any possibility these new demands will change, and if so, how and when?

VI. Conclusion

VII. References

VIII. Exhibits

Introduction

The subject of managed care is not only in the news, but also in the minds of all the stakeholders in health care: health care consumers, physicians and other medical personnel, and employers from hospitals to managed care facilities. Three recent articles have attempted to shed some light on the various factors involved in either the perception of the quality of an MCO by those stakeholder groups (or in one case, part of a single stakeholder group) and on the quality of MCOs; in one case, commentary is made also on the cost of new programs designed ostensibly to enhance both the quality and perception of quality of MCOs. This one is, however, more an attempt to explain facts and processes already known and established than to discover new and helpful information, although it does offer helpful information.

Objective

Each of these studies has a different objective, although each is allied to the improvement of the perception of MCOs. The study by Weisman et al. concerns determining the variables that affect women patients' perceptions of the quality of managed care, while the Thompson study has as its objective determining much the same thing concerning the perceptions of three sets of stakeholders: patients, physicians and employers. The Thompson study is more simply presented and the information is less difficult to assess, although the researcher did new original research while the first study simply used available data obtained from another source. The Grimaldi article did not so much use data as retell information regarding programs already constructed in its single objective of explaining the demands and results of two new mandates that are supposed to enhance managed care quality.

Subjects

In Weisman et al., the subjects were respondents to an NCQA survey, and included 97,873 men and women over the age of 18. The Thonpson study used a much smaller sample consisting of focus groups all drawn from a homogeneous base in a single state. The Grimaldi article reported on ways to assess various effects of MCO quality measures on various populations rather than conducting any original research as the second study, or assessing the findings of research as the first study had done.

Hypothesis

The Weisman et al. study took as its hypothesis the idea that the differences between men's and women's perceptions of health care were different, but minor. On the other hand, the hypothesis underlying the Thompson study was that three stakeholder groups would have very different perceptions, or perhaps more accurately, desires concerning what constitutes quality in an MCO. The Grimaldi paper had relatively little in the way of a hypothesis, although the paper concluded that the new programs described would result in administrative costs for MCOs hat would balloon rapidly and lead to various fee increases, although it seemed that the author didn't believe the quality results to be gained from his hypothesis would be worth the additional expense.