"report cards," to the incentives driving doctors within health plans, to financial solvency information involving a plan, to disenrollment rates in a given area. Beneficiaries need to understand a plan's responsibilities and their rights as members—not only their rights to appeal decisions but also their rights to access to quality care in a timely manner.

Furthermore, although plans may provide a wide range of information, they may not be providing comprehensive information. In other words, they may not elaborate on areas that are often open for interpretation by the consumer. For example, in the California marketplace, officials are concerned that plans are not providing enough information to members regarding what exactly constitutes emergency care, how much coverage enrollees can expect when they seek care outside of an area covered by their plan (if they need care when traveling), and under what circumstances enrollees can negotiate referrals to specialists. 28

There are questions regarding just how much information consumers need. Some consumer advocates argue for the provision of data on the satisfaction of people who have been involved in a grievance process or the satisfaction rates for those who suffered major medical illnesses. Others argue for consumer information on profits or compensation for chief executive officers. Although some say that this level of information could be irrelevant and overwhelming for the consumer, others argue that interested consumers are capable of processing this kind of information (Rodwin, 1996). Medicare consumers want, need, and have a right to a variety of information. If consumers do not understand some of the information provided, insurance counseling groups, such as the ones operated by United Seniors Health Cooperative, can help them understand and interpret it.29

Other areas of disclosure involve the performance of a health plan in terms of both quality and service. Although plans generally provide extensive information on covered benefits, costs, and required copayments, little information is available to con-

28  

Comment by Lucy Johns.

29  

Comment by Priscilla Itzcoitz.



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