DOES DISSATISFACTION WITH ACCESS TO SPECIALISTS AFFECT THE DESIRE TO LEAVE A MANAGED CARE PLAN

Frequent changes in health plan enrollment may lead to discontinuity o f care and compromise quality. Using multiple logistic regression, we investigated how four dimensions of patient satisfaction were associat ed with the desire to disenroll from a managed care plan. A total of 1 7,196 enrollees from a large health plan in California responded to a survey regarding their satisfaction with care and desire to disenroll from the plan. Nineteen percent stated that they wanted to change from the plan. Dissatisfaction with access to specialty care and convenien ce of care produced the highest calculated relative risks of desire to leave the plan (relative risk [RR] = 2.7 and 2.6 respectively), while dissatisfaction with the quality of care and with hospital care produ ced lower relative risks (1.8 and 1.5, respectively). Because limiting direct access to specialists is a cardinal feature of most managed ca re organizations, managed care organizations may need to reexamine the ir approaches to the specialty care referral process.