Americans are generally upbeat about their experiences with their health plans, despite the fact that half say they've had a problem with their plan in the last year, according to a survey released in June 2000 by the Kaiser Family Foundation.

The telephone survey of 2,500 insured adults ages 18 to 64 shows 64 percent of consumers grade their health plan an A or B, even though 51 percent report some difficulty with their plans. The study indicates people enrolled in "strict" managed care plans (such as HMOs, which require the selection of a primary care physician and referrals to specialists) are less enthusiastic about their experiences than those in less restrictive managed care and traditional "fee-for-service" plans.

Fifty-one percent of the insureds in "strict" managed care marked their plan an A or B compared with 70 percent in "loose" managed care (HMOs that allow greater choice of doctors) and 74 percent in traditional plans. According to the study, consumers enrolled in strict HMOs, those in poor health, and women in general are the most likely to report problems.

Although more than 38 percent who report problems say the consequences are relatively minor, "they clearly cause aggravation," says Mollyann Brodie, vice president for public opinion and media research for the Kaiser Family Foundation. These consumers report experiencing similar stress levels for transactions involving their health insurance companies as doing their taxes and dealing with their auto mechanics.

The National Survey of Consumer Experiences with Health Plans, a joint project by the Kaiser Family Foundation and Consumer Reports, was designed and analyzed by the foundation, a nonprofit health care philanthropy. Other survey highlights include:

Types of problems:

• Delays or denial of coverage or care (32 percent of survey participants reporting difficulties).
• Difficulty seeing a physician (27 percent of those with problems).

• Paying more for treatment or services than they normally would have (30 percent of consumers reporting problems).
• Lost time from work, school, or other major life activities (21 percent of people with problems). Note: Though most difficulties were resolved with losses of less than a week away from work or school, the study shows the loss did amount to at least one week in 28 percent of the problem cases.

• One in five (21 percent of the insureds having difficulties) say their health worsened as a result of dealing with their insurer. Although most report the decline was not serious, a small minority of those with problems (6 percent) say they suffered permanent or long-lasting disability.