Does dissatisfaction with health plans stem from having no choices?

Data from a 1997 nationwide telephone survey are used to assess the relationship between choice and public opinion about managed care. We found that only a minority of the working-age population effectively control what health plan they get. Persons without choice were markedly more dissatisfied with their health plan, especially when enrolled in managed care. In multivariate analysis, how respondents rated their health plan depended as much on whether they lacked choice as on whether they were enrolled in managed care. Persons without choice also had more negative opinions about managed care in general. The results suggest that the managed care "backlash" may persist so long as consumers have little control over health insurance decisions.