| Health plans are continually seeing the need to strike a balance between health care costs and providing value and satisfaction with their members' healthcare experiences. Over the last few decades, public opinion of traditional closed-network managed care plans has changed radically from positive to negative (Pauly and Nicholson 1999). Within preferred provider organization (PPO) style plans, enrollment grew from 39% in 1998 to 58% in 2008 of workers insured through their employer; these plans are more flexible managed care products that offer fewer restrictions and provide for additional out-of-network benefits in comparison to health maintenance organization (HMO) plans, which only allow the member to use in-network services (Kaiser Family Foundation 2008). Employees often continue to choose these more-flexible plans even though PPO premium costs are slightly higher on average than traditional HMO premiums (Kaiser Family Foundation 2008).;Although several studies have looked to understand the relationship between satisfaction and plan cost, provider interaction, and the amount of choice people have when choosing the health plan, few studies have analyzed whether the utilization of out-of-network benefits affect a household's satisfaction with its health plan. It is possible that households who utilize out-of-network benefits may have higher health plan satisfaction because they have more personal autonomy and choice with a broader range of health plan benefits and a less-limiting choice of providers. Alternatively it is hypothesized that the additional administrative, communication, and cost burdens associated with out-of-network services will negatively influence a consumers' satisfaction with the health plan.;Applying a linear probability regression model to a population enrolled in a PPO style managed care plan, this study attempts to understand the relationship between out-of-network utilization and overall health plan satisfaction using data from a 2007 private health plan member satisfaction survey for both Medicare and non-Medicare populations. The results indicate that high out-of-network utilization for the non-Medicare population reduces the probability by a small amount of being highly satisfied with the health plan. In contrast the Medicare population did not yield any statistically significant results indicating there is a difference between out-of-network plan payment spending groups with regards to a probability for lower satisfaction. Findings suggest individuals are using out-of-network services, however, are not severely dissatisfied with their health plan as a result. Future research targeting specific aspects of out-of-network utilization that may be problematic to members, including claims processing, customer service, network convenience, and additional out-of-pocket costs, is critical to fully understand the member experience and member values of their health plan with regards to out-of-network utilization. |
