time he or she had to spend in a waiting room. This detailed information allows for greater comparisons rather than simply providing information on whether one person's personal expectations were met.36

The Agency for Health Care Policy and Research through its Consumer Assessment of Health Plans Study is working to identify the different types of consumer satisfaction information that should be made available and how that information should be distributed. The project's goal is to develop appropriate consumer satisfaction instruments and then to make certain that the information collected is comparable across health plans. The project will consider what literacy level the information should be targeted to and the level of cognitive skills people need to process the comparative information.

From another perspective, in 1994 the PPRC undertook a survey using data from the Medicare Current Beneficiary Survey to look at Medicare beneficiaries' general perceptions of access to and satisfaction with care. The study and its supplements address beneficiary perceptions of access to care and include information on utilization of services, health insurance coverage, access to health care services, satisfaction with care, expenditures, and demographic data, among other issues (Physician Payment Review Commission, 1996). As a follow-up to the study, PPRC has contracted with Mathematica Policy Research, Inc. to develop and conduct a survey to monitor beneficiary access to and satisfaction with services in the Medicare managed care program.


Current evidence indicates that the disenrollment rate among Medicare beneficiaries in Medicare risk contracts is about 5 percent. A 1993 survey conducted by the Office of the Inspector General of the U.S. Department of Health and Human Services showed that Medicare beneficiaries most often cited the following four reasons for leaving an HMO:


Material presented by Susan Edgman-Levitan.

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