Health insurance characteristics and health care evaluations among persons with rheumatic diseases in California

Abstract

Objective. To describe the health insurance characteristics of a sample of persons with rheumatic diseases, to review their evaluations of health care, and to identify the health insurance characteristics associated with those evaluations. Methods. Data were obtained from a mail survey of a random sample of persons (n = 2,484) on mailing lists of participating rheumatic disease organizations. The survey included specific aspects of health insurance coverage, demographic and health status information, and evaluations of health care. Results. In California, managed care plans (MCPs) were providing health care to 59% of respondents under age 65. Among respondents under age 65, prescription drug coverage was almost universal, 60% had seen a plan rheumatologist, and 17% had been unable to obtain referrals to specialists (with significantly more respondents in MCPs reporting this problem). Among respondents age ≥65, 37% had seen a plan rheumatologist, and 11% reported being unable to obtain referrals to specialists. Overall, drug coverage was less common in this age group, although 90% of those in MCPs had drug coverage. Relatively few respondents in either age group knew about coverage for physical or occupational therapy or for assistive devices. Patient evaluations were more positive for non- MCPs. Limitation in access to physicians was the strongest predictor of poor evaluations of health plans and physician care. Having seen a plan rheumatologist was associated with more positive evaluations. Conclusion. Surveys of patient satisfaction or patient evaluations are required by many regulatory bodies. Managed care organizations should carefully evaluate whether limitations in access or services are worth the generalized negative perceptions that they may create among patients.