Impacts of managed care patient protection laws on health services utilization and patient satisfaction with care.
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.


METHODS
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.


METHODS
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.


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.


RESULTS
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.


CONCLUSIONS
Enactment of managed care patient protection laws did not generally increase utilization of health services or improve patient satisfaction with care.
Sloan
Frank A
FA
Duke University, 125 Old Chemistry Bldg., Box 90253, Durham, NC 27708, USA.
Rattliff
John R
JR
Hall
Mark A
MA
D000293:Adolescent; D000328:Adult; D005260:Female; D019538:Health Care Surveys; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006304:Health Status; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D008875:Middle Aged; D010344:Patient Advocacy / Q000331:legislation & jurisprudence*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D035502:Trust; D014481:United States; D014600:Utilization Review