The managed care backlash: Did consumers vote with their feet?

M. Susan Marquis, Jeannette A. Rogowski, José J. Escarce

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


The managed care backlash led many to predict the demise of health maintenance organizations (HMOs). This paper examines trends in HMO enrollment in all metropolitan communities from 1994 to 2000 to identify factors that led to diminishing enrollment in the backlash era and circumstances in which HMOs maintained or expanded their presence. We use a database constructed from a wide variety of sources that describe HMO penetration and other characteristics of all metropolitan statistical areas. We found the backlash is not evidenced in a large degree of consumer switching. However, HMOs were more likely to maintain their presence in areas with high-cost growth and with greater managed care experience. Medicaid HMO growth continued to expand rapidly, indicating the possibility of a two-tiered system in which low-income beneficiaries have less choice than the privately insured.

Original languageEnglish (US)
Pages (from-to)376-390
Number of pages15
Issue number4
StatePublished - 2004

All Science Journal Classification (ASJC) codes

  • Health Policy


Dive into the research topics of 'The managed care backlash: Did consumers vote with their feet?'. Together they form a unique fingerprint.

Cite this