Problems, Complaint Action, and Resolution of Problems in a Managed Care Health Benefits Plan: Implications for Consumer Education

The trend towards managed care health is unmistakable. In 1992, 48 % of all health care plans were classified as managed care. The figure rose to 70 % in 1995 (Glazer, 1996), a growth of 46 % in only three years. Studies show that consumers are satisfied with these plans (Glazer, 1996; Schmidt, 1996), but there is no clear picture of satisfaction beyond general measures. This study examines the types of action taken by consumers dissatisfied with their primary care physician in a managed care health plan. It investigates the relationship among the types of problems experienced, the types of actions taken, and how or whether the problem was resolved. The analysis can provide insight into why consumers take particular actions when dissatisfied, and whether the type of action and type of problem are related to problem resolution. By painting a more revealing picture of the actions of dissatisfied consumers and how problems are resolved, steps can be outlined to improved consumer satisfaction with primary care physicians. Medical services have been described as a "loose monopoly." 'I Consumers have limited choice, limited information, and often lack the II ability to detect poor quality of services (Andreasen, 1985; Hirschman