July 8, 2013

Satisfaction with Health Care Coverage

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Cover Michigan Survey July 2013

Introduction

The Center for Healthcare Research & Transformation (CHRT), in partnership with the Institute for Public Policy and Social Research at Michigan State University, has surveyed Michigan residents three times (in 2009, 2010 and 2012) on key issues relating to health care coverage, access to care and health status. The latest survey, Cover Michigan Survey 2013, was fielded in the third quarter of 2012. This brief describes how satisfied Michiganders reported being with their source of health coverage in 2012 and the experiences and factors that were associated with coverage satisfaction.

Key Findings

  • Respondents with individually-purchased coverage were least satisfied with their coverage (45 percent rated their coverage as “fair” or “poor”) and the least concerned about losing coverage (12 percent said they were “very” or “somewhat” concerned).
  • Respondents with Medicaid were the most satisfied of any group (65 percent rated their coverage as “excellent” or “very good”) and were also the most concerned about losing coverage (75 percent were “very” or “somewhat” concerned about losing coverage).
  • Negative experiences with coverage played a large role in respondents’ reported satisfaction with their coverage. Those who encountered a negative experience reported higher levels of dissatisfaction with coverage (28 percent rated their coverage as “fair” or “poor” if they had a negative experience, compared to 15 percent who rated their coverage as “fair” or “poor” but did not have a negative experience).
  • Respondents who reported that scheduling specialty care appointments was “very” or “somewhat” easy rated their coverage the highest, regardless of their ability to schedule primary care appointments.

Picture of Overall Satisfaction in Michigan

Overall, roughly half of all insured respondents rated their health care coverage as “excellent” or “very good.” Only 4 percent of individuals rated their coverage as “poor,” and 18 percent rated their coverage as “fair.” About one-quarter rated their coverage as “good.” Figure 1

Figure 1
Overall coverage rating

Although the overall picture of satisfaction with coverage appears relatively high, there are clear differences by coverage source. Respondents with Medicaid reported the highest level of satisfaction, whereas those with individually-purchased coverage reported the lowest. Nearly two-thirds (65 percent) of respondents with Medicaid thought their coverage was “excellent” or “very good,” compared to 43 percent of those with individually-purchased coverage. Forty-five percent of respondents with individually-purchased coverage rated their coverage as “fair” or “poor”—more than double that of any other insured group. Figure 2

Figure 2
Coverage rating by coverage source, 2012*

  Source of health coverage
  Medicare Medicaid Employer-sponsored Individually-purchased
Excellent or very good 54% 65% 51% 43%
Good 29% 19% 31% 12%
Fair or poor 17% 16% 18% 45%
TOTAL 100% 100% 100% 100%

* Significant difference in coverage rating among coverage types

Additionally, consumers with individually-purchased coverage are the least concerned about losing that coverage (only 12 percent of respondents with individually-purchased coverage reported being “very” or “somewhat” concerned about losing coverage). Medicaid respondents reported the most concern about losing coverage compared to any other insured group. The percentage of respondents in the Medicaid group who reported being “very” or “somewhat” concerned about losing coverage increased 108 percent since 2009. Figure 3

Figure 3
Concern about losing coverage source, 2009 & 2012*

  Source of health coverage
  Medicare Medicaid Employer-sponsored Individually-purchased
  2009 2012 2009 2012 2009 2012 2009 2012
Very or somewhat concerned 40% 38% 36% 75% 44% 24% 38% 12%
Not too concerned or not concerned at all 60% 62% 64% 25% 56% 76% 62% 88%
TOTAL 100% 100% 100% 100% 100% 100% 100% 100%

* Significant difference in concern by coverage types for 2012 data

Significant difference in concern from 2009 to 2012 for Medicaid, employer-sponsored and individually-purchased coverage

Negative Experiences with Current Coverage

To better understand the factors that affect satisfaction with coverage, respondents were asked whether they encountered a negative experience with their current coverage, such as:

  • They received expensive medical bills for services not covered by their current insurance coverage.
  • Their doctor charged more than their current coverage would pay, and they had to pay the difference.1

About half of respondents (48 percent) reported having a negative experience with their current coverage, while 52 percent reported having zero negative experiences. Figure 4

Figure 4
Negative experiences with current coverage

Having a negative coverage experience is correlated with satisfaction. Of those who reported having a negative experience, 28 percent rated their coverage as “fair” or “poor,” compared to only 15 percent of those who rated their coverage “fair” or “poor” and did not report a negative experience. Figure 5

Figure 5
Coverage rating by negative experiences*

  Had zero negative experiences Had a negative experience
Excellent or very good 63% 40%
Good 22% 32%
Fair or poor 15% 28%
TOTAL 100% 100%

* Significant difference in coverage rating by negative experiences reported

Both those with public and private coverage reported having negative experiences with their coverage. However, those with private coverage (employer-sponsored or individually-purchased coverage) reported having a negative experience with their insurance in significantly higher proportions than those with public coverage (Medicare or Medicaid). Figure 6

Figure 6
Proportion of respondents who reported a negative experience by public or private coverage*

70%60%50%40%30%20%10%0%
 Public  Private
Had zero negative experiences 60% 47%
Had a negative experience 40% 53%

* Significant difference in negative experiences reported by public and private coverage

Medicaid recipients were least likely to report having negative experiences. Fifty-nine percent of Medicaid recipients reported having zero negative experiences. Conversely, those with individually-purchased coverage were more likely than all other insured groups to have a negative experience (61 percent reported having a negative experience). Figure 7

Figure 7
Negative experiences with current coverage by coverage type*

  Source of health coverage
  Medicare Medicaid Employer-sponsored Individually-purchased
Had zero negative experiences 55% 59% 48% 39%
Had a negative experience 45% 41% 52% 61%
TOTAL 100% 100% 100% 100%

* Significant difference in negative experiences reported by coverage type

1 Survey questions about negative experiences with current insurance were modeled after a survey conducted by The Commonwealth Fund for the following report: Collins, S.R. et al. April 2013. Insuring the Future: Current Trends in Health Coverage and the Effects of Implementing the Affordable Care Act (New York: The Commonwealth Fund).

Scheduling Primary and Specialty Care Appointments

Ease of scheduling both primary and specialty care appointments was highly correlated with coverage satisfaction. Respondents were more likely to rate their coverage as either “excellent” or “very good” if they had a “very” or “somewhat” easy time scheduling appointments with primary care physicians. Fifty-three percent of respondents reported that their coverage was “excellent” or “very good” if their ease of scheduling primary care appointments was “very” or “somewhat” easy. Figure 8

Figure 8
Coverage rating by ease of scheduling primary care appointments*

  Very or somewhat easy Very or somewhat difficult
Excellent or very good 53% 33%
Good 27% 25%
Fair or poor 20% 42%
TOTAL 100% 100%

* Significant difference in coverage rating by ease of scheduling primary care appointments

Of those individuals who had a “very” or “somewhat” easy time scheduling specialty care appointments, 59 percent rated their health coverage as “excellent” or “very good.” One half of respondents who had a “very” or “somewhat” difficult time scheduling a specialty care appointment rated their health coverage as “fair” or “poor.” Figure 9

Figure 9
Coverage rating by ease of scheduling specialty care appointments*

  Very or somewhat easy Very or somewhat difficult
Excellent or very good 59% 17%
Good 26% 33%
Fair or poor 15% 50%
TOTAL 100% 100%

* Significant difference in coverage rating by ease of scheduling primary care appointments

While ease of scheduling appointments—both primary and specialty care—clearly impacts satisfaction with coverage, specialty care appears to be more important to respondents. Respondents rated their coverage the highest if they had an easy time scheduling specialty care appointments, even if they had a difficult time scheduling primary care appointments. Figure 10

Figure 10
Coverage rating by ease of scheduling appointments (among those who scheduled both primary and specialty care appointments)*

  Easy to schedule primary AND specialty care appointments Easy to schedule primary care BUT difficult for specialty care appointments Easy to schedule specialty care BUT difficult for primary care appointments Difficult to schedule primary AND specialty care appointments
Excellent or very good 59% 13% 67% 20%
Good 26% 33% 10% 35%
Fair or poor 15% 54% 23% 45%
TOTAL 100% 100% 100% 100%

* Significant difference in coverage rating by ease of scheduling primary care AND specialty care appointments

From 2010 to 2012, significant improvements in ease of scheduling both primary and specialty care appointments were reported among respondents with Medicaid. Figures 11 and 12 In the same time period, respondents with individually-purchased coverage reported an increasingly difficult time scheduling primary and specialty care appointments. Respondents with individually-purchased coverage were the only group to report a harder time accessing specialty care in 2012 than 2010.2 Figures 11 and 12

Figure 11
Trends in reporting ease of scheduling primary care appointments as “very” or “somewhat” easy by coverage type, 2010* and 20123

 2010  2012
Medicare 92%
96%
Medicaid 91%
74%
Employer-sponsored 90%
92%
Individually-purchased 83%
96%
0%10%20%30%40%50%60%70%80%90%

* Significant difference in ease of scheduling primary care appointments by coverage type in 2010

Significant difference in ease of scheduling primary care appointments by coverage type between 2010 and 2012 for respondents with Medicaid and individually-purchased coverage

Figure 12
Trends in reporting ease of scheduling specialty care appointments as “very” or “somewhat” easy by coverage type, 2010* and 2012**

 2010  2012
Medicare 90%
87%
Medicaid 83%
50%
Employer-sponsored 83%
83%
Individually-purchased 73%
82%
0%10%20%30%40%50%60%70%80%90%

* Significant difference in ease of scheduling specialty care appointments by coverage type in 2010

** Significant difference in ease of scheduling specialty care appointments by coverage type in 2012

Significant difference in ease of scheduling specialty care appointments by coverage type in 2010 and 2012 for respondents with Medicaid

2 D. Young, et al. March 2013. Access to Health Care in Michigan. Cover Michigan Survey 2013 (Ann Arbor, MI: CHRT).

3 Relationship between coverage and ease of scheduling appointments in 2012 is not statistically significant when “very” and “somewhat” easy and “very” and “somewhat” difficult are combined. Relationships are statistically significant for 2012 when the variables are not combined.

A Closer Look at Those with Individually-Purchased Coverage

A major finding of this brief is that those with individually-purchased coverage had the lowest reported satisfaction with their coverage compared to any other insured group—43 percent rated their coverage as “excellent” or “very good,” compared to 65 percent of those with Medicaid, 54 percent of those with Medicare and 51 percent of those with employer-sponsored coverage.

Compared to other insured groups, those with individually-purchased coverage were more likely to report:

  • A negative experience with their coverage—61 percent of those with individually-purchased coverage reported having a negative experience, compared to 52 percent of those with employer-sponsored coverage, 45 percent of those with Medicare and 41 percent of respondents with Medicaid.
  • Greater difficulty scheduling both primary and specialty care appointments, compared to other insured groups.
    • In 2012, 83 percent of those with individually-purchased coverage reported that scheduling primary care appointments was “very” or “somewhat” easy compared to 90 percent of those with employer-sponsored coverage, 91 percent of those with Medicaid and 92 percent of those with Medicare.
    • In 2012, 73 percent of those with individually-purchased coverage reported scheduling specialty care appointments as “very” or “somewhat” easy, compared to 83 percent each of those with employer-sponsored coverage and Medicaid, and 90 percent of those with Medicare.

Furthermore, ease of scheduling both primary and specialty care appointments decreased for those with individually-purchased coverage since 2010. In fact, those with individually-purchased coverage were the only respondents for whom access became more difficult. In 2012, the proportion who rated access to primary care appointments as “very” or “somewhat” easy declined to 83 percent (down from 96 percent in 2010) and declined to 72 percent for specialty care (down from 83 percent in 2010).

Finally, those with individually-purchased coverage were least likely to report concern about losing coverage, only 12 percent reported they were “very” or “somewhat” concerned about losing coverage.

This trend in the individual insurance market also has been observed nationally. Studies have shown that those with individually-purchased coverage are less satisfied than other insured groups because of problems with insurance4 and lack of coverage for important benefits, such as maternity care.5

4 K. Davis et al. 2012. Medicare Beneficiaries Less Likely to Experience Cost- and Access-Related Problems than Adults with Private Coverage. Health Affairs, 31(8): 1–10.

5 H. Whitmore et al. 2011. The Individual Insurance Market Before Reform: Low Premiums and Low Benefits. Medical Care Research and Review, 68(5): 594–606.

Conclusion

Overall, consumers in Michigan, especially those with Medicaid, reported being satisfied with their coverage, with roughly half of all respondents rating their coverage as “excellent” or “very good” and a quarter rating coverage as “good.” However, those with private coverage reported lower rates of satisfaction than those with public coverage. Those with coverage purchased in the individual market reported the highest proportion of dissatisfaction of any insured group. Those on the individual market had a more difficult time accessing specialty care than other insured groups and encountered a negative experience in greater proportions. They were also the least likely to have been concerned about losing their coverage.

The cost of medical care to consumers is a significant reason why Americans are less satisfied with their health care compared to citizens of other countries.6 Those in the individual market seem to have the most experience with these kinds of challenges.

6 Papanicolas, I; Cylus, J; Smith, PC. 2013. An analysis of survey data from eleven countries finds that satisfaction with health system performance means many things. Health Affairs, 32(4): 734–742.

Methodology

The results presented in this report were produced from a series of survey questions added to the Michigan State University Institute for Public Policy and Social Research (IPPSR) quarterly State of the State Survey. The survey was fielded in the third quarter of calendar year 2012 and included a sample of 1,018 Michigan adults. The margin of error for the entire sample was +/- 6.5 percent. The sampling design, a random stratified sample based on regions within the state, was a telephone survey conducted via landline and cellular phones of Michigan residents.

For analytical purposes, survey data were weighted to adjust for the unequal probabilities of selection for each stratum of the survey sample (e.g., region of the state, listed vs. unlisted telephones, etc.). Additionally, data were weighted to adjust for non-response based on age, gender and race according to population distributions from the United States Census 2010. Results were analyzed using SAS 9.3 software.

Statistical significance of one-year variation was tested using a chi-squared test for independence (denoted with a * or **). Z-tests were used to determine the statistical significance of individual groups when two years were compared (denoted with a †). All relationships and tables marked as statistically significant are significant at p ≤ 0.05. Percentages may not add up to 100 due to rounding.

A full report of the IPPSR State of the State Survey methodology can be found at: http://ippsr.msu.edu/soss/.


Suggested Citation: Young, Danielle; Hammoud, Abdullah; Udow-Phillips, Marianne; Riba, Melissa; Stadler, Phillip. Satisfaction with Health Care Coverage. Cover Michigan Survey 2013. July 2013. Center for Healthcare Research & Transformation. Ann Arbor, MI.

Acknowledgements: The staff at the Center for Healthcare Research & Transformation would like to thank Matthew M. Davis, MD, MAPP, and Helen Levy, PhD, at the University of Michigan, Robert Goodman, DO, at Blue Care Network of Michigan, and the staff of the Institute for Public Policy and Social Research (IPPSR) at Michigan State University for their assistance with the design and analysis of the survey.