Understanding how this new paradigm works will also help Medicare enrollees understand that their current fee-for-service primary care physician may operate differently in a managed care network. They may not get the same degree of individual attention from their customary physician working in a network. The incentives for the physician under a fee-for-service system are different from those for the physician under an HMO, in which the goal of the HMO is to make certain not only that coordinated, appropriate care is given but also that costs are controlled.25
In general, Medicare beneficiaries are most interested in information about how their plan works, how much it will cost them, if their physician is in the plan, and what benefits are covered. As shown in Table 2-2, the types of information in which Medicare enrollees are interested range from information on quality, to service, to accessibility and choice. In terms of hospital care, they want to know if their preferences will be respected, how much information they will be given, how well their care will be coordinated, if they will receive emotional support, how their physical comfort needs will be met, and what will happen to them when they leave the hospital and return home.
In terms of ambulatory care, their concerns are centered around issues of access. Will they have access to the physician whom they choose or to specialists when needed? Will they be able to afford that physician's services? How long does it take someone to answer the phone, and how long does it take to get an appointment? They also want to know what will happen when they get to the doctor's office. How much information will they receive? What will the testing procedure be? And what follow-up activity can be expected?
Medicare beneficiaries are also interested in the overall quality of care and how satisfied they will be with the services pro-