Address correspondence to: Frank Sloan, Ph.D., Duke University, 125 Old Chemistry Bldg., Box 90253, Durham, NC 27708. Frank A. Sloan is with The Center for Health Policy, Law, and Management and also with Department of Economics, Duke University. John R. Rattliff, Ph.D., is with The Center for Health Policy, Law, and Management, Duke University. Mark A. Hall, J.D., is with Wake Forest University School of Law and also with Wake Forest University School of Medicine.
Impacts of Managed Care Patient Protection Laws on Health Services Utilization and Patient Satisfaction with Care
Article first published online: 24 MAY 2005
Health Services Research
Volume 40, Issue 3, pages 647–668, June 2005
How to Cite
Sloan, F. A., Rattliff, J. R. and Hall, M. A. (2005), Impacts of Managed Care Patient Protection Laws on Health Services Utilization and Patient Satisfaction with Care. Health Services Research, 40: 647–668. doi: 10.1111/j.1475-6773.2005.00378.x
- Issue published online: 24 MAY 2005
- Article first published online: 24 MAY 2005
- Managed care;
- patient bill of rights;
- satisfaction with care;
- health services utilization
Objective. To assess effects of patient protection laws implemented by the vast majority of states during the 1990s on the public's satisfaction and trust relating to health care, and on key utilization measures.
Data Sources/Study Setting. Measures of individuals' health care utilization and satisfaction, and control variables, came from three waves of the Community Tracking Study (CTS) Household Surveys conducted in 1996–1997, 1998–1999, and 2000–2001. The CTS was conducted in 60 randomly selected communities, throughout the U.S. In addition, a supplemental national sample of households from CTS was also included, resulting in a combined sample with cases from 48 states and the District of Columbia. After applying exclusion restrictions, the analysis sample was 149,688 adults.
Study Design. Using a fixed-effects methodology, we assessed the influence of patient protection laws on satisfaction with care and utilization of services for the entire sample and for subsamples of persons in poor health, with low income, and who were enrolled in HMOs.
Data Collection/Extraction Methods. One of the authors (Hall) compiled relevant laws in all U.S. states through 2001 from primary legal sources, checking for accuracy by conducting independent research on statutory changes and by asking three to five regulators in each state to verify that the information was correct.
Principal Findings. Overall, patient protection laws had little or no effect on either trust, satisfaction with care, or utilization. Significance was found postenactment of a state patient protection law only for emergency room visits in the general sample, and only for physician trust in the low-income sample. Because of the number of possible associations examined, occasional findings of significance could occur by chance.
Enactment of managed care patient protection laws did not generally increase utilization of health services or improve patient satisfaction with care.