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

Objective. To describe the hearth 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 thos e evaluations. Methods. Data were obtained from a mail survey of a random sample of person s (n = 2,484) on mailing lists of participating rheumatic disease organizat ions. The survey included specific aspects of health insurance coverage, de mographic and health status information, and evaluations of health care. Results. In California, managed care plans (MCPs) were providing health car e to 59% of respondents under age 65, Among respondents under age 65, presc ription drug coverage was almost universal, 60% had seen a plan rheumatolog ist, and 17% had been unable to obtain referrals to specialists (with signi ficantly more respondents in MCPs reporting this problem). Among respondent s age greater than or equal to 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 irt MCPs had drug coverage. Relatively few respondents in either age group knew abo ut coverage for physical or occupational therapy or for assistive devices. Patient evaluations were more positive for non-MCPs, Limitation in access t o physicians was the strongest predictor of poor evaluations of health plan s and physician care. Having seen a plan rheumatologist was associated with more positive evaluations. Conclusion. Surveys of patient satisfaction or patient evaluations are requ ired by many regulatory bodies, Managed care organizations should carefully evaluate whether limitations in access or services are worth the generaliz ed negative perceptions that they may create among patients.