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Kaiser Family Foundation/Princeton Survey Research Associates Study of Media Coverage of Managed Care: January 1990 – June 1997 – News Release

Is There A Bias?

Overall Media Neutral In Coverage Of Managed Care,Although Network TV And Special Series In Newspapers mostly Critical

Focus of Coverage Shifting From Business to Patient Care Issues

Embargoed for Release until: 9:00 am, ET, Tuesday, January 13, 1998

New Study of Media Coverage of Managed Care Published in Health Affairs:

Washington, DC — More than a thousand health care bills related to managed care were considered by state legislatures across the nation last year, and managed care regulation is expected to be high on the Congressional agenda in 1998. Fueling this activity is a growing perception of a “backlash” against managed care — one that is often linked by those in the industry to media coverage that they say incites public anxieties with so-called “horror stories.”

The most comprehensive study to date of media coverage of managed care this decade by the Kaiser Family Foundation finds that overall the press has been largely neutral in its coverage of managed care, with the exception of network television newscasts and special series in newspapers which have tended to be mostly critical in tone. Across all media types — daily newspapers, business press, and network television — two thirds (64%) of the stories reviewed for the study, which spanned 1990 to mid-1997, took neither a positive nor negative tone toward managed care. A quarter (25%) of the coverage mainly criticized managed care, and 11 percent mostly praised it. During the study period, the amount of all coverage devoted to managed care issues increased seven-fold, and among broadcast media the increase was more than twice that much. (An explanation about how “tone” was determined is discussed in the methodology at the end of this release.)

“We’re about to have a national debate about managed care. How the media covers this issue in the coming year will be pivotal in shaping the public’s judgement over how best to protect consumers in the changing marketplace and the role of the Federal government,” said Drew E. Altman, Ph.D., President, Kaiser Family Foundation, and one of the study’s authors.

The study, published in the January/February 1998 issue of Health Affairs, is being presented today in Washington, D.C. at a forum on the media’s coverage of managed care. sponsored by the Kaiser Family Foundation, Health Affairs, and the Columbia University Graduate School of Journalism.

The study found that throughout the decade, most coverage of managed care remained neutral (64%); although mid-decade, stories with a tone switched from being more positive to more critical. In 1990, positive managed care stories (27% of coverage) appeared twice as often as those that were critical (12%); 61 percent were neutral. By 1993, critical coverage (27%) was more common than positive (10%), although most was still neutral (63%). This trend continued into 1997 with 28 percent of coverage expressing a critical tone and just 4 percent, a positive tone; the majority of coverage, 68 percent, remained neutral.

“One could argue endlessly whether media coverage provides an accurate reflection of managed care or a distorted version of it. As with any complicated story, it provides both, depending on the medium and the message,” said John Iglehart, Editor, Health Affairs.

Managed care was most likely to be criticized in special series that appeared in daily newspapers (79% of coverage was critical, 20% neutral, and 1% positive) and on network television newscasts (55% critical, 26% neutral, and 19% positive). The business/financial press kept a largely neutral tone on the topic of managed care (74% of coverage neutral, 15% critical, and 12% positive), as was the case in daily newspapers’ regular coverage (57% neutral, 32% critical, and 11% positive).

Both newspaper special series and network television coverage were more likely than other media sources to rely on anecdotes, including those characterized as “high drama,” to tell a story about managed care. Nine out of ten (91%) of the managed care stories on network television analyzed during the study period used an anecdote, nearly a third of which (28% of all coverage) involved “high drama.” Three-quarters (73%) of the stories in the special series on managed care used anecdotes; 24 percent used “high-drama” anecdotes. By comparison, a quarter (26%) of daily newspaper stories and 16 percent of business coverage used anecdotes; neither made regular use of highly dramatic stories (5% newspapers; 2% business press). One out of every two (50%) stories that used anecdotes had a critical tone towards managed care, 41 percent were neutral, and 10 percent were positive.

Following the “Big Story”

Throughout this decade, economic and business issues related to managed care, such as employee benefits and employer costs, have remained a dominant theme in managed care coverage. But, in recent years, stories emphasizing the quality of care and focusing on the patient’s or health care consumer’s perspective have been on the rise. In 1990, four out of five (82%) managed care stories had a primary or secondary focus on economic and business-related issues; just 31 percent addressed medical and patient care issues. By 1997, coverage of economic and business issues had fallen to 57 percent of stories, while patient care issues were now a focus in 44 percent of managed care coverage. More recently, regulatory issues have been gaining attention: rising from just 3 percent of managed care stories in 1990 to 16 percent by mid-1997.


Methodology

The Kaiser Family Foundation/Princeton Survey Research Associates Study of Media Coverage of Managed Care: January 1990 – June 1997 was designed and analyzed by researchers at the Foundation and Princeton Survey Research Associates (PSRA). It is reported in an article entitled, Media Coverage of Managed Care: Is There A Negative Bias?, authored by Mollyann Brodie, Ph.D., Kaiser Family Foundation, Lee Ann Brady, PSRA, and Drew E. Altman, Ph.D., Kaiser Family Foundation, in the January/February 1998 issue of Health Affairs. The study analyzed a sample of more than 2,100 news stories that appeared in selected newspapers, business/financial news magazines, and on network television newscasts between January 1990 and June 1997. The study defines “tone” by quantifying and evaluating the positive and negative comments, interpretations, and innuendos offered by the story or presented as quotes from sources; headlines carry double weight. A story required a 2:1 ratio of positive, negative, or neutral references to be scored as having a particular tone. A more detailed methodology is included in the Health Affairs article.

The Kaiser Family Foundation, based in Menlo Park, California, is a non-profit, independent national health care philanthropy and is not associated with Kaiser Permanente or Kaiser Industries. The Foundation’s work is focused on four main areas: health policy, reproductive health, and HIV policy in the United States, and health and development in South Africa.

Reprints of Media Coverage of Managed Care: Is There A Negative Bias? are available by calling the Kaiser Family Foundation’s publication request line at 1-800-656-4533. (Ask for document # 1355).

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