Dimensions of consumer-assessed quality of Medicare managed-care health plans.
OBJECTIVE
We investigated relationships at the health-plan level among member ratings of and reports on plans in the Consumer Assessment of Health Plans Survey (CAHPS). We sought a more parsimonious description of the reports that can be used in analyses of the distribution and correlates of consumer-assessed quality.


METHODS
There were 89,419 Medicare beneficiaries enrolled in 212 Medicare managed-care health plans who responded to CAHPS in 1998.


METHODS
There were 39 survey items measuring consumer ratings of and reports on care.


METHODS
We adjusted correlations for sampling variability in the plan means and performed a principal factor analysis of the report items with oblique rotation. We grouped items that loaded heavily on the different factors, formed composites, and regressed rating items on the report composites.


RESULTS
Four factors explained 75% of the variance in the reports. The corresponding groups of items were concerned with the following subjects: (1) interactions around delivery of care in the doctor's office; (2) customer service from the plan; (3) access to medical services provided by the plan, such as specialist care, equipment, therapy, or drugs; and (4) advice on health-promoting activities. Corrected Cronbach alpha for composites were 0.97, 0.93, 0.86, and 0.60. The "delivery" composite was strongly predictive of overall ratings of care, doctor, and specialist; the "customer" composite was strongly predictive of overall ratings of the plan.


CONCLUSIONS
CAHPS distinguishes among dimensions of between-plan variability of consumer-assessed quality. Different global ratings are related to distinct groups of consumer reports on their experiences.
Zaslavsky
A M
AM
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts 02115, USA. zaslavsk@hcp.med.harvard.edu
Beaulieu
N D
ND
Landon
B E
BE
Cleary
P D
PD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003258:Consumer Behavior / Q000706:statistics & numerical data*; D003953:Diagnosis-Related Groups; D005163:Factor Analysis, Statistical; D005260:Female; D019538:Health Care Surveys / Q000191:economics; D006297:Health Services Accessibility; D006304:Health Status; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000592:standards*; D006278:Medicare / Q000458:organization & administration*; D008875:Middle Aged; D010353:Patient Education as Topic; D011785:Quality Assurance, Health Care / Q000379:methods*; D012044:Regression Analysis; D012959:Socioeconomic Factors; D014481:United States