title: A closer look at the managed care backlash.
abstract: BACKGROUND
  Much anecdotal evidence exists regarding the managed care backlash of the late 1990s, but limited empirical evidence is available.
  
  
  OBJECTIVE
  Using a unique series of employer surveys, we examined trends in enrollment rates in health maintenance organizations (HMOs) and other plan types between 1997 and 2003.
  
  
  METHODS
  We present enrollment rates in employer-sponsored health plans by plan type. These plan-level enrollment rates are disaggregated by whether or not enrollees had a choice of plan types and by firm size and year.
  
  
  METHODS
  Employees who were enrolled in employer-sponsored health insurance in private sector establishments.
  
  
  CONCLUSIONS
  Although we found evidence of a decline in the popularity of HMOs, it occurred later than indicated in earlier studies. In our data, HMO enrollment rates fell from roughly 32% to 26% between 1997 and 2003, with most of the decline occurring after 2001. Earlier studies reported that the decline in HMO enrollment rates occurred between 1996 and 1998, and between 2000 and 2001. In addition, an interesting story emerged when we examined trends by firm size. We found evidence of a decline in the HMO enrollment rate for large employers starting in 1998. However, this was offset by an increase in the HMO enrollment rate in small employers, which explains the stability in our figures before 2002. Our data also indicated that when workers were given a choice between an HMO and other plan types, workers increasingly opted for the non-HMO plan during this time period.
authors.affiliation: Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland, USA.
authors.forename: Philip F
authors.initials: PF
authors.lastname: Cooper
authors.forename: Kosali I
authors.initials: KI
authors.lastname: Simon
authors.forename: Jessica
authors.initials: J
authors.lastname: Vistnes
mesh_terms: D002755:Choice Behavior; D003132:Commerce / Q000145:classification / Q000191:economics; D003258:Consumer Behavior / Q000706:statistics & numerical data*; D004651:Employment / Q000706:statistics & numerical data; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data; D006264:Health Benefit Plans, Employee / Q000145:classification / Q000706:statistics & numerical data* / Q000639:trends; D019538:Health Care Surveys; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D015273:Insurance Selection Bias; D008329:Managed Care Programs / Q000706:statistics & numerical data / Q000639:trends; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011243:Preferred Provider Organizations / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States