ticipants talk about the need to understand the source of information: the value system, beliefs, and intelligence of the person or people from whom it was acquired. Word-of-mouth information, on the other hand, was seen as extremely valuable. Participants were much more interested in the opinions of their family members, friends, or neighbors than in those of their coworkers or other employees from their former places of employment.

In 1994, NCQA conducted focus groups as part of the Consumer Information Project that included Medicare recipients. Two of the groups who were composed of consumers who had chronic conditions or were retirees. The findings of that study—both for all consumers and for these two groups—were similar to the focus group findings described above. Participants were very interested in comparative information on costs, the benefits package, and how the plan worked. They also expressed dismay that no comparable information exists for fee-for-service coverage. They wanted assurances that the technical quality of care had been assessed and wanted information about other aspects of quality. They were primarily concerned with the quality of the physicians, their technical skill, their ability to communicate, and their accessibility, especially in the event of an emergency. Many found the typical information about how to pick a doctor confusing. Several participants said, "Just tell me if I can pick my doctor or not!"

Many elderly and chronically ill focus group participants made negative comments about the information provided to them about access. They did not want ratings, because they could not interpret another person's tolerance for waiting times for appointments or in the waiting room. They wanted to know the number of days or the time spent waiting in the office so that they could judge for themselves. Interestingly, they also wanted to know about access to information over the phone so that they could avoid an appointment, if possible.

Again, these consumers—some of whom were low-income patients with little education—were very able to critically evaluate the information provided to them. They wanted to know the source of the information, the size of the population measured, the sample size, and how the results compared with national



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