This paper examines the depth and breadth of the public backlash against managed care and the reasons for it. We conclude that the backlash is real and influenced by at least two principal factors: (1) A significant proportion of Americans report problems with managed care plans; and (2) the public perceives threatening and dramatic events in managed care that have been experienced by just a few. In addition, public concern is driven by fear that regardless of how well their plans perform today, care might not be available or paid for when they are very sick.

Telephone interviews elicited information on motivational responses of blood donors and nondonors from a completely random sample of an entire community. Results indicated that more males than females are current donors and that 63 per cent of the males and 89 per cent of the females who have donated previously have become nondonors. Most donors express no fears before donating and state direct appeal, convenience, and peer pressure as the motivational aspects that caused them to donate in the first place, and altruism as the major reason for continuing to donate. The two largest categories mentioned by nondonors for inhibiting their donating were medical disqualification and fear. When both donors and nondonors made suggestions for improving blood donor recruitment, they tended to mention publicity (including education), emergency appeal, and personal solicitation. The first two were not mentioned by actual donors as to what motivated them to give blood initially. Blood procurement agencies should, therefore, be aware of a distinction between actual motivating factors and those that are only hypothetical.

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A 1994-1995 survey of men and women aged 18-44 in the United States, Canada and the Netherlands revealed considerable differences in public knowledge and perceptions about unplanned pregnancy and contraception. The proportion who believe that unplanned pregnancy is a "very big problem" is 60% in the United States, 36% in Canada and 6% in the Netherlands. Americans are more likely than their Canadian or Dutch counterparts to cite societal problems as significant factors in the rate of unplanned pregnancy; higher proportions of Americans also cite the cost of contraceptives (52% vs. 46% of Canadians and 34% of Dutch men and women) and an inability to obtain methods (66%, 51% and 33%, respectively). In all three countries, adults are generally well informed about the relative effectiveness of commonly used contraceptives, but Americans are more skeptical about method safety and effectiveness. For example, 17% think the pill is "very safe," compared with 21% of Canadians and 40% of the Dutch; and whereas 64% of Americans consider the pill "very effective," 73% of Canadians and 90% of Dutch men and women give it this rating. Health care professionals are the most frequently cited source of contraceptive information, but only 51-63% of adults have ever discussed contraception with such a practitioner.