Penn Researchers Find Negative Bias In Newspaper Coverage of Managed Care -- In "Media Vs. Managed Care," Media Takes Round #1

October 26, 1998

(Philadelphia, PA) -- Two-thirds of analyzed newspaper coverage of managed care organizations provided a negative representation of this growing form of health insurance, according to a study by researchers at the University of Pennsylvania Health System. Although the precise impact of the media's representation may be difficult to determine, one possible related outcome is that more than 1,000 anti-managed care, legislative initiatives have been proposed since the period of analysis. The study -- a detailed review of three months' worth of print coverage about HMOs (health maintenance organizations) in six leading daily newspapers -- appears in today's issue of Archives of Internal Medicine.

"In fully two-thirds of the analyzed cases, we believed that the articles portrayed a message so unfavorable that the reader was less likely to join, or might even decide to leave, a managed- care organization," explained lead author David J. Shulkin, MD, Chief Medical & Quality Officer at the University of Pennsylvania Health System. "This finding is especially troubling when one realizes that people's opinions are being negatively framed around an issue with which they have little familiarity or understanding," adds Shulkin. "This trend was important at the time we completed our study ... and it has even greater relevance today."

To determine message content, Shulkin and four research colleagues independently reviewed and scored 85 articles about managed-care that appeared during the last three months of 1995 in the following U.S. dailies: The New York Times, The Los Angeles Times, The Chicago Tribune, The Philadelphia Inquirer, The Washington Post, and The Boston Globe. All articles related predominantly to discussions of clinical quality, cost of care, resource utilization, or satisfaction with managed care. The researchers found that the content of seven articles (or 8% of the total) was thought likely to influence the reader so that they would be willing to join, or stay with, a managed care organization; in 57 articles (or 67%), the representation of managed care was so unfavorable that it might lead the reader to be less likely to join, or possibly even leave, a managed care organization; and 21 articles (or 25%) were considered to have little or no effect on the willingness of the reader to join or leave an HMO.

According to the study, the newspaper articles focused most of their content on patient concerns with managed care. Indeed, many of the print stories related patients' hostile encounters with HMOs -- typically as a result of being denied services perceived as necessary by the patient. Most of the articles concentrated on issues involving clinical quality (58%) and cost of care in a managed-care setting (56%). There was also frequent discussion of the adequacy of insurance coverage with managed care (38%), and physician concerns with managed care organizations (28%). Satisfaction with HMOs was a primary issue in approximately 25% of the articles reviewed.

"The public's perception of managed care is shaped by many factors, including the media," explains David B. Bernard, MD, Director of the Health and Disease Management Programs at Penn, and a co-author of the study. "This form of healthcare coverage will continue to grow as the public discourse over its positive and negative qualities continues as well. We believe that if the current negative representation of managed care continues in the press, we will see a widespread backlash of public opinion ...which will set the stage for even more political involvement in this area."
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Contact:Rebecca Harmon
(215) 349-5660
harmonr@mail.med.upenn.edu

Editor's Note: Dr. Shulkin can be reached directly at (215) 662-2271.
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University of Pennsylvania School of Medicine

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