Does dissatisfaction with access to specialists affect the desire to leave a managed care plan?

Frequent changes in health plan enrollment may lead to discontinuity of care and compromise quality. Using multiple logistic regression, we investigated how four dimensions of patient satisfaction were associated with the desire to disenroll from a managed care plan. A total of 17,196 enrollees from a large health plan in California responded to a survey regarding their satisfaction with care and desire to disenroll from the plan. Nineteen percent stated that they wanted to change from the plan. Dissatisfaction with access to specialty care and convenience of care produced the highest calculated relative risks of desire to leave the plan (relative risk [RR] = 2.7 and 2.6 respectively), while dissatisfaction with the quality of care and with hospital care produced lower relative risks (1.8 and 1.5, respectively). Because limiting direct access to specialists is a cardinal feature of most managed care organizations, managed care organizations may need to reexamine their approaches to the specialty care referral process.