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Many Misjudge HMOs' Slice of Premium Pie

MANAGED CARE December 2002. © MediMedia USA
News and Commentary

Many Misjudge HMOs' Slice of Premium Pie

MANAGED CARE December 2002. ©MediMedia USA

A significant gap exists between how a health care premium dollar is spent and how patients perceive it's being spent, a new Zogby survey reveals.

Respondents believe that 49.5 percent of premiums are spent on medical care, 26.8 percent on insurer's business expenses, and 23.7 percent goes to profit for the insurer.

In reality, 90 percent of premiums are spent on medical care, 7.5 percent for business expenses, and about 2.5 percent is income.

The poll of 800 HMO members with employer-based coverage was conducted from Sept. 16 to 21. The respondents are enrollees of BlueCross BlueShield of the Rochester Area, BlueCross and BlueShield of Central New York, and BlueCross BlueShield of Utica-Watertown.

"The polling data make clear a substantial disconnect between how consumers see their premium being spent and the reality of where the money really goes," says John Zogby, president and CEO of Zogby International. Of the amount spent on medical care, respondents believe that 32.8 percent pays for physician services, 30.1 percent goes for hospital services, 24.6 percent goes for prescription drugs, and 12.5 percent goes for other health care services.

In reality, 42 percent goes to hospital services, 34 percent is for physician services, 18 percent is used to purchase prescription drugs, and 6 percent is for other health services.

Another interesting finding of the Zogby poll is that the level of education of the respondent had little to do with how accurately he can assess how premiums are spent.

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