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Dimensions of Consumer-Assessed Quality of Medicare Managed-Care Health Plans

Zaslavsky, Alan M. PhD*; Beaulieu, Nancy Dean PhD; Landon, Bruce E. MD, MBA*; Cleary, Paul D. PhD*

Original Articles

Objectives. 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.

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

Measures. 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 α 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.

*From the Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.

From Harvard Business School. At the time of this research, Dr. Beaulieu was an Agency for Health Care Policy and Research postdoctoral fellow with the Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts.

Address correspondence to: Dr. Alan M. Zaslavsky, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115. E-mail:

Received April 22, 1999; initial review completed June 1, 1999; accepted August 20, 1999.

© 2000 Lippincott Williams & Wilkins, Inc.