title: Private sector unlikely to follow Medicare lead in providing health plan disenrollment comparisons.
abstract: BACKGROUND
  There have been substantial efforts to improve the measurement and reporting of comparative quality information. A three-stage effort to develop comparative voluntary disenrollment measures for private health insurance plans is described. The literature on disenrollment and how key groups might use disenrollment information is reviewed; the development of a comparative survey of disenrollment is described; reasons employers, purchasing coalitions, and plans were ultimately unwilling or unable to sponsor the survey are delineated; and implications of these findings are discussed.
  
  
  METHODS
  Methods used to develop the survey included review of existing literature on disenrollment, review of extant disenrollee surveys, cognitive testing, and expert review of the survey. Informal and formal interviews were conducted to assess the feasibility of different sponsors.
  
  
  RESULTS
  A disenrollment survey instrument that covered areas of common interest to consumers, purchasers, and plans could be developed, but sponsors to test the collection and reporting of these data could not be recruited. This was due to four interrelated factors: technical challenges in developing appropriate samples, wide variation in resources and capabilities of purchasers and plans, the perception that the costs of the survey outweighed the benefits of comparative information on disenrollment to the different sponsors, and the absence of strong demand from purchasers, regulators, or consumers to motivate plans to collect or report comparative information on disenrollment.
  
  
  CONCLUSIONS
  Several major barriers must be overcome before disenrollment information can become a component of comparative health care quality measures for the privately insured.
authors.affiliation: American Institutes for Research, 1000 Thomas Jefferson St, NW, Washington, DC 20007-3835, USA. kcarman@air.org
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Carman
authors.forename: Sarah
authors.initials: S
authors.lastname: Daugherty
authors.forename: Lauren D
authors.initials: LD
authors.lastname: Harris-Kojetin
authors.forename: James S
authors.initials: JS
authors.lastname: Lubalin
mesh_terms: D019985:Benchmarking / Q000379:methods*; D003258:Consumer Behavior / Q000706:statistics & numerical data*; D003365:Costs and Cost Analysis; D003625:Data Collection; D005240:Feasibility Studies; D006264:Health Benefit Plans, Employee / Q000592:standards* / Q000706:statistics & numerical data*; D006265:Health Care Coalitions; D019538:Health Care Surveys / Q000191:economics / Q000379:methods*; D006801:Humans; D015271:Insurance Pools / Q000592:standards* / Q000706:statistics & numerical data*; D007407:Interviews as Topic; D006278:Medicare / Q000592:standards / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000379:methods*; D011795:Surveys and Questionnaires; D014481:United States; D016270:United States Agency for Healthcare Research and Quality