Quality Improvement

Consumers may be willing to accept restrictions on provider access in exchange for very high quality of care

Consumers may be willing to accept restricted access to health care providers if a plan provides very high quality of care, concludes a study supported by the Agency for Healthcare Research and Quality (T31 HS00046 and HS10367). This implies that relatively small plans that restrict provider access can successfully compete against less restrictive plans when they can demonstrate high quality. However, based on the results of this study, the level of quality required for consumers to accept access restrictions may be so high as to be unattainable, notes study author, Katherine M. Harris, Ph.D., of RAND.

Dr. Harris administered a survey to 206 relatively affluent and healthy adults in Los Angeles. Participants had private insurance obtained through an employer or purchased individually, which asked respondents to make choices among hypothetical sets of plan alternatives. She examined the impact of consumer and expert evaluations of network provider quality of care and network features (percent of local doctors in the network, out-of-network coinsurance, ability to see a specialist without a referral, and presence of one's personal doctor in the network) on respondents' hypothetical willingness to enroll in health plans with restrictive provider networks.

Respondents used both expert and consumer assessments of quality when available. However, the quality ratings were less important than access to specialists and having one's own doctor in the network. Even a 100 percent point difference was not sufficient to make respondents indifferent to restricted access in a high quality plan. The only quality measure as influential as either of these two network features was satisfaction with results of care. Quality ratings based on the proportion of survey respondents who were extremely satisfied with the results of care had the greatest impact on plan choice, while the proportion of network doctors affiliated with university medical centers had the least.

See "Can high quality overcome consumer resistance to restricted provider access? Evidence from a health plan choice experiment," by Dr. Harris, in the June 2002 Health Services Research 37(3), pp. 551-571.

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