Sick patients in managed-care health plans feel they're not getting the time, attention and treatment they think they need, according to a national survey released yesterday.
The patients reported long waits for doctor's appointments, getting exams that weren't thorough, and dealing with physicians who spent little time with them and seemed not to care.
But the same opinion survey found that the patients said they were paying less for their medical care and filling out less paperwork.
Conducted by researchers at the Harvard School of Public Health, the survey of sick patients compared their opinions about their treatment under the two major types of health plans: fee-for-service and managed care.
A fee-for-service plan allows patients to choose their doctors, while managed-care plans rely on primary physicians who coordinate and control a patient's care and access to specialists. Many patients belong to a managed-care plan known as a health maintenance organization, or HMO.
"In general, sick patients report more problems in managed care than in fee-for-service," said Dr. Robert Blendon, professor and chairman of the Department of Health Policy and Management at Harvard.
The managed-care plans tout prevention as a way to lower costs. But the survey found doctors in those plans were no more likely than fee-for-service physicians to encourage preventive services, such as prenatal care, immunizations and screening tests.
The study couldn't say whether the patients health suffered as a result of the faults in medical care they complained about.
Officials with various managed- care plans protested being lumped as a group. They also said their surveys have found high levels of patient satisfaction, and that they have a proven record of quality.
"We think that contrasting the views of people in 'fee-for-service' with 'managed-care plans' is quite like thinking that you know the public's views of trains, planes, buses and roller blades by merely asking their views on transportation," said Susan Pisano, spokeswoman for the Group Health Association of America, the trade group for health maintenance organizations, or HMOs.
While there are different types of managed-care plans, the overall concept has won support from businesses and government trying to control health care costs.
Roughly 20 percent of Americans belong to an HMO -- including one in three Marylanders, according to the Group Health Association.
Dr. Blendon said managed-care surveys have polled mostly healthy people, and that the sick patients -- who are in the minority -- are the critical ones to interview.
The Harvard survey, financed by the Robert Wood Johnson Foundation, relied on telephone interviews with 2,374 adults from June 1994 to April 1995.
Among healthy people, fee-for-service and managed-care plans were ranked about the same.
But the survey's most interesting results came from a sub-group of 473 seriously ill, non-elderly patients.
The survey found the managed- care patients complained more about inadequate service than their fee-for service counterparts. (The group was roughly divided between fee-for service patients and managed-care patients.)
Of the 60 questions asked, one of the most telling dealt with whether sick patients got treatment for problems that they and their physicians viewed as necessary.
Responding affirmatively to the question were 13 percent of patients in the fee-for-service plans, compared with 22 percent in the managed-care plans.
Managed-care patients also reported waiting an average of 17 days to see a specialist, five more than the average reported in fee-for-service.
For routine care, managed-care patients said they waited an average of 38 minutes, about 10 more than fee-for-service patients.