Regulating Managed Care: Theory, Practice, and Future Options

performs today, care might not be available or paid for when they are very sick.

Some experts believe that providing report-card ratings of health plans will enable consumers to make the best decisions for their families and negate the need for government regulation. However, report cards will be seen as providing little protection by the large portion of the population who have no experience using this type of rating. As a result, if concerns arise about the threatening behavior of individual health plans, a share of the public is likely to support some degree of regulation rather than depending on report-card ratings as a way of avoiding the consequences of plan decisions. For example, for airline safety, although safety reports and consumer complaints are provided by airlines as a matter of public record, experience suggests that these reports have not quelled the public's desire for some level of government safety regulation. Still, report cards could play a role in the decision making of employers who want to make the best choice of health plans for their employees. This in turn could have an influence on the quality of plans available in the marketplace.

Public concerns about the need for increased regulation of managed care are likely to be with us for the long term. Experience in other industries suggests that Americans have limits on how far they will allow marketplace decisions to put them at individual risk. As with airline safety and banking, public support for regulation is being driven in part by the anxiety the public feels over the occurrence of visible events questioning the behavior of managed care plans, as well as the problems people experience in their own lives. As a result, debate about regulation of the managed care industry is likely to be a permanent fixture on the health care agenda for years to come.

-224-