Depressive symptoms and plan switching under managed care

Objective: A central assumption underlying managed care is that plan switch ing is a viable option for enrollees when they are dissatisfied. The author s used a national employee survey to test the hypothesis that this mechanis m is less effective for enrollees with high levels of depressive symptoms t han for the remainder of the population. Method: The study used data from t he Employee Health Care Value Survey, a 1993 survey of 20,283 employees of three major corporations. The authors used the Medical Outcomes Study 36-it em Short-Form Health Survey to identify individuals with the highest decile of depressive and physical symptoms. They examined the relationship betwee n symptoms and dissatisfaction and, for dissatisfied individuals, how sympt oms predicted plan switching. Multivariate models were used to control for potential demographic, health, and health coverage confounders. Results: De pressive and physical symptoms were both associated with dissatisfaction wi th care. Unlike physical symptoms, depressive symptoms were associated with a significantly lower likelihood of actually disenrolling among people who were dissatisfied or who intended to disenroll. This effect was most prono unced for satisfaction with administrative aspects of care (e.g., gatekeepi ng, utilization review). Conclusions: People with high levels of depressive symptoms appeared to be less willing or able to act on their dissatisfacti on by switching plans. In particular, they were willing to tolerate higher rates of dissatisfaction with the administrative aspects of their health co verage without disenrolling. Plan switching is an essential mechanism under pinning a health care system predicated on competition; it may be less effe ctive for people with depressive disorders.