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Voices Unheard: Barriers to Expressing Dissatisfaction to Health Plans
Author(s) -
Schlesinger Mark,
Mitchell Shan,
Elbel Brian
Publication year - 2002
Publication title -
the milbank quarterly
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 101
eISSN - 1468-0009
pISSN - 0887-378X
DOI - 10.1111/1468-0009.00029
Subject(s) - voice , public relations , business , service provider , health plan , employee voice , state (computer science) , test (biology) , service (business) , psychology , marketing , health care , political science , law , philosophy , linguistics , paleontology , algorithm , computer science , biology
A s american medicine and health policy have incorporated market perspectives, the emphasis on patients' ability to act as effective consumers has grown. Empowering consumers is expected to achieve two goals (Andreason 1988). First, informed consumers can protect themselves from inadequate or inequitable treatment. Second, their actions can provide incentives for health plans to improve the quality of care for all enrollees. To produce these effects, consumers must be able to assess their health care experiences accurately and take appropriate action when they believe the plan has not performed satisfactorily. In recent years, state and federal policies to facilitate medical consumerism have been designed to expand consumer options, improve their decision‐making abilities, and provide supportive services (Pollitz, Dallek, and Tapay 1998; Rodwin 2001). During the 1990s, many private employers pursued similar policies for their workers (Maxwell et al. 1998). Consumers dissatisfied with their health plan can either "exit" (switch service providers) or "voice" (complain to the current provider). Policymakers' efforts to help consumers voice their dissatisfaction to health plans or external mediators have been disappointing, in part because little is known about the determinants of voice. This article represents the first comprehensive assessment of voicing in response to problematic experiences with health plans. A national consumer survey from 1999 is used to test hypotheses about characteristics of problems, patients, and settings that might inhibit voice and assess state regulations intended to enhance voice. Although problems associated with plans led to more voice than exit, voice is circumscribed by several factors: certain groups, such as racial minorities, do not express their grievances as often; episodes with severe health consequences for patients are not reported as regularly. The findings suggest that even though regulatory initiatives have not increased the frequency of voice, they have made grievances more effective, at least in jurisdictions where citizens know about the laws.